Regional Differences in American Indian/Alaska Native Chronic Respiratory Disease Disparity: Evidence from National Survey Results

Abstract

American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.

Keywords: American Indian/Alaska Native; BRFSS; disparity; geographic variation; respiratory disease.

Figure 1

Unequal prevalence and disparity of asthma and/or COPD in the US when dividing the country based on historical AI/AN resident populations. (A) An 11-state region (light gray) is historically defined as high in the AI/AN population (AI/AN-high region) and consists of states AK, AZ, MN, MT, NE, NM, NC, ND, OK, SD, and WI. The remaining 39 states (dark gray) comprised a region relatively low in AI/AN population (AI/AN-low region). (B) Values of weighted disease prevalence in the AI/AN-low geographic region are plotted with 95% CI. Specific values are presented in Table 1. Comparisons of disease prevalence between the two populations are significant for all years within 2011–2019 using the Rao–Scott χ² test.