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. 2025 Jul 21.
doi: 10.1007/s40615-025-02492-9. Online ahead of print.

Incidence Rates of COVID-19-Associated Hospitalization and Risk Factors for Severe Disease Among American Indian and Alaska Native Persons in the Southwest USA and Alaska

Chelsea S Lutz  1 , Catherine G Sutcliffe  1   2 , James W Keck  3 , Rachel M Hartman  1 , Christine Desnoyers  4 , Amy Swango-Wilson  3 , Amanda B Burrage  5 , Angela P Campbell  6 , Loretta Christensen  7 , Ryan M Close  8 , Shawnell Damon  9 , Jennifer Dobson  4 , Starla Garcia  1 , Natasha Halasa  10 , Elvira Honie  1 , Verlena Little  1 , Meredith L McMorrow  6 , Dennie Parker  1 , Mila M Prill  6 , Jennifer Richards  1 , Puthiery Va  11 , Mark Veazie  11 , Dan VanDeRiet  1 , Del Yazzie  12 , Rosalyn J Singleton  3 , Laura L Hammitt  13
Affiliations

Incidence Rates of COVID-19-Associated Hospitalization and Risk Factors for Severe Disease Among American Indian and Alaska Native Persons in the Southwest USA and Alaska

Chelsea S Lutz et al. J Racial Ethn Health Disparities. .

Abstract

Introduction: COVID-19 causes significant morbidity in the USA, particularly among American Indian/Alaska Native (AI/AN) persons. Estimates of COVID-19 burden among AI/AN communities are needed to identify health outcome disparities and inform prevention strategies, but under-ascertainment of AI/AN status in national data may result in underestimation of COVID-19 disease burden.

Methods: Surveillance for acute respiratory illness was conducted among AI/AN persons at eight healthcare facilities in Arizona and Alaska to identify COVID-19-associated hospitalizations and outpatient visits. Weekly and annual incidence rates of COVID-19-associated hospitalizations per 100,000 persons were calculated overall and by site and age. Risk factors for COVID-19-associated hospitalizations (versus outpatient visits) were assessed.

Results: From January 2021 to December 2022, 1159 COVID-19-associated hospitalizations were identified. Incidence rates were 439.8 per 100,000 in 2021 and 332.6 per 100,000 in 2022 and highest among adults ≥ 65 years at all sites. Compared to national estimates from 2021 to 2022, incidence rates by time and age were similar among older adults, whereas incidence rates among AI/AN children were over twice as high. Among adults, older age, chronic lung disease, chronic kidney disease, and diabetes increased the risk of hospitalization; frequent mask use outside the home and COVID-19 vaccination were protective, particularly if vaccinated within the past year. Among children, younger age and heart conditions increased the risk of hospitalization.

Conclusions: The findings demonstrate a substantial burden of COVID-19 in AI/AN persons and provide critically needed data regarding the risks for severe outcomes. AI/AN children experience a disproportionate burden of COVID-19 disease.

Keywords: COVID-19; Indigenous health; Risk factor; SARS-CoV-2.

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Conflict of interest statement

Declarations. Ethics Approval: This study was reviewed and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB) and the ethics review board for each participating tribe (Arizona sites: Navajo Nation Human Research Review Board and Phoenix Area Indian Health Service IRB; Alaska sites: Alaska Area IRB, Alaska Native Tribal Health Consortium, Southcentral Foundation, and Yukon-Kuskokwim Health Corporation). This study was reviewed by the Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy [62]. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines [63]. Consent to Participate: Informed consent was obtained from all adult participants included in the study. Informed consent was obtained from the legal guardians of child participants included in the study, and assent was also obtained for child participants 7–17 years of age included in the study. Competing interests: CSL — none. CGS — research grants to her institution from Merck and Pfizer. JWK — none. RMH — none. CD — none. ASW — none. ABB — none. APC — none. LC — none. LC — none. SD — none. JD — none. SG — none. NH — none. EH — none. VL — none. MLM — none. DP — none. MMP — none. JR — none. PV — none. MV — none. DV — none. DY — none. RJS — none. LLH — research grants to her institution from AstraZeneca, Merck and Pfizer. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Indian Health Service.

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