Native Americans are a diverse group of peoples from varied cultural backgrounds. More than 500 tribal groups are recognized by the Federal government. The population of Native Americans in 1986 was estimated at 1.6 million or 0.7% of the entire U.S. population. The American Indian and Alaska Native (AI/AN) population served by the Indian Health Service (IHS) is young (32% below age 15) and is growing at a rate of 2.7% per year. The AI/AN birth rate is 1.8 times the birth rate of all races in the U.S.
The Native American population is poor with a per capita income that is half that of all races in the U.S., and with twice the proportion of persons below the poverty level. The proportion of AI/AN persons who have finished college is half that of all races in the U.S. and the percent of the AI/AN labor force that is unemployed is twice as high as among all U.S. races.
Native Americans face a unique set of health problems that include high rates of diabetes (up to 50% of some tribes), mortality from accidental death (2.3 times that of all U.S. races), alcoholism, tuberculosis, homicide and youth suicide. Native Americans have a relatively low incidence of cancer from all sites (half that of all races in the U.S.) and low mortality rates from cardiovascular diseases, cancer and chronic obstructive pulmonary disease. The life expectancy of Native Americans is 3.6 years less for men and 3.0 years less for women than that of men and women of all races in the U.S. Of the numerous health problems prevalent among this growing population, many are amenable to preventive efforts including obesity, alcohol abuse and mortality from accidental death.
Native Americans are the smallest minority group in the U.S. numbering approximately 1.6 million in 1986 or about 0.7% of the entire U.S. population.
Native Americans include persons of American Indian, Eskimo (Inuit and Yupik) and Aleut origin, although 96% are American Indians.
The American Indian and Alaska Native population served by the Indian Health Service is growing at a rate of 2.7% per year.
1980 Census figures show that 32% of the AI/AN population served by the IHS was below age 15 and 5% was older than 64 years, compared to 23% and 11% for all races in the U.S. The median age was 22.6 years for Indians in 1980, compared to 30.0 years for all races in the U.S.
The average American Indian family has 4.6 members, which is the largest family size of any minority or nonminority group.
Nearly 25% of American Indian households are headed by a woman. Approximately 48% of American Indian women are employed outside the home.
Prior to 1940, 90% of Indians lived on reservations, but by 1977 more than 50% lived in urban centers.
Half of all American Indians live in the western United States. 24% of American Indians live on reservations and an additional 8% live on historic trust lands.
Many American Indians and Alaska Natives live in areas where the availability of physicians is half the national average.
General Health Status
The leading causes of hospitalization at Indian Health Service and contract general hospitals in 1985 were complications of pregnancy, childbirth and puerperium (23.8% of all hospital discharges), injuries and poisonings (11.8%), respiratory system diseases (9.4%) and digestive system diseases (9.4%). Circulatory system diseases accounted for 5.1% of all hospitalizations in 1985.
The leading causes of visits to Indian Health Service outpatient facilities in 1985 were, in order: upper respiratory infection, diabetes mellitus, prenatal care, hypertensive disease, acute otitis media and well-child care.
Preliminary prevalence and incidence data suggest that coronary heart disease and stroke risk may be increasing in the Native American population.
Diabetes is a major public health problem in most Native American populations. Among adults 35 years or older, 50% of Pimas, 42% of Papagos, 25% of San Carlos Apaches and 13% of Navajos have diabetes.
In full-heritage Indians, diabetes is almost exclusively the non-insulindependent, ketosis-resistant type, with the same manifestations and vascular complications as in non-Indians.
The prevalence of diabetes increases with the degree of Indian heritage.
In a study of the Three Affiliated Tribes of North Dakota, 22.3% of those with full Indian ancestry had diabetes, compared to 14.9% of those with less than full but greater than half Indian ancestry.
American Indians appear to have end-stage renal disease more frequently than other U.S. populations, probably as a result of high rates of diabetes. About half of all deaths from vascular causes in Pima diabetics were attributed to diabetic nephropathy.
The 1981-83 birth rate for AI/AN was 28.5 (births per 1,000 population), over 79% greater than the 1982 birth rate of 15.9 for all races in the U.S.
In 1983, 22% of births to American Indian women were to teenagers compared to 25% of births to Blacks and 12% of births to whites.
About 58% of American Indian mothers began prenatal care during the first trimester of pregnancy in 1983, compared to 80% of white mothers.
The percent of American Indian infants born of low birthweight (less than 2500 grams) was 6% in 1983 compared to 5.7% of white infants and 12.8% of Black infants.
In 1983, the hospital discharge rate for alcohol-related disorders among Indians was 2.5 times the rate for all races in the U.S. The alcohol-related hospital discharge rate was over 4 times higher among Indian males than females.
Among 35-44 year olds discharged from Indian Health Service hospitals, one of every six discharges was alcohol related. Among males 35-44 years old, one in three hospital discharges was alcohol related. For males 25-34 and 45-64 years of age, one in four hospital discharges was alcohol related.
Overall Mortality and Life Expectancy
During 1979-1981, the life expectancy at birth for AI/AN in reservation states was 67.1 years for males and 75.1 years for females, compared to 70.7 years for white males and 78.1 years for white females in 1980.
The six leading causes of death (with mortality rates per 100,000 population) among Native American males in 1981-83 were accidents (127.3), heart disease (126.8), cancer (63.0) and cerebrovascular disease and homicide (both 22.9).
Among Native American females, the six leading causes of death (with mortality rates per 100,000 population) in 1981-1983 were heart disease (87.9), cancer (55.6), accidents (42.6), cerebrovascular disease (23.6), chronic liver disease and cirrhosis (20.8) and diabetes (17.2).
The age-adjusted mortality rates for the following causes were higher among American Indians than among all races in the U.S in 1983:
- Tuberculosis–560% greater
- Alcoholism–374% greater
- Accidents–135% greater
- Diabetes–107% greater
- Homicide–91% greater
- Pneumonia and influenza–39% greater
In the age group 15-44, the death rate for all causes among Native Americans was approximately twice that for all races in the U.S. in 1982.
Of all Native Americans who died during 1981-83, 35% were under 45 years of age, compared to approximately 12% of all races in the U.S. in 1982.
Excess deaths are those deaths in excess of what would be expected if the death rate of the white population applied to the minority population being studied. Among American Indians under 45 years of age in 1979-81, 45% of deaths or 1165 deaths per year were excess deaths.
The leading cause of excess deaths to American Indians in 1979-81 was death from unintentional injuries which accounted for 48% of excess deaths among males and 40% of excess deaths for females. Cirrhosis accounted for 11% of male and 20% of female excess deaths for American Indians followed by homicide with 9% and 8% of excess deaths to American Indian males and females under age 45.
The cardiovascular disease death rate among Native Americans (170.9 deaths per 100,000) in 1983 was 27% lower than the rate among all races in the U.S. (235.0).
Under age 35 years, heart disease mortality for Native Americans is approximately twice as high as for all other Americans.
In 1983, the age-adjusted death rate from diabetes among AI/AN (20.5 deaths per 100,000 population) was 2.1 times the rate for all races in the U.S. (9.9).
Homicide, Suicide and Unintentional Death
Unintentional injuries account for an estimated 21% of all deaths among Native Americans and are the leading cause of mortality. An estimated 75% of all accidental deaths among Indians are alcohol-related.
Native Americans have the highest rate of death from unintentional injuries or accidents of any racial or ethnic group. The 1983 death rate from accidents among AI/AN (82.9 deaths per 100,000) was 2.3 times the rate among all races in the U.S. (35.3).
Motor vehicle accidents account for most (54%) deaths by accidents among AI/AN. The motor vehicle death rate for AI/AN (44.6 deaths per 100,000) was 2.4 times the rate for all races in the U.S. (18.5) in 1983.
In 1982, the age-adjusted homicide death rate (per 100,000 population) among AI/AN was 16.4, compared to 8.6 for all races and 26.4 for all nonwhites.
The highest suicide death rate for AI/AN in 1983 was among males aged 15-24 years, who had a rate of 46.2 (suicide deaths per 100,000 population) that was 2.3 times the rate for comparable males of all races in the U.S.
Suicide rates among AI/AN peak at ages 15 to 39 years, compared to the general population in which suicides most often occur after 40 years of age.
In 1983, the age-adjusted death rate from alcoholism among AI/AN (28.9 alcoholism deaths per 100,000 population) was 4.7 times the rate among all races in the U.S. (6.1).
Alcohol is involved in an estimated 75% of all accidental deaths, 80% of suicide deaths and 90% of homicide deaths among Native Americans.
Five of the top ten causes of death among Indians are directly related to alcohol: accidents, cirrhosis of the liver, alcoholism, suicide and homicide. These five causes of death account for 35% of all deaths among Native Americans.
Maternal and Infant Mortality
The 1981-83 maternal mortality rate for AI/AN was 8.9 (maternal deaths per 100,000 live births), 13% above the 1982 rate of 7.9 for all races in the U.S.
In 1982, the infant mortality rate (infant deaths per 1,000 live births) was 11.0 for AI/AN, 10.6 for AI alone, 16.3 for AN alone, 11.5 for all races in the U.S. and 19.6 for Blacks.
In 1981-83 for AI/AN, the infant (birth to one year) mortality rate was 11.0 with the neonatal (birth to 28 days) mortality rate being 5.0 and the postneonatal (28 days to one year) mortality rate being 6.1.
The AI/AN infant mortality rate was similar to that for all races; however, the neonatal mortality rate of AI/AN was 0.6 times that of all races in the U.S. and the postneonatal mortality rate was 1.6 times the rate for all U.S. races.
The leading causes of neonatal deaths for both AI/AN and all races in the U.S. were congenital anomalies and respiratory distress syndrome.
The leading causes of postneonatal deaths for both AI/AN and all races in the U.S. were sudden infant death syndrome and congenital anomalies.
AI/AN infants are 3.0 times more likely to die of meningitis, 2.0 times as likely to die of pneumonia and influenza and 1.8 times more likely to die of sudden infant death syndrome than all races of the U.S.
Risk Factor Prevalence
Alcohol and Substance Abuse
The proportion of Native American adults who drink alcohol varies according to the tribe from as low as 30% to as high as 80%, compared to 67% of the general U.S. population.
Heavy alcohol use (greater than 1.6 ounces of alcohol more than once a week), according to one study, was more common among Indians than in whites, and was most common among southwestern Indians.
Alcoholism accounts for an estimated 3.2% of all Native American deaths, about four times the rate of the general population.
Alaska Natives, who comprise 17% of Alaska’s population, account for 60% of the state’s alcoholism deaths.
The proportion of Native American high school seniors who had ever used marijuana (88%) and inhalants (34.4%) exceeded that of national high school seniors (59.5% and 12.3% respectively) in a 1980-81 survey. The reported daily use of marijuana among Native American youth (13.4%) in the two months prior to the 1980-81 survey was higher than in non-Native American urban youth (2.6%).
Heavy cigarette smoking (greater than 1 pack per day) was found to be rare among southwestern Indians but was about the same as among the general population for non-southwestern Indians.
Other Risk Factors
Comparisons of cholesterol levels between whites and Native Americans indicate equal or lower levels in Native Americans.
The prevalence of hypertension among Native Americans is generally reported as lower than in whites.
From 1967 to 1977, the average increase in mean body weight among Pima Indians ages 15-24 years was 9.24 kilograms for males and 6.56 kilograms for females.
Life expectancy at birth among AI/AN has increased 41% from 51.0 years in 1939-41 to 71.1 years in 1979-81.
The prevalence of diabetes among Pima Indians ages five years and older increased 42% from 24.0% in 1967 to 34.1% in 1977 in a study using a glucose tolerance test as the criterion.
The age-adjusted accident death rate for AI/AN decreased 54% from 181.8 (deaths by all accidents per 100,000 population) in 1970 to 82.9 in 1983. During the same period the rate for all races in the U.S. declined 34% to 35.3 in 1983.
The age-adjusted suicide death rate for AI/AN has decreased 31% since a peak of 21.2 (suicide deaths per 100,000 population) in 1975 to 14.7 in 1983. The rate for all races in the U.S. in 1983 was 11.4.
The age-adjusted gastrointestinal disease death rate for AI/AN has decreased 46% from a rate of 7.8 (deaths per 100,000 population) in 1970 to 4.2 in 1983. The comparable rate in 1983 for all races in the U.S. was 2.8.
The percent of all AI/AN deaths caused by cerebrovascular disease, heart disease and malignant neoplasms increased from 31.6% in 1969-71 to 36.3% in 1979-81.
The Native American infant mortality rate declined 44% from 24.7 (infant deaths per 1,000 live births) in 1969-71 to 13.8 in 1979-81.