Behind every statistic lies a human story, and the story of health among American Indians and Alaska Natives is one of alarming and persistent disparity.
Key Takeaways
- In 2018, the age-adjusted diabetes prevalence among American Indians/Alaska Natives (AI/AN) was 14.5%, more than double the 7.1% rate for non-Hispanic whites
- AI/AN adults have a diabetes mortality rate 1.7 times higher than the general U.S. population (52.8 vs 31.1 per 100,000)
- Among AI/AN in Arizona, diabetes prevalence reached 19.2% in 2019, compared to 9.5% statewide
- AI/AN age-adjusted heart disease death rate is 189.1 per 100,000, 1.2 times higher than whites (2018)
- Stroke mortality among AI/AN is 48.5 per 100,000, 1.3 times the white rate (2015-2019)
- AI/AN have hypertension prevalence of 34.1%, vs 30.2% U.S. adults, but poorer control (2017)
- AI/AN cancer incidence rate is 327.8 per 100,000, similar to whites but mortality 13% higher (2014-2018)
- Liver cancer mortality in AI/AN is 3.3 times higher than whites (15.5 vs 4.7 per 100,000)
- Colorectal cancer death rate for AI/AN 20.6 per 100,000, 25% higher than whites
- AI/AN suicide rate is 3.5 times the national average (16.1 per 100,000 in 2019)
- AI/AN youth suicide death rate 2.5 times whites (10.1 vs 4.0 per 100,000, ages 10-24)
- 22% of AI/AN adults report serious psychological distress vs 4% whites (2019 NSDUH)
- Tuberculosus incidence in AI/AN 3.3 times U.S. rate (3.9 vs 1.2 per 100,000, 2020)
- COVID-19 death rate for AI/AN 2.1 times whites (254 vs 121 per 100,000, 2021)
- Hepatitis C prevalence 2.5% in AI/AN vs 1.0% whites (2015-2018)
Native Americans face severe and disproportionate health crises across multiple diseases.
Cancer
- AI/AN cancer incidence rate is 327.8 per 100,000, similar to whites but mortality 13% higher (2014-2018)
- Liver cancer mortality in AI/AN is 3.3 times higher than whites (15.5 vs 4.7 per 100,000)
- Colorectal cancer death rate for AI/AN 20.6 per 100,000, 25% higher than whites
- Breast cancer mortality in AI/AN women 1.4 times whites (27.2 vs 19.5)
- Lung cancer incidence in AI/AN men 54.9 per 100,000, highest due to smoking
- Kidney cancer mortality 1.8 times higher in AI/AN (5.9 vs 3.3 per 100,000)
- Cervical cancer death rate 2.1 times whites in AI/AN women (4.9 vs 2.3)
- Prostate cancer incidence similar but stage-at-diagnosis later in AI/AN (45% regional)
- Pancreatic cancer mortality 1.3x higher (13.4 vs 10.3)
- In Northern Plains tribes, gallbladder cancer rates 5x national average
- AI/AN 5-year cancer survival 54% vs 67% whites
- Oral cancer death rate 1.5x higher (3.7 vs 2.5 per 100,000)
- HPV-related cancer incidence 1.7x whites in AI/AN women
- In Alaska Natives, nasopharyngeal cancer 10x higher
- Late-stage breast cancer diagnosis 50% more common in AI/AN
- Liver cancer in AI/AN linked to HCV, with 70% late diagnosis
- Colorectal screening rates 52% in AI/AN vs 68% whites (2020)
- Stomach cancer mortality 2.1x higher (7.0 vs 3.3 per 100,000)
- Multiple myeloma incidence 1.4x whites (7.9 vs 5.7)
- In Southwest, liver fluke-related cholangiocarcinoma elevated
- AI/AN cancer treatment delays average 30 days longer
- Bladder cancer mortality similar but 20% higher recurrence in AI/AN
- In urban AI/AN, cancer mortality 15% above rural peers
- Esophageal cancer death rate 1.6x whites (5.2 vs 3.3)
- Leukemia incidence 1.2x higher in AI/AN children
- Melanoma mortality lower but rising 5% annually in AI/AN
- Thyroid cancer incidence highest in AI/AN women (18.5 per 100,000)
Cancer Interpretation
When you see that a population's cancer incidence is nearly identical to the national average, yet they face dramatically higher death rates across nearly every site, from later-stage diagnoses and treatment delays to crumbling screening infrastructure, it paints a chillingly clear picture: our healthcare systems are failing at delivering equitable survival.
Cardiovascular Disease
- AI/AN age-adjusted heart disease death rate is 189.1 per 100,000, 1.2 times higher than whites (2018)
- Stroke mortality among AI/AN is 48.5 per 100,000, 1.3 times the white rate (2015-2019)
- AI/AN have hypertension prevalence of 34.1%, vs 30.2% U.S. adults, but poorer control (2017)
- Coronary heart disease hospitalization rates for AI/AN are 25% higher than whites (2016)
- In Alaska Natives, cardiovascular mortality is 20% higher than U.S. average (2019)
- AI/AN adults have 1.5 times higher prevalence of high cholesterol (39% vs 26%)
- Heart failure rates among AI/AN Medicare enrollees 1.4 times higher (2018)
- AI/AN women experience MI mortality 1.6 times higher than white women
- In Southwest tribes, rheumatic heart disease persists at 5-10 per 1,000, vs <1 nationally
- AI/AN have 40% higher rates of peripheral artery disease linked to CVD
- Smoking prevalence 31% in AI/AN contributes to 50% higher CVD death risk
- AI/AN youth have 2x higher congenital heart defects prevalence
- In Montana, AI/AN heart disease death rate 248 per 100,000 vs 180 whites (2019)
- Urban AI/AN CVD hospitalization 30% above national average (UIHI)
- AI/AN have lower statin prescription rates (45% vs 60% diabetics with CVD)
- Cerebrovascular disease death rate for AI/AN men 1.4x whites (65.2 vs 46.1)
- In IHS areas, 25% of AI/AN adults have uncontrolled hypertension
- AI/AN post-MI 30-day mortality 15% higher
- Atrial fibrillation prevalence 1.3x higher in AI/AN over 65
- In Oklahoma, AI/AN stroke rate 62 per 100,000 vs 38 whites
- AI/AN have 2x higher aortic aneurysm rupture rates
- CVD contributes to 24% of AI/AN deaths, vs 23% nationally but at younger ages
- AI/AN rural residents have 1.8x CVD mortality disparity
- Carotid artery stenosis screening underutilized in AI/AN (only 20% screened)
Cardiovascular Disease Interpretation
These statistics paint a grim portrait of a system failing Native communities, where the heart of the issue isn't just biology but a legacy of inequity that leaves cardiovascular health broken treaty by broken treaty.
Diabetes
- In 2018, the age-adjusted diabetes prevalence among American Indians/Alaska Natives (AI/AN) was 14.5%, more than double the 7.1% rate for non-Hispanic whites
- AI/AN adults have a diabetes mortality rate 1.7 times higher than the general U.S. population (52.8 vs 31.1 per 100,000)
- Among AI/AN in Arizona, diabetes prevalence reached 19.2% in 2019, compared to 9.5% statewide
- End-stage renal disease due to diabetes is 3.8 times higher in AI/AN than in whites (2017 data)
- AI/AN youth aged 10-19 have a type 2 diabetes prevalence of 1.4%, over 3 times higher than white youth (0.4%)
- In the IHS service population, diabetes-related amputations occur at a rate 3-4 times higher than the U.S. average
- Pima Indians in Arizona have the highest diabetes prevalence globally at 38% in adults over 35
- AI/AN women have gestational diabetes rates 8.3 times higher than white women (8.4% vs 1.0%)
- Diabetes hospitalization rates for AI/AN are 2.3 times higher than for whites (2016-2018)
- In South Dakota, AI/AN diabetes death rate was 77.5 per 100,000 vs 22.4 for whites (2015-2019)
- AI/AN have diabetic retinopathy prevalence of 22%, double the U.S. average
- Among Navajo Nation, diabetes prevalence is 21.1% (2018 survey)
- AI/AN adults with diabetes have uncontrolled A1C (>9%) in 42% of cases vs 26% whites
- Diabetes contributes to 13% of AI/AN deaths under 65, vs 4% nationally
- In Alaska Natives, diabetes prevalence doubled from 5.7% in 1993 to 11.4% in 2017
- AI/AN Medicare beneficiaries have 50% higher rates of diabetes-related ER visits
- Type 1 diabetes incidence in AI/AN youth is 12.2 per 100,000, similar to whites but with higher complications
- In Oklahoma, AI/AN diabetes prevalence is 15.8% vs 10.2% non-Hispanic whites (BRFSS 2020)
- AI/AN with diabetes have 2.5 times higher risk of lower extremity amputation
- Urban AI/AN diabetes rate is 12.6%, 1.8 times national average (UIHI 2019)
- Diabetes is the 5th leading cause of death for AI/AN, with age-adjusted rate 2.1 times whites
- In Montana, AI/AN diabetes mortality is 58.3 per 100,000 vs 20.1 whites (2018)
- AI/AN adults report physical inactivity 1.5 times higher among diabetics (50% vs 33%)
- Diabetic ketoacidosis hospitalization rates 4 times higher in AI/AN youth
- In New Mexico, Pueblo Indians have 25% diabetes prevalence
- AI/AN diabetes patients have 30% lower statin use for cholesterol control
- From 2014-2018, AI/AN diabetes death rate increased 12%, vs 5% decline nationally
- AI/AN women with diabetes have 3.2 times higher preeclampsia risk
- In California, AI/AN diabetes prevalence 13.2% vs 8.9% whites (2019)
- AI/AN have 2.8 times higher prevalence of diabetic neuropathy
Diabetes Interpretation
These statistics aren't just a disparity; they are the relentless arithmetic of historical trauma, systemic neglect, and a fractured healthcare ecosystem, written on the bodies of Native people.
Infectious Diseases
- Tuberculosus incidence in AI/AN 3.3 times U.S. rate (3.9 vs 1.2 per 100,000, 2020)
- COVID-19 death rate for AI/AN 2.1 times whites (254 vs 121 per 100,000, 2021)
- Hepatitis C prevalence 2.5% in AI/AN vs 1.0% whites (2015-2018)
- HIV diagnosis rate 1.3 times national average (8.1 per 100,000)
- Pneumococcal pneumonia hospitalization 2x higher in AI/AN (2018)
- Influenza mortality 1.7x whites during 2018-2019 season
- Chlamydia rates in AI/AN women 3.8x whites (1,098 vs 289 per 100,000, 2021)
- Gonorrhea incidence 4.5 times higher (652 vs 145 per 100,000)
- In Alaska Natives, pertussis outbreaks 10x national
- Syphilis rates 3.2x whites (42 vs 13 per 100,000, 2021)
- Lower respiratory infections death rate 1.4x higher (48 per 100,000)
- Hepatitis A outbreaks in AI/AN communities 5x impact (2016-2020)
- MRSA skin infections 2x prevalence in AI/AN (2019)
- In Navajo Nation, COVID positivity 35% higher (2020)
- Infant pertussis mortality 4x U.S. average in AI/AN
- Chronic hepatitis B 2.2% carrier rate in high-risk tribes
- Invasive Hib disease 3x higher pre-vaccine, persists in under-vaccinated areas
- In Montana reservations, TB rate 15 per 100,000 vs 0.5 state
- COVID vaccination hesitancy 40% in AI/AN vs 20% whites initially
- Sepsis hospitalization from infections 1.8x higher
- HPV prevalence 25% in AI/AN young adults vs 15% whites
- In urban AI/AN, STI rates 2.5x national (UIHI 2022)
- Meningococcal disease outbreaks 3x in AI/AN dorms
- Chronic viral hepatitis deaths 2x whites (2018)
- Respiratory syncytial virus hospitalization in AI/AN infants 2.2x
- In Southwest, Valley fever rates 5x non-Native
- Post-COVID long hauler symptoms 50% in AI/AN hospitalized
Infectious Diseases Interpretation
If infectious diseases were holding auditions for their favorite host, they'd apparently see America's first peoples not as a population but as a perpetually open casting call, a grim reality born of systemic neglect and not, as some might lazily assume, any inherent vulnerability.
Mental Health
- AI/AN suicide rate is 3.5 times the national average (16.1 per 100,000 in 2019)
- AI/AN youth suicide death rate 2.5 times whites (10.1 vs 4.0 per 100,000, ages 10-24)
- 22% of AI/AN adults report serious psychological distress vs 4% whites (2019 NSDUH)
- PTSD prevalence 15% in AI/AN veterans, 2x non-Native vets
- Depression rates 17.5% in AI/AN vs 6.6% whites (BRFSS 2018)
- AI/AN have highest suicide attempt rate (2.7%) among U.S. ethnic groups (ages 18+)
- In Alaska Native youth, suicide cluster rates reached 50 per 100,000 in some villages
- 40% of AI/AN report frequent mental health distress (14+ days/month)
- Urban AI/AN anxiety disorder prevalence 28% vs 18% national (UIHI)
- AI/AN women suicide rate 5.6 per 100,000, 3.4x white women
- Only 17% of AI/AN with mental illness receive treatment vs 46% whites
- Bipolar disorder diagnosis 2x higher in AI/AN (4.2% vs 2.1%)
- In Navajo Nation, suicide ideations 25% among high schoolers
- AI/AN elderly depression 12% vs 7% whites, with higher suicide risk
- Schizophrenia prevalence 1.5% in AI/AN, undertreated
- Mental health hospitalization rates 2x higher but shorter stays in AI/AN
- AI/AN opioid misuse with mental illness 45% comorbidity
- Youth suicide prevention gaps: 60% of AI/AN schools lack counselors
- In South Dakota tribes, suicide rate 4x state average (42 per 100,000)
- AI/AN LGBTQ+ youth suicide attempt 40% vs 20% non-Native
- Historical trauma correlates with 30% higher PTSD in AI/AN
- Telepsychiatry access only 10% in rural AI/AN areas
- AI/AN overdose deaths with mental health dx 3x whites
- Seasonal affective disorder 25% in Alaska Natives
- AI/AN children ADHD diagnosis 14%, treatment 60% gap
- Suicide by firearm 50% of AI/AN suicides, highest method
- Alcohol use disorder 15% in AI/AN with depression comorbidity
- AI/AN veterans PTSD suicide risk 4x general population
Mental Health Interpretation
These statistics are not a collection of abstract data points but the quantifiable echoes of historical trauma, where the shattered promises and severed ties of the past continue to fracture the present, leaving an entire people battling a silent epidemic of grief with tragically few lifelines.
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