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
1AI/AN cancer incidence rate is 327.8 per 100,000, similar to whites but mortality 13% higher (2014-2018)
Verified2Liver cancer mortality in AI/AN is 3.3 times higher than whites (15.5 vs 4.7 per 100,000)
Verified3Colorectal cancer death rate for AI/AN 20.6 per 100,000, 25% higher than whites
Verified4Breast cancer mortality in AI/AN women 1.4 times whites (27.2 vs 19.5)
Directional5Lung cancer incidence in AI/AN men 54.9 per 100,000, highest due to smoking
Single source6Kidney cancer mortality 1.8 times higher in AI/AN (5.9 vs 3.3 per 100,000)
Verified7Cervical cancer death rate 2.1 times whites in AI/AN women (4.9 vs 2.3)
Verified8Prostate cancer incidence similar but stage-at-diagnosis later in AI/AN (45% regional)
Verified9Pancreatic cancer mortality 1.3x higher (13.4 vs 10.3)
Directional10In Northern Plains tribes, gallbladder cancer rates 5x national average
Single source11AI/AN 5-year cancer survival 54% vs 67% whites
Verified12Oral cancer death rate 1.5x higher (3.7 vs 2.5 per 100,000)
Verified13HPV-related cancer incidence 1.7x whites in AI/AN women
Verified14In Alaska Natives, nasopharyngeal cancer 10x higher
Directional15Late-stage breast cancer diagnosis 50% more common in AI/AN
Single source16Liver cancer in AI/AN linked to HCV, with 70% late diagnosis
Verified17Colorectal screening rates 52% in AI/AN vs 68% whites (2020)
Verified18Stomach cancer mortality 2.1x higher (7.0 vs 3.3 per 100,000)
Verified19Multiple myeloma incidence 1.4x whites (7.9 vs 5.7)
Directional20In Southwest, liver fluke-related cholangiocarcinoma elevated
Single source21AI/AN cancer treatment delays average 30 days longer
Verified22Bladder cancer mortality similar but 20% higher recurrence in AI/AN
Verified23In urban AI/AN, cancer mortality 15% above rural peers
Verified24Esophageal cancer death rate 1.6x whites (5.2 vs 3.3)
Directional25Leukemia incidence 1.2x higher in AI/AN children
Single source26Melanoma mortality lower but rising 5% annually in AI/AN
Verified27Thyroid cancer incidence highest in AI/AN women (18.5 per 100,000)
VerifiedCancer 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
1AI/AN age-adjusted heart disease death rate is 189.1 per 100,000, 1.2 times higher than whites (2018)
Verified2Stroke mortality among AI/AN is 48.5 per 100,000, 1.3 times the white rate (2015-2019)
Verified3AI/AN have hypertension prevalence of 34.1%, vs 30.2% U.S. adults, but poorer control (2017)
Verified4Coronary heart disease hospitalization rates for AI/AN are 25% higher than whites (2016)
Directional5In Alaska Natives, cardiovascular mortality is 20% higher than U.S. average (2019)
Single source6AI/AN adults have 1.5 times higher prevalence of high cholesterol (39% vs 26%)
Verified7Heart failure rates among AI/AN Medicare enrollees 1.4 times higher (2018)
Verified8AI/AN women experience MI mortality 1.6 times higher than white women
Verified9In Southwest tribes, rheumatic heart disease persists at 5-10 per 1,000, vs <1 nationally
Directional10AI/AN have 40% higher rates of peripheral artery disease linked to CVD
Single source11Smoking prevalence 31% in AI/AN contributes to 50% higher CVD death risk
Verified12AI/AN youth have 2x higher congenital heart defects prevalence
Verified13In Montana, AI/AN heart disease death rate 248 per 100,000 vs 180 whites (2019)
Verified14Urban AI/AN CVD hospitalization 30% above national average (UIHI)
Directional15AI/AN have lower statin prescription rates (45% vs 60% diabetics with CVD)
Single source16Cerebrovascular disease death rate for AI/AN men 1.4x whites (65.2 vs 46.1)
Verified17In IHS areas, 25% of AI/AN adults have uncontrolled hypertension
Verified18AI/AN post-MI 30-day mortality 15% higher
Verified19Atrial fibrillation prevalence 1.3x higher in AI/AN over 65
Directional20In Oklahoma, AI/AN stroke rate 62 per 100,000 vs 38 whites
Single source21AI/AN have 2x higher aortic aneurysm rupture rates
Verified22CVD contributes to 24% of AI/AN deaths, vs 23% nationally but at younger ages
Verified23AI/AN rural residents have 1.8x CVD mortality disparity
Verified24Carotid artery stenosis screening underutilized in AI/AN (only 20% screened)
DirectionalCardiovascular 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
1In 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
Verified2AI/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)
Verified3Among AI/AN in Arizona, diabetes prevalence reached 19.2% in 2019, compared to 9.5% statewide
Verified4End-stage renal disease due to diabetes is 3.8 times higher in AI/AN than in whites (2017 data)
Directional5AI/AN youth aged 10-19 have a type 2 diabetes prevalence of 1.4%, over 3 times higher than white youth (0.4%)
Single source6In the IHS service population, diabetes-related amputations occur at a rate 3-4 times higher than the U.S. average
Verified7Pima Indians in Arizona have the highest diabetes prevalence globally at 38% in adults over 35
Verified8AI/AN women have gestational diabetes rates 8.3 times higher than white women (8.4% vs 1.0%)
Verified9Diabetes hospitalization rates for AI/AN are 2.3 times higher than for whites (2016-2018)
Directional10In South Dakota, AI/AN diabetes death rate was 77.5 per 100,000 vs 22.4 for whites (2015-2019)
Single source11AI/AN have diabetic retinopathy prevalence of 22%, double the U.S. average
Verified12Among Navajo Nation, diabetes prevalence is 21.1% (2018 survey)
Verified13AI/AN adults with diabetes have uncontrolled A1C (>9%) in 42% of cases vs 26% whites
Verified14Diabetes contributes to 13% of AI/AN deaths under 65, vs 4% nationally
Directional15In Alaska Natives, diabetes prevalence doubled from 5.7% in 1993 to 11.4% in 2017
Single source16AI/AN Medicare beneficiaries have 50% higher rates of diabetes-related ER visits
Verified17Type 1 diabetes incidence in AI/AN youth is 12.2 per 100,000, similar to whites but with higher complications
Verified18In Oklahoma, AI/AN diabetes prevalence is 15.8% vs 10.2% non-Hispanic whites (BRFSS 2020)
Verified19AI/AN with diabetes have 2.5 times higher risk of lower extremity amputation
Directional20Urban AI/AN diabetes rate is 12.6%, 1.8 times national average (UIHI 2019)
Single source21Diabetes is the 5th leading cause of death for AI/AN, with age-adjusted rate 2.1 times whites
Verified22In Montana, AI/AN diabetes mortality is 58.3 per 100,000 vs 20.1 whites (2018)
Verified23AI/AN adults report physical inactivity 1.5 times higher among diabetics (50% vs 33%)
Verified24Diabetic ketoacidosis hospitalization rates 4 times higher in AI/AN youth
Directional25In New Mexico, Pueblo Indians have 25% diabetes prevalence
Single source26AI/AN diabetes patients have 30% lower statin use for cholesterol control
Verified27From 2014-2018, AI/AN diabetes death rate increased 12%, vs 5% decline nationally
Verified28AI/AN women with diabetes have 3.2 times higher preeclampsia risk
Verified29In California, AI/AN diabetes prevalence 13.2% vs 8.9% whites (2019)
Directional30AI/AN have 2.8 times higher prevalence of diabetic neuropathy
Single sourceDiabetes 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
1Tuberculosus incidence in AI/AN 3.3 times U.S. rate (3.9 vs 1.2 per 100,000, 2020)
Verified2COVID-19 death rate for AI/AN 2.1 times whites (254 vs 121 per 100,000, 2021)
Verified3Hepatitis C prevalence 2.5% in AI/AN vs 1.0% whites (2015-2018)
Verified4HIV diagnosis rate 1.3 times national average (8.1 per 100,000)
Directional5Pneumococcal pneumonia hospitalization 2x higher in AI/AN (2018)
Single source6Influenza mortality 1.7x whites during 2018-2019 season
Verified7Chlamydia rates in AI/AN women 3.8x whites (1,098 vs 289 per 100,000, 2021)
Verified8Gonorrhea incidence 4.5 times higher (652 vs 145 per 100,000)
Verified9In Alaska Natives, pertussis outbreaks 10x national
Directional10Syphilis rates 3.2x whites (42 vs 13 per 100,000, 2021)
Single source11Lower respiratory infections death rate 1.4x higher (48 per 100,000)
Verified12Hepatitis A outbreaks in AI/AN communities 5x impact (2016-2020)
Verified13MRSA skin infections 2x prevalence in AI/AN (2019)
Verified14In Navajo Nation, COVID positivity 35% higher (2020)
Directional15Infant pertussis mortality 4x U.S. average in AI/AN
Single source16Chronic hepatitis B 2.2% carrier rate in high-risk tribes
Verified17Invasive Hib disease 3x higher pre-vaccine, persists in under-vaccinated areas
Verified18In Montana reservations, TB rate 15 per 100,000 vs 0.5 state
Verified19COVID vaccination hesitancy 40% in AI/AN vs 20% whites initially
Directional20Sepsis hospitalization from infections 1.8x higher
Single source21HPV prevalence 25% in AI/AN young adults vs 15% whites
Verified22In urban AI/AN, STI rates 2.5x national (UIHI 2022)
Verified23Meningococcal disease outbreaks 3x in AI/AN dorms
Verified24Chronic viral hepatitis deaths 2x whites (2018)
Directional25Respiratory syncytial virus hospitalization in AI/AN infants 2.2x
Single source26In Southwest, Valley fever rates 5x non-Native
Verified27Post-COVID long hauler symptoms 50% in AI/AN hospitalized
VerifiedInfectious 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
1AI/AN suicide rate is 3.5 times the national average (16.1 per 100,000 in 2019)
Verified2AI/AN youth suicide death rate 2.5 times whites (10.1 vs 4.0 per 100,000, ages 10-24)
Verified322% of AI/AN adults report serious psychological distress vs 4% whites (2019 NSDUH)
Verified4PTSD prevalence 15% in AI/AN veterans, 2x non-Native vets
Directional5Depression rates 17.5% in AI/AN vs 6.6% whites (BRFSS 2018)
Single source6AI/AN have highest suicide attempt rate (2.7%) among U.S. ethnic groups (ages 18+)
Verified7In Alaska Native youth, suicide cluster rates reached 50 per 100,000 in some villages
Verified840% of AI/AN report frequent mental health distress (14+ days/month)
Verified9Urban AI/AN anxiety disorder prevalence 28% vs 18% national (UIHI)
Directional10AI/AN women suicide rate 5.6 per 100,000, 3.4x white women
Single source11Only 17% of AI/AN with mental illness receive treatment vs 46% whites
Verified12Bipolar disorder diagnosis 2x higher in AI/AN (4.2% vs 2.1%)
Verified13In Navajo Nation, suicide ideations 25% among high schoolers
Verified14AI/AN elderly depression 12% vs 7% whites, with higher suicide risk
Directional15Schizophrenia prevalence 1.5% in AI/AN, undertreated
Single source16Mental health hospitalization rates 2x higher but shorter stays in AI/AN
Verified17AI/AN opioid misuse with mental illness 45% comorbidity
Verified18Youth suicide prevention gaps: 60% of AI/AN schools lack counselors
Verified19In South Dakota tribes, suicide rate 4x state average (42 per 100,000)
Directional20AI/AN LGBTQ+ youth suicide attempt 40% vs 20% non-Native
Single source21Historical trauma correlates with 30% higher PTSD in AI/AN
Verified22Telepsychiatry access only 10% in rural AI/AN areas
Verified23AI/AN overdose deaths with mental health dx 3x whites
Verified24Seasonal affective disorder 25% in Alaska Natives
Directional25AI/AN children ADHD diagnosis 14%, treatment 60% gap
Single source26Suicide by firearm 50% of AI/AN suicides, highest method
Verified27Alcohol use disorder 15% in AI/AN with depression comorbidity
Verified28AI/AN veterans PTSD suicide risk 4x general population
VerifiedMental 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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