Rebecca Araujo

Urban Health Today

A study in <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809788" target="_blank" rel="noopener">JAMA Network Open</a> found a significant heart disease burden among American Indian and Alaska Native (AIAN) individuals who are Medicare beneficiaries.&ldquo;Pervasive structural racism, broken treaty obligations, settler colonialism, genocide, and exclusionary governmental policies have concentrated poverty and fueled health inequities among Indigenous populations in the US,&rdquo; the authors wrote, leading to a &ldquo;disproportionate burden of chronic disease, with the lowest life expectancy of all racial groups in the US.&rdquo;The population-based cohort study used data from AIAN adults aged 65 years and older who were enrolled in Medicare Part A and B between January 2015 and December 2019. Primary outcomes were the annual incidence, prevalence, and mortality associated with coronary artery disease, <a href="https://urbanhealthtoday.com/post/coexistent-social-risk-factors-linked-hospitalization-heart-failure">heart failure</a>, atrial fibrillation/flutter, and cerebrovascular disease (eg, stroke and transient ischemic attack). The population included 220,598 individuals.The median age was 72.5 years, and 57.8% of the cohort was female. According to the Distressed Communities Index, 38.8% of participants came from communities in the &ldquo;most economically distressed&rdquo; quintile. Regarding patient cardiovascular risk factors, 44.8% of patients had diagnosed <a href="https://urbanhealthtoday.com/post/health-literacy-improve-diabetes-self-management">diabetes</a>, 61.3% had hyperlipidemia, and 72.2% had hypertension.<h2>Prevalence of Cardiovascular Disease</h2>In 2015, the prevalence of coronary artery disease was 38.6%, compared with 36.7% in 2019 (p&lt;.001). Incidence of acute myocardial infarction increased from 6.9 to 7.7 cases per 1,000 person-years in 2015 and 2019, respectively (percentage change, 4.79%; p&lt;.001).Heart failure prevalence was 22.9% in 2015 and 21.4% in 2019, with incidence rising from 26.1 cases per 1,000 person-years to 27.0 per 1,000 person-years, respectively (percentage change, 4.08%; p&lt;.001). Atrial fibrillation prevalence was 9% in 2015 and remained stable across the study period. Incidence of cerebrovascular disease decreased slightly from 2015 to 2019, from 12.7 to 12.1 per 1,000 person-years, respectively (percentage change, 5.08%; p=.004).Half of the participants (n=110,244) had at least 1 severe cardiovascular condition, and the overall mortality rate was 19.8%. Among participants who entered the cohort in 2015, the 5-year mortality rate was 25.5%.In conclusion, the authors stated, &ldquo;Solutions to improve cardiovascular health must be community designed and community led and must center tribal sovereignty,&rdquo; noting that there have been greater effects for interventions on weight loss and glycemic control &ldquo;that incorporate tribal history, language, and craft making &hellip; than standard physical activity recommendations and diet intervention.&rdquo;

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Heart Disease Burden Persists in American Indian and Alaska Native Populations

Heart Health

Half of the more than 220,000 Native participants analyzed had at least 1 severe cardiovascular condition. 

Heart Disease Burden in American Indians and Alaska Natives 

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