Heart Disease Burden Persists in American Indian and Alaska Native Populations

By Rebecca Araujo - October 3, 2023

A study in JAMA Network Open found a significant heart disease burden among American Indian and Alaska Native (AIAN) individuals who are Medicare beneficiaries.

“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,” the authors wrote, leading to a “disproportionate burden of chronic disease, with the lowest life expectancy of all racial groups in the US.”

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, heart failure, 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 “most economically distressed” quintile. Regarding patient cardiovascular risk factors, 44.8% of patients had diagnosed diabetes, 61.3% had hyperlipidemia, and 72.2% had hypertension.

Prevalence of Cardiovascular Disease

In 2015, the prevalence of coronary artery disease was 38.6%, compared with 36.7% in 2019 (p<.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<.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<.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, “Solutions to improve cardiovascular health must be community designed and community led and must center tribal sovereignty,” noting that there have been greater effects for interventions on weight loss and glycemic control “that incorporate tribal history, language, and craft making … than standard physical activity recommendations and diet intervention.”

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