BACKGROUND
Academic research on the disproportionate impact of COVID-19 among Native Americans has largely been restricted to particular indigenous groups or reservations.

OBJECTIVE
We estimate COVID-19 mortality for Native Americans relative to other racial/ethnic groups and explore how state-level mortality is associated with known risk factors.

METHODS
We use the standardized mortality ratio (SMR), adjusted for age, to estimate COVID-19 mortality by racial/ethnic groups for the United States and 16 selected states that account for three-quarters of the Native American population. The prevalence of risk factors is derived from the American Community Survey and the Behavioral Risk Factor Surveillance System.

RESULTS
The SMR for Native Americans greatly exceeds those for Black and Latino populations and varies enormously across states. There is a strong positive correlation across states between the share of Native Americans living on a reservation and the SMR. The SMR for Native Americans is highly correlated with the income-poverty ratio, the prevalence of multigenerational families, and health insurance (excluding the Indian Health Service). Risk factors associated with socioeconomic status and comorbidities are generally more prevalent for Native Americans living on homelands, a proxy for reservation status, than for those living elsewhere.

CONCLUSIONS
Most risk factors for COVID-19 are disproportionately high among Native Americans. Reservation life appears to increase the risk of COVID-19 mortality.



中文翻译：

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美洲原住民的 COVID-19 风险因素和死亡率（作者：Katherine Leggat-Barr、Fumiya Uchikoshi、Noreen Goldman）

背景
关于 COVID-19 对美洲原住民的不成比例影响的学术研究在很大程度上仅限于特定的土著群体或保留地。

目标
我们估计美洲原住民相对于其他种族/族裔群体的 COVID-19 死亡率，并探讨州级死亡率与已知风险因素之间的关系。

方法
我们使用根据年龄调整的标准化死亡率 (SMR) 来估计美国和占美洲原住民人口四分之三的 16 个选定州的种族/族裔群体的 COVID-19 死亡率。风险因素的流行来自美国社区调查和行为风险因素监测系统。

结果
美洲原住民的 SMR 大大超过黑人和拉丁裔人口的 SMR，并且各州之间差异很大。居住在保留地的美洲原住民比例与 SMR 之间存在很强的正相关性。美洲原住民的 SMR 与收入贫困率、多代家庭的流行率和健康保险（不包括印第安人健康服务）高度相关。与社会经济地位和合并症相关的风险因素对于居住在家园的美洲原住民（代表保留状态）通常比居住在其他地方的美洲原住民更为普遍。

结论
在美洲原住民中，COVID-19 的大多数风险因素都高得不成比例。保留期限似乎会增加 COVID-19 死亡的风险。