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Systematic Review of Health Disparities for Cardiovascular Diseases and Associated Factors among American Indian and Alaska Native Populations

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  • Rebecca Newlin Hutchinson
  • Sonya Shin

Abstract

Background: American Indians and Alaska Native (AI/AN) populations experience significant health disparities compared to non-Hispanic white populations. Cardiovascular disease and related risk factors are increasingly recognized as growing indicators of global health disparities. However, comparative reports on disparities among this constellation of diseases for AI/AN populations have not been systematically reviewed. Objectives: We performed a literature review on the prevalence of diabetes, metabolic syndrome, dyslipidemia, obesity, hypertension, and cardiovascular disease; and associated morbidity and mortality among AI/AN. Data sources: A total of 203 articles were reviewed, of which 31 met study criteria for inclusion. Searches were performed on PUBMED, MEDLINE, the CDC MMWR, and the Indian Health Services. Study eligibility criteria: Published literature that were published within the last fifteen years and provided direct comparisons between AI/AN to non-AI/AN populations were included. Study appraisal and synthesis methods: We abstracted data on study design, data source, AI/AN population, comparison group, and. outcome measures. A descriptive synthesis of primary findings is included. Results: Rates of obesity, diabetes, cardiovascular disease, and metabolic syndrome are clearly higher for AI/AN populations. Hypertension and hyperlipidemia differences are more equivocal. Our analysis also revealed that there are likely regional and gender differences in the degree of disparities observed. Limitations: Studies using BRFSS telephone surveys administered in English may underestimate disparities. Many AI/AN do not have telephones and/or speak English. Regional variability makes national surveys difficult to interpret. Finally, studies using self-reported data may not be accurate. Conclusions and implications of key findings: Profound health disparities in cardiovascular diseases and associated risk factors for AI/AN populations persist, perhaps due to low socioeconomic status and access to quality healthcare. Successful programs will address social determinants and increase healthcare access. Community-based outreach to bring health services to the most vulnerable may also be very helpful in this effort. Systematic review registration number: N/A

Suggested Citation

  • Rebecca Newlin Hutchinson & Sonya Shin, 2014. "Systematic Review of Health Disparities for Cardiovascular Diseases and Associated Factors among American Indian and Alaska Native Populations," PLOS ONE, Public Library of Science, vol. 9(1), pages 1-9, January.
    • Handle: RePEc:plo:pone00:0080973
    DOI: 10.1371/journal.pone.0080973
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    1. Acton, K.J. & Ríos Burrows, N. & Moore, K. & Querec, L. & Geiss, L.S. & Engelgau, M.M., 2002. "Trends in diabetes prevalence among American Indian and Alaska Native children, adolescents, and young adults," American Journal of Public Health, American Public Health Association, vol. 92(9), pages 1485-1490.
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    3. Jernigan, V.B.B. & Duran, B. & Ahn, D. & Winkleby, M., 2010. "Changing patterns in health behaviors and risk factors related to cardiovascular disease among American Indians and Alaska natives," American Journal of Public Health, American Public Health Association, vol. 100(4), pages 677-683.
    4. Duran, B.M., 2005. "American Indian/Alaska Native health policy," American Journal of Public Health, American Public Health Association, vol. 95(5), pages 758-758.
    5. Denny, C.H. & Holtzman, D. & Goins, R.T. & Croft, J.B., 2005. "Disparities in chronic disease risk factors and health status between American Indian/Alaska Native and white elders: Findings from a telephone survey, 2001 and 2002," American Journal of Public Health, American Public Health Association, vol. 95(5), pages 825-827.
    6. ver Ploeg, Michele & Breneman, Vince & Farrigan, Tracey & Hamrick, Karen & Hopkins, David & Kaufman, Phillip & Lin, Biing-Hwan & Nord, Mark & Smith, Travis A. & Williams, Ryan & Kinnison, Kelly & Olan, 2009. "Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences: Report to Congress," Administrative Publications 292130, United States Department of Agriculture, Economic Research Service.
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