Systematic review of health disparities for cardiovascular diseases and associated factors among American Indian and Alaska Native populations.
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.


OBJECTIVE
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.


METHODS
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.


METHODS
Published literature that were published within the last fifteen years and provided direct comparisons between AI/AN to non-AI/AN populations were included.


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.


CONCLUSIONS
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
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.
N/A.
Lankenau Medical Center, Wynnewood, Pennsylvania, United States of America.
Rebecca Newlin
RN
Hutchinson
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Sonya
S
Shin
D000413:Alaska; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D012935:Social Justice