Study finds higher COVID-19 death rates among Native Americans

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JACKSON, Miss. (WJTV) — While Native Americans make up less than 1% of Mississippi’s population, they accounted for 4.5% of recorded COVID-19 deaths in July 2020.

New research from the University of Mississippi Medical Center seeks to explain why this is the case. The study, published online March 30 in JAMA Network Open, found that Native American COVID-19 patients were more likely to die in hospital from disease than white or black patients even after accounting for pre-existing health conditions.

Leslie Musshafen, executive director of research at UMMC, led the study.

“I started hearing doctors say they were seeing much worse outcomes in Native American patients with the virus,” Musshafen said. “Without exception, greater comorbidity burdens among indigenous populations have been suggested to explain the phenomenon.”

Musshafen, who will earn a doctorate in population health sciences next month from the John D. Bower School of Population Health, decided to test this idea as part of his thesis.

She and her colleagues used health records from the Mississippi Department of Health’s Inpatient Data System. They found 18,000 COVID-19 patients admitted to 103 Mississippi hospitals in 2020. They used the Elixhauser Comorbidity Index (ECI) to estimate a patient’s risk of death. The index includes 31 health conditions or risk factors, including heart disease, cancer and diabetes. Research throughout the pandemic shows that these and other conditions can make COVID-19 more severe or increase an individual’s risk of death.

“The higher the score, the higher the risk of death with COVID-19,” she said.

They also sorted the patients into groups based on race. Black and white patients each made up about 49% of the study sample, while Native American or Alaska Native, or AIAN, patients made up 1%.

They found that, on average, AIAN patients had lower ECI scores than both black and white patients.

“That means we would expect, overall, Native Americans to have lower death rates,” Musshafen said.

However, that is not what the study found. Of all COVID-19 patients included, 29.8% of AIAN patients died, compared to 14.6% of white patients and 13.6% of black patients.

They also compared smaller groups with similar comorbidity risk scores. At each level, AIAN patients were more likely to die in hospital than white or black patients.

AIAN patients also had the longest average hospital stay at 9.9 days, compared to 8 days for black patients and 7.8 for white patients.

The article follows an initial study, which showed similar trends in UMMC patients alone using a smaller set of risk factors.

“UMMC is the only Level 1 hospital in the state and is not particularly close to any of the Choctaw communities in Mississippi,” Musshafen said. “We wondered if our results were skewed because the COVID-19 patients we admitted at the time were probably among the sickest of the sick. We conducted a larger statewide study to determine if the results would be true.

The only federally recognized tribe in Mississippi is the Band of Mississippi Choctaw Indians, primarily based in eight communities in the eastern part of the state.

Musshafen said race and geography issues that create a “double disparity” can impact death rates. She and her co-authors note a history of discrimination and marginalization of Indigenous peoples. Additionally, rural populations of all races tend to have poorer health outcomes, in part due to fewer and more remote health facilities.

“All eight Choctaw communities are in rural and medically underserved areas,” Musshafen said.

Dr. Loretta Christensen and Shawnell Damon of the Indian Health Service posted a guest comment on the article. They say the findings are an “important” part of understanding the effects of COVID-19 on AIAN populations early in the pandemic. They also note that successful public health outreach can help reduce the disparity.

Study co-authors include Dobbs, Dr. Seth Lirette, assistant professor of data science, Dr. Richard Summers, associate vice chancellor for research, and Dr. Caroline Compretta, associate professor of preventive medicine, all from the UMMC; and Lamees El-Sadek, MSDH epidemiologist.

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