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American Indian Health
Avian Influenza
Fetal Surgery
Macular Degeneration
Nonalcoholic Steatohepatitis

Other Elements
Table of Contents

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Magills Medical Guide, 4th rev. ed.

Editors: Anne Lynn S. Chang, M.D., Stanford University; H. Bradford Hawley, M.D., Wright State University; Laurence M. Katz, M.D., University of North Carolina, Chapel Hill; Nancy A. Piotrowski, Ph.D., University of California, Berkeley; Connie Rizzo, M.D., Ph.D., Columbia University

ISBN: 978-1-58765-384-1
List Price: $395

November 2007 · 5 volumes · 3,206 pages · 8"x10"

Combines Print & Online Access

Magill's Medical Guide 4th rev. ed.
American Indian Health

Specialties and Related Fields: All

Definition: Statistics and medical problems of persons descended from the original inhabitants of North America.

Key Terms
alcoholism: a disorder characterized by the excessive consumption of alcohol, leading to dependency

cirrhosis: a chronic disease of the liver in which normal tissue is replaced with fibrous tissue, resulting in the loss of functional liver cells

diabetes mellitus: a disorder of carbohydrate metabolism, resulting in excessive amounts of glucose in the blood and urine

hepatitis: inflammation of the liver characterized by jaundice, liver enlargement, and fever

obesity: a weight more than 20 percent above normal

otitis media: inflammation of the middle ear, characterized by pain, dizziness, and impaired hearing

sudden infant death syndrome (SIDS): a fatal sudden cessation of breathing in healthy sleeping infants under a year old

syphilis: a chronic infectious disease either transmitted by direct contact (usually in sexual intercourse) or passed from mother to child in utero

tuberculosis: an infectious disease of humans and animals caused by the tubercle bacillus and characterized by the coughing up of mucus and sputum, fever, weight loss, and chest pain

years of potential life lost: a measure of the burden of premature deaths

Population and Statistics
More than three million residents of the United States are of American Indian ancestry. This diverse population consists of more than five hundred tribes speaking more than three hundred different languages. There are three hundred American Indian reservations in the continental United States. In the American Indian population, 33 percent are below the age of fifteen and 6 percent are older than sixty-four. In comparison, in the total U.S. population, 22 percent are younger than fifteen and 13 percent are over the age of sixty-four. Of American Indians, 8.9 percent have at least a college degree (compared to 20.3 percent of the total U.S. population). The unemployment rate among American Indians is 14.8 percent (6.3 percent for the total U.S. population), and 31 percent of American Indians are below poverty level (13.1 percent for the total U.S. population).

The Urban Indian Health Institute analyzed census and vital statistics data from 1990 to 2000 and found health disparities between American Indians and the general U.S. population. The Federal Indian Health Service reported health trends for 2000 to 2001. Average life expectancy of American Indians was 70.6 years, compared to 76.5 for the total U.S. population. The years of potential life lost (YPLL) rate (per 1,000) for American Indians was 88, compared to the total U.S. population of 48.4. The death rate (per 1,000) for all ages was 715.2 for American Indians and 479.1 for the total U.S. population. For American Indians aged five to fourteen, the top two causes of death were unintentional injuries and homicide. For the corresponding U.S. population, the top two were unintentional injuries and malignant neoplasms. American Indians aged fifteen to twenty-four were most likely to die from unintentional injuries or suicide (for the U.S. population, they were unintentional injuries or homicide). For ages twenty-five to forty-four, the top two causes of death in American Indians were unintentional injuries and chronic liver disease, whereas the top causes of death in the U.S. population were unintentional injuries and malignant neoplasms. For the total U.S. population, the top five leading causes of death were heart disease, malignant neoplasms, stroke, chronic lower respiratory disease, and unintentional injuries. The top five leading causes of death for American Indians of all ages were heart disease, malignant neoplasms, unintentional injuries, diabetes mellitus, and chronic liver disease.

Major Health Concerns
Heart disease is the leading cause of death in American Indians. The incidence is twice that of the general U.S. population. Diabetes mellitus plays a large part in heart disease. While mortality rates from heart disease have decreased in general in the United States, American Indians have seen no change in the death rate from heart disease, which is 8 percent higher than the rate for all races.

Malignant neoplasm, or cancer, was unknown to American Indians until the latter part of the twentieth century. Cancer is the third leading cause of death in American Indian women. Furthermore, American Indians have lower survival rate from all cancers than any other group. The five-year survival rate for American Indian women is 35.2 percent. For Caucasian women, that number is 50.3 percent. Although the rates of breast cancer are lower in American Indians than in Caucasians, breast cancer mortality rates are increasing in American Indians. For breast cancer, the five-year survival rates are 49 percent for American Indians and 76 percent for Caucasian women. In American Indian men, the five major cancer sites that lead to death are the lungs, prostate, colon, stomach, and liver. The overall cancer mortality rate for American Indian men aged fourteen to twenty-four years is 3.7 percent. The rate for U.S. men of all races in the same age range is 3.3 percent. Gallbladder cancer rates are high for both male and female American Indians. This form of cancer is 8.9 times more likely to occur in American Indians than in Caucasians. Death rates from lung cancer have been increasing in American Indian populations. This increase may be due, in part, to the observation that urban American Indians are more likely to be habitual tobacco users than people of other races. For example, in 1998 the Catawba tribe of South Carolina reported that 30.2 percent of their population were current smokers (the rate was 20 percent for African Americans and 25.7 percent for Caucasians). Maternal tobacco use is also a serious risk factor for infant death.

American Indian infant health status is lower compared with most children in the United States. Premature births and infant mortality rates are higher for American Indians than for the general population. Sudden infant death syndrome (SIDS) was the leading cause of American Indian infant mortality between 1995 and 2000 at twice the rate of the general population. One risk factor, maternal alcoholism, is three to four times more common in American Indians than in the total population. In one study, first trimester binge drinking was related to six times the risk for SIDS.

Approximately 75 percent of all American Indian childhood deaths are the result of injuries, twice the rate for the total U.S. population. Although rarely fatal, otitis media is another health concern for American Indian children. Otitis media is seen twice as often in American Indian children than in the general U.S. population. For infants, the rate of otitis media in American Indians was three times higher than in the general population.

While diabetes mellitus was virtually nonexistent in American Indians before 1950, Type II diabetes is now the fourth leading cause of death in this population. The common cold and diabetes are the two most frequent causes of outpatient visits to American Indian health centers. The prevalence of diabetes mellitus is 15 percent in American Indian adults, compared with 7 percent in total U.S. adults. In adult American Indians over age fifty-five, the prevalence doubles to 30 percent, with a higher frequency in women than in men. There is an increasing incidence in American Indians under the age of twenty. Diabetes mellitus is associated with thyroid disease and impaired circulation that occurs with high blood sugar (glucose). Complications of diabetes mellitus include blindness, kidney failure, lower extremity amputation, heart disease, circulation problems, coma, and depression. Of all people with diabetes, American Indians are six times more likely to suffer kidney failure. Amputations related to diabetes mellitus are three to four times higher in American Indians than in others with the disease. American Indians have the highest death rate in the world from diabetes mellitus. American Indians are three times more likely to die from diabetes mellitus than the general U.S. population.

The increase in the prevalence of diabetes mellitus may be explained, in part, by genetics. One theory is that American Indians have a "thrifty genotype." Because they were hunter-gatherers, their bodies had to adapt to fluctuations in weight, from famine to feast. When food was available, body fat was stored quickly in preparation for periods without food. When this lifestyle changed, this genotype became maladaptive. Food is now no longer scarce. Whereas hunter-gatherer diets consisted of wild game, fish, nuts, fruits, and vegetables, U.S. government commodities given to American Indians have high fat and sugar content. This diet promotes fat storage in a body that is already genetically predisposed to store fat rapidly, an adaptation that is no longer necessary for survival. Consequently, obesity, a risk factor in diabetes mellitus, is a major health concern for American Indians.

American Indians exhibit the highest prevalence of obesity among all racial groups. Obesity starts early in the lives of American Indians. In the general U.S. population, 11 percent of six- to eleven-year-olds are overweight. The rate is 28.6 percent in American Indian children of the same age. A survey conducted by the Indian Health Services in 1990 showed that 40 percent of five- to eighteen-year-old American Indians were overweight. From the study of the Catawba, 63.4 percent reported being overweight and 42.8 percent were physically inactive. In American Indian men, 34 percent are overweight. The rate for American Indian women is 40 percent. Diet plays a large part in obesity. One study indicated that American Indians' high consumption of sugary drinks may be a major contributor to obesity. In support of this conclusion, American Indian children have five times the dental decay than the average U.S. child. Dental problems are also associated with alcohol abuse.

Alcohol-related hospitalizations for American Indians are 1.6 times greater than in the general population. A variety of medical problems are associated with alcoholism: kidney and bladder problems, hearing and vision problems, and head injuries. Alcohol abuse has a high rate of co-occurrence with smoking, suggesting a genetic predisposition to both addictions. A genetic basis to alcoholism is also indicated by the reduced ability of some Asians and American Indians to metabolize alcohol. This same genetic predisposition affects vulnerability to alcohol cirrhosis. Alcoholism is related to some of the leading causes of American Indian deaths that occur at rates three to four times the national average: accidents, suicides, homicides, and cirrhosis. Excessive use of alcohol can lead to drug-related hepatitis.

Perspective and Prospects
Research in genetics led to the conclusion that American Indians migrated to the North American continent from east-central Asia. European contact reduced the population of American Indians. Major health concerns of the American Indians were infectious diseases against which they had no immunity, such as typhoid, diphtheria, measles, smallpox, syphilis, and tuberculosis. For example, following the Spanish colonization of California, between 1800 and 1802 there was a diphtheria epidemic among the Chumash. As a result, 15 percent of the tribe's population died.

The Indian Removal Act of 1830 forced American Indians to leave their homelands and travel to designated reservations. The combination of stress and poor nutrition made them susceptible to infectious diseases. For example, the Choctaws were devastated by cholera. Between 1836 and 1840, ten thousand American Indians died from smallpox. Some American Indians dealt with the stress of disease and removal by drinking alcohol. American Indians began dying of alcohol poisoning.

As a result of the move to reservations, inadequate housing and nutrition led to infant deaths from pneumonia, gastrointestinal disorders, tuberculosis, heart disease, and syphilis. Yakama infants died most frequently from pneumonia, which developed from influenza. Bacilli spread through the air and on blankets, dishes, and clothing. Malnutrition, heart disease, tuberculosis, and infection increased the risk of developing pneumonia. Children died from vomiting, diarrhea, and infections resulting from gastrointestinal disorders. Tuberculosis developed quickly as a result of malnutrition and unsanitary housing. A fetus developed congenital heart disease as a result of the mother's poor nutrition, lack of prenatal care, and infection or disease such as rubella. Syphilis in adults caused increased sterility. In the Yakama tribe, 79 percent of people who died of syphilis were children who had contracted the disease from their mothers. In all, a child's life expectancy was 6.4 years.

Acculturation resulting from European contact is associated with the major health concerns of American Indians. Forced cultural changes have resulted in changed lifestyles. For example, between 1936 and 1946, American Indians went from an agricultural to an industrial society. The increased incidence of diabetes mellitus among American Indians is associated with urban, industrialized, and sedentary lifestyles added to an increase of store-bought foods in their diet. More generally, profound cultural changes can result in stress that leads to health problems.

Improvements in American Indian health can be made through research, education, and community-based prevention programs. For example, educational programs emphasize breast cancer awareness and screenings. As another example, to reduce the incidence of diabetes mellitus, interventions promote exercise, a reduced-fat diet, and glucose control. Efforts to change diets must take into account what foods are currently part of the diet and what importance those foods have for a particular American Indian tribe. Educational programs to promote weight loss must pay attention to some tribal beliefs that large bodies indicate wealth, while skinny bodies represent weakness and illness. Breast-feeding programs encourage and support American Indian women to breast-feed their babies for at least two months. Research indicates that breast-fed babies are less likely to develop diabetes. Prevention strategies are aimed at the leading causes of injury-related death, such as car wrecks and suicide. Programs to reduce the incidence of alcoholism show an encouraging reduction in the number of alcohol-related American Indian deaths.

Elizabeth Marie McGhee Nelson, Ph.D.

See Also
Accidents; Addiction; African American health; Alcoholism; Asian American health; Cancer; Cirrhosis; Diabetes mellitus; Ear infections and disorders; Gallbladder cancer; Heart disease; Hepatitis; Liver; Liver disorders; Men's health; Obesity; Smoking; Sudden infant death syndrome (SIDS); Suicide; Syphilis; Tobacco; Tuberculosis; Women's health.

Further Information
Castor, Mei L., et al. "A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties." American Journal of Public Health 96, no. 8 (August, 2006): 1478-1484. This article examines the health status of American Indian populations living in urban areas through an analysis of U.S. census and vital statistics data.

Denny, Clark H., et al. "Disparities in Chronic Disease Risk Factors and Health Status Between American Indian/Alaska Native and White Elders: Finding from a Telephone Survey, 2001 and 2002." American Journal of Public Health 95, no. 5 (May, 2005): 825-827. Compares American Indians and Caucasians for prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status.

Grossman, David C., et al. "Disparities in Infant Health Among American Indians and Alaska Natives in U.S. Metropolitan Areas." Pediatrics 109, no. 4 (April, 2002): 627-633. Addresses the health status of American Indian children.

Joe, Jennie R. "Out of Harmony: Health Problems and Young Native American Men." Journal of American College Health 49 (March, 2001): 237-242. This article emphasizes the major health problems in American Indian men.

MedlinePlus. Native-American Health. Provides online health information on American Indian health issues.

Rhodes, Everett R., ed. American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore: Johns Hopkins University Press, 2000. From a native perspective, this book looks at American Indian health taking into account history and politics. It includes a review of the most important diseases emphasizing cultural and medical perspectives.

Trafzer, Clifford E., and D. Weiner, eds. Medicine Ways: Disease, Health, and Survival Among Native Americans. Walnut Creek, Calif.: AltaMira Press, 2001. From the perspective of American Indians, the authors of this collection of essays examine health issues in a historical and socioeconomic context.

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