University of Arizona School of Sociology, Tucson, Arizona (Dr Rodriguez-Lonebear); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Semel Institute, Los Angeles, California (Dr Barceló); Public Policy and American Indian Studies Departments, Luskin School of Public Affairs, UCLA, Los Angeles, California (Dr Akee); Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health and Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona (Dr Carroll).
J Public Health Manag Pract. 2020 Jul/Aug;26(4):371-377. doi: 10.1097/PHH.0000000000001206.
To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states.
Multivariate analysis with population weights.
Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands.
The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records.
By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (-2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (-6.40, P = .326).
Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.
确定与美国本土 48 个州内印第安人保留地 COVID-19 发病率变化最密切相关的家庭和社区特征。
具有人口权重的多变量分析。
287 个印第安人保留地和部落家园（在俄克拉荷马州），以及截至 2020 年 4 月 10 日，这些保留地土地上的 861 例 COVID-19 病例。
部落保留地和/或社区一级每 1000 人报告的 COVID-19 病例率与 2018 年 5 年美国社区调查记录中平均家庭特征之间的关系。
截至 2020 年 4 月 10 日，在回归分析中，缺乏室内管道的家庭比例更高（10.83，P=.001），而仅讲英语的家庭比例更低（-2.43，P=.03），COVID-19 病例更有可能发生。在这项分析中，家庭拥挤程度指标没有统计学意义（-6.40，P=.326）。
在大流行期间，不考虑缺乏完整的室内管道和饮用水的供应可能是 COVID-19 病例发病率增加的一个重要决定因素。获得许多保留区居民所说的语言传达的相关信息可能在某些部落社区 COVID-19 的传播中发挥关键作用。在目前的情况下，家庭拥挤似乎与 COVID-19 感染无关。先前的研究已经确定了家庭管道和拥挤，以及语言是潜在的大流行和疾病感染风险因素。这些风险因素仍然存在。为了保护印第安人社区，有必要在部落公共卫生和家庭基础设施方面进行投资，这是条约和其他协议中规定的。
