Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, MO 65212, USA.
Institute for Data Science and Informatics, University of Missouri, Columbia, MO 65212, USA.
Int J Environ Res Public Health. 2024 Aug 15;21(8):1070. doi: 10.3390/ijerph21081070.
American Indian/Alaska Native (AI/AN) persons in the US experience a disparity in chronic respiratory diseases compared to white persons. Using Behavioral Risk Factor Surveillance System (BRFSS) data, we previously showed that the AI/AN race/ethnicity variable was not associated with asthma and/or chronic obstructive pulmonary disease (COPD) in a BRFSS-defined subset of 11 states historically recognized as having a relatively high proportion of AI/AN residents. Here, we investigate the contributions of the AI/AN variable and other sociodemographic determinants to disease disparity in the remaining 39 US states and territories. Using BRFSS surveys from 2011 to 2019, we demonstrate that irrespective of race, the yearly adjusted prevalence for asthma and/or COPD was higher in the 39-state region than in the 11-state region. Logistic regression analysis revealed that the AI/AN race/ethnicity variable was positively associated with disease in the 39-state region after adjusting for sociodemographic covariates, unlike in the 11-state region. This shows that the distribution of disease prevalence and disparity for asthma and/or COPD is non-uniform in the US. Although AI/AN populations experience this disease disparity throughout the US, the AI/AN variable was only observed to contribute to this disparity in the 39-state region. It may be important to consider the geographical distribution of respiratory health determinants and factors uniquely impactful for AI/AN disease disparity when formulating disparity elimination policies.
美国的美洲印第安人/阿拉斯加原住民(AI/AN)在慢性呼吸道疾病方面与白人存在差异。我们之前使用行为风险因素监测系统(BRFSS)的数据表明,在 BRFSS 定义的 11 个州中,AI/AN 种族/民族变量与哮喘和/或慢性阻塞性肺疾病(COPD)无关,这些州历史上被认为有相对较高比例的 AI/AN 居民。在这里,我们研究了 AI/AN 变量和其他社会人口决定因素对其余 39 个美国州和领土疾病差异的贡献。使用 2011 年至 2019 年的 BRFSS 调查,我们表明,无论种族如何,39 个州的哮喘和/或 COPD 的年调整患病率均高于 11 个州。逻辑回归分析表明,在调整了社会人口学协变量后,AI/AN 种族/民族变量与 39 个州的疾病呈正相关,而与 11 个州的情况相反。这表明美国的哮喘和/或 COPD 疾病流行率和差异分布不均匀。尽管 AI/AN 人群在美国各地都经历着这种疾病差异,但只有在 39 个州的地区才观察到 AI/AN 变量对这种差异的贡献。在制定消除差异政策时,考虑呼吸健康决定因素的地理分布以及对 AI/AN 疾病差异有独特影响的因素可能很重要。