Lutz Chelsea S, Sutcliffe Catherine G, Keck James W, Hartman Rachel M, Desnoyers Christine, Swango-Wilson Amy, Burrage Amanda B, Campbell Angela P, Christensen Loretta, Close Ryan M, Damon Shawnell, Dobson Jennifer, Garcia Starla, Halasa Natasha, Honie Elvira, Little Verlena, McMorrow Meredith L, Parker Dennie, Prill Mila M, Richards Jennifer, Va Puthiery, Veazie Mark, VanDeRiet Dan, Yazzie Del, Singleton Rosalyn J, Hammitt Laura L
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Racial Ethn Health Disparities. 2025 Jul 21. doi: 10.1007/s40615-025-02492-9.
COVID-19 causes significant morbidity in the USA, particularly among American Indian/Alaska Native (AI/AN) persons. Estimates of COVID-19 burden among AI/AN communities are needed to identify health outcome disparities and inform prevention strategies, but under-ascertainment of AI/AN status in national data may result in underestimation of COVID-19 disease burden.
Surveillance for acute respiratory illness was conducted among AI/AN persons at eight healthcare facilities in Arizona and Alaska to identify COVID-19-associated hospitalizations and outpatient visits. Weekly and annual incidence rates of COVID-19-associated hospitalizations per 100,000 persons were calculated overall and by site and age. Risk factors for COVID-19-associated hospitalizations (versus outpatient visits) were assessed.
From January 2021 to December 2022, 1159 COVID-19-associated hospitalizations were identified. Incidence rates were 439.8 per 100,000 in 2021 and 332.6 per 100,000 in 2022 and highest among adults ≥ 65 years at all sites. Compared to national estimates from 2021 to 2022, incidence rates by time and age were similar among older adults, whereas incidence rates among AI/AN children were over twice as high. Among adults, older age, chronic lung disease, chronic kidney disease, and diabetes increased the risk of hospitalization; frequent mask use outside the home and COVID-19 vaccination were protective, particularly if vaccinated within the past year. Among children, younger age and heart conditions increased the risk of hospitalization.
The findings demonstrate a substantial burden of COVID-19 in AI/AN persons and provide critically needed data regarding the risks for severe outcomes. AI/AN children experience a disproportionate burden of COVID-19 disease.
新冠病毒病（COVID-19）在美国造成了严重的发病情况，尤其是在美洲印第安人/阿拉斯加原住民（AI/AN）人群中。需要对AI/AN社区的COVID-19负担进行评估，以确定健康结果差异并为预防策略提供依据，但国家数据中AI/AN身份的报告不足可能导致对COVID-19疾病负担的低估。
在亚利桑那州和阿拉斯加的八家医疗机构对AI/AN人群进行急性呼吸道疾病监测，以确定与COVID-19相关的住院和门诊就诊情况。计算了每10万人中与COVID-19相关的住院的每周和年度发病率，并按地点和年龄进行了计算。评估了与COVID-19相关住院（与门诊就诊相比）的危险因素。
2021年1月至2022年12月，共确定了1159例与COVID-19相关的住院病例。2021年的发病率为每10万人439.8例，2022年为每10万人332.6例，在所有地点的65岁及以上成年人中发病率最高。与2021年至2022年的全国估计数相比，老年人按时间和年龄划分的发病率相似，而AI/AN儿童的发病率则高出两倍多。在成年人中，年龄较大、患有慢性肺病、慢性肾病和糖尿病会增加住院风险；经常在家外佩戴口罩和接种COVID-19疫苗具有保护作用，特别是在过去一年内接种疫苗的情况下。在儿童中，年龄较小和患有心脏病会增加住院风险。
研究结果表明AI/AN人群中COVID-19负担沉重，并提供了关于严重后果风险的急需数据。AI/AN儿童承受着不成比例的COVID-19疾病负担。
