Health and Health-Influencing Behaviors of Urban American Indians and Alaska Natives: Findings from the Behavioral Risk Factor Surveillance System

Background: More than half of American Indians and Alaska Natives (AIAN) live in urban areas, however most current surveillance activities do not include urban AIAN as a separate population, leading to a scarcity of information about their health and factors that influence health. The Behavioral Risk Factor Surveillance System (BRFSS) was analyzed to learn more about AIAN living in selected urban areas.

Methods: BRFSS results from 34 areas served by the network of urban Indian health organizations affiliated with the Indian Health Service were analyzed using aggregated data from 2001 through 2005. Responses from AIAN were compared to non-AIAN. Additional analyses stratified respondents into those reporting incomes above and below 200% of the federal poverty level (FPL).

Results: Differences existed between urban AIAN and non-AIAN in terms of access to healthcare, risk behaviors, and certain health outcomes. Income played a role in explaining some disparities, but major differences still existed between AIAN and non-AIAN in similar income groups. Among urban AIAN, prevalence of reported diabetes (9.5% among those >200% FPL vs. 9.6% among those <200% FPL), hypertension (18.3% vs. 18.6%), obesity (30.6% vs. 30.9%), and smoking (24.8% vs. 26.0%) were not associated with income. This was not the case among non-AIAN, where those with lower incomes had higher rates of these health problems.

Conclusion: The relationship between income and certain health indicators appeared to be different among urban AIAN compared with non-AIAN. Factors in addition to income differences must exist to explain the significant health disparities faced by this population.