Exploring the Historical Context of American Indian/Alaska Native Intensive Care Inequities: A Narrative Review

Area of Science:

• Pediatric Intensive Care
• Health Equity
• Social Determinants of Health

Background:

• American Indian/Alaska Native (AI/AN) populations experience unique health inequities.
• Social drivers including settler colonialism, historical trauma, and systemic racism disproportionately affect AI/AN health.
• These factors contribute to disparities in pediatric intensive care.

Purpose of the Study:

• To provide historical context for AI/AN pediatric intensive care.
• To identify and suggest mitigation strategies for social drivers impacting AI/AN children in intensive care.
• To highlight understudied inequities in AI/AN pediatric intensive care.

Main Methods:

• A narrative review of recent literature was conducted.
• Pertinent studies on AI/AN pediatric intensive care outcomes were identified and summarized.
• Focus on identifying social drivers and their impact on care.

Main Results:

• AI/AN children experience disproportionate admission rates for injuries and infectious diseases.
• Higher mortality rates are observed in AI/AN children due to injuries and post-cardiac surgery.
• Unique social drivers significantly contribute to these health inequities.

Conclusions:

• Understudied inequities in AI/AN pediatric intensive care require dedicated evaluation.
• Institutions and providers must offer culturally competent care.
• Achieving workforce equity is essential to improve outcomes for AI/AN children in intensive care.