Inclusion matters: Describing CF health inequities in American Indian/Alaska Native individuals in Oklahoma

American Indian and Alaskan Native (AI/AN) communities face significant disparities in respiratory health, including cystic fibrosis (CF). The objectives of the current study were to describe the demographic makeup of the AI/AN CF population in Oklahoma and compare their health status to that of their non-Hispanic White peers.

This retrospective study analyzed 2023 CF Foundation Patient Registry data from AI/AN and non-Hispanic White individuals seen at Oklahoma CF centers. Individuals were identified as AI/AN regardless of multiracial identity. Participants were grouped by race/ethnicity and age. Chi-square, Fisher's exact, Welch's t-test, and Mann-Whitney U tests were conducted with a significance threshold of p < .05.

The study sample was composed of 299 individuals including 169 children and 130 adults. Twenty-eight percent of children and 16.9% of adults were AI/AN. AI/AN children demonstrated higher all-cause hospitalization/home IV rates (31.3% vs. 13.2%, p = .006) and hospitalizations/home IV use due to pulmonary exacerbations (22.9% vs. 6.6%, p = .002). Additionally, a greater percentage of AI/AN children were observed to have a positive culture finding for 'other bacterial and fungi' compared to their non-Hispanic White peers. Higher rates of comorbid conditions including CF-related diabetes were reported in AI/AN children. Hospitalization/home IV rates did not differ in adults. Among adults, AI/AN individuals had higher rates of osteopenia, osteoporosis, and asthma, and lower rates of anxiety and depression compared to their peers. A greater percentage of AI/AN received Medicaid and lived in non-metro areas compared to their peers.

Disparate outcomes in hospitalization/home IV rates for AI/AN children support the need for further CF health equity work. Continued research using inclusive methodological practices is needed to better understand outcomes in other AI/AN populations.