COVID-19 Incidence and Mortality Among American Indian/Alaska Native and White Persons — Montana, March 13–November 30, 2020
Laura Williamson, Todd S. Harwell, T Koch, Stacey Anderson, Magdalena Kendall Scott, James S. Murphy, Greg S. Holzman, Helen F Tesfai
Abstract
Geographic differences in infectious disease mortality rates have been observed among American Indian or Alaska Native (AI/AN) persons in the United States (1), and aggregate analyses of data from selected U.S. states indicate that COVID-19 incidence and mortality are higher among AI/AN persons than they are among White persons (2,3). State-level data could be used to identify disparities and guide local efforts to reduce COVID-19-associated incidence and mortality; however, such data are limited. Reports of laboratory-confirmed COVID-19 cases and COVID-19-associated deaths reported to the Montana Department of Public Health and Human Services (MDPHHS) were analyzed to describe COVID-19 incidence, mortality, and case-fatality rates among AI/AN persons compared with those among White persons. During March-November 2020 in Montana, the estimated cumulative COVID-19 incidence among AI/AN persons (9,064 cases per 100,000) was 2.2 times that among White persons (4,033 cases per 100,000).* During the same period, the cumulative COVID-19 mortality rate among AI/AN persons (267 deaths per 100,000) was 3.8 times that among White persons (71 deaths per 100,000). The AI/AN COVID-19 case-fatality rate (29.4 deaths per 1,000 COVID-19 cases) was 1.7 times the rate in White persons (17.0 deaths per 1,000). State-level surveillance findings can help in developing state and tribal COVID-19 vaccine allocation strategies and assist in local implementation of culturally appropriate public health measures that might help reduce COVID-19 incidence and mortality in AI/AN communities. Reports of COVID-19 cases and COVID-19-associated deaths were analyzed to assess the number, percentage, and crude rates of COVID-19 cases and deaths occurring among AI/AN persons and White persons in Montana during March 13-November 30, 2020. Case data were derived from the Montana Infectious Disease Information System. Montana residents who met the definition of a confirmed case (i.e., having received a positive test result for SARS-CoV-2, the virus that causes COVID-19, from a respiratory specimen, using a molecular amplification test and reported to MDPHHS) were * Race data were missing for 13,913 of 63,339 (22%) patients, and ethnicity data were missing for 23,435 of 63,339 (37%) patients. Race and ethnicity data were complete for all deaths. Cumulative incidences by race were considered estimates because of the large proportion of missing race/ethnicity data.