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Racial and Ethnic Health Disparities"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009\u2265\u200965 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40615-025-02492-9","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T23:08:22Z","timestamp":1753139302000},"page":"3205-3219","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence Rates of COVID-19-Associated Hospitalization and Risk Factors for Severe Disease Among American Indian and Alaska Native Persons in the Southwest USA and Alaska"],"prefix":"10.1007","volume":"13","author":[{"given":"Chelsea S.","family":"Lutz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine G.","family":"Sutcliffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Keck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel M.","family":"Hartman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Desnoyers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Swango-Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda B.","family":"Burrage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela P.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loretta","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Close","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawnell","family":"Damon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Dobson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Starla","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Halasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Honie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verlena","family":"Little","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith L.","family":"McMorrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dennie","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mila M.","family":"Prill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Richards","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puthiery","family":"Va","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Veazie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"VanDeRiet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Del","family":"Yazzie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalyn J.","family":"Singleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura L.","family":"Hammitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"2492_CR1","unstructured":"World Health Organization. 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This study was reviewed by the Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy [\n                      \n                      ]. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines [\n                      \n                      ].","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Informed consent was obtained from all adult participants included in the study. Informed consent was obtained from the legal guardians of child participants included in the study, and assent was also obtained for child participants 7\u201317 years of age included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"CSL \u2014 none.\u00a0CGS \u2014 research grants to her institution from Merck and Pfizer.\u00a0JWK \u2014 none.\u00a0RMH \u2014 none.\u00a0CD \u2014 none.\u00a0ASW \u2014 none.\u00a0ABB \u2014 none.\u00a0APC \u2014 none.\u00a0LC \u2014 none.\u00a0LC \u2014 none.\u00a0SD \u2014 none.\u00a0JD \u2014 none.\u00a0SG \u2014 none.\u00a0NH \u2014 none.\u00a0EH \u2014 none.\u00a0VL \u2014 none.\u00a0MLM \u2014 none.\u00a0DP \u2014 none.\u00a0MMP \u2014 none.\u00a0JR \u2014 none.\u00a0PV \u2014 none.\u00a0MV \u2014 none.\u00a0DV \u2014 none.\u00a0DY \u2014 none.\u00a0RJS \u2014 none.\u00a0LLH \u2014 research grants to her institution from AstraZeneca, Merck and Pfizer.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the Indian Health Service.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}