National health surveillance instruments are intended to monitor important health issues and health status of all populations in the United States. Several population subgroups present with disparities in health conditions and health care. To effectively create programs and policies to address these issues requires accurate identification of key population subgroups. Among the subgroups with the highest rates of poor health outcomes is the American Indian/Alaska Native (AIAN) population, which is also at significant risk of misidentification in national surveillance instruments.
Selection of data sets for study inclusion was based on significant use of data sets in the literature, collection of AIAN designation, and availability of key health indicators. Thus, the Behavior Risk Factor Surveillance System (BRFSS), the National Health Interview Survey (NHIS), the National Survey of Children’s Health (NSCH), the National Health and Nutrition Examination Survey (NHANES), the National Survey of Drug Use and Health (NSDUH), Population Assessment of Tobacco and Health (PATH), and the Medicare Current Beneficiary Survey (MCBS) were selected. Additionally, the research team reviewed the California Health Interview Survey (CHIS), due to its inclusion of a large AIAN population.
This report shares methodological challenges in identifying and quantifying health and social determinants of health of the diverse populations of AIAN across the US. There is variation in classification, coding, tabulation, and reporting practices among national surveys. We provide an assessment of how methodological decisions about racial classification and, in select data sets, how weighting affect population estimates of leading health indicators among AIANs, including specific examples of prevalence estimates using existing and revised weights.