Research ReportsA Forgotten Danger: Burden of Influenza Mortality Among American Indians and Alaska Natives, 1999-2016Doxey, Matthew MPH; Chrzaszcz, Lyle MPH; Dominguez, Adrian MS; James, Rosalina D. PhD Author Information Urban Indian Health Institute, Seattle, Washington. Correspondence: Matthew Doxey, MPH, Urban Indian Health Institute, 611 12th Ave South, Seattle, WA 98144 ([email protected]). The authors declare that they have no conflicts of interest. Journal of Public Health Management and Practice: September/October 2019 - Volume 25 - Issue - p S7-S10 doi: 10.1097/PHH.0000000000001062 Buy Metrics Abstract American Indians and Alaska Natives (AI/ANs) are the only racial group in the United States that is identified as having a higher risk for developing influenza-related complications. As such, influenza-related mortality has consistently been one of the leading causes of death among AI/ANs. In addition, estimating influenza-related mortality is hampered by significant degrees of racial misclassification and underreporting of both morbidity and mortality data in the AI/AN population. Using data available from the Centers for Disease Control and Prevention, we analyzed influenza mortality by geography, race, gender, and age group to improve our understanding of the influenza burden on AI/AN communities. We found that while mortality rates generally declined across the AI/AN population, significant disparities exist between AI/ANs and non-Hispanic whites (NHWs). The greatest disparities occurred at the earliest stages of life, with mortality rates for AI/AN children younger than 5 years being more than 2 times higher than for NHW children. Similarly, the burden of influenza-related mortality among AI/AN adults emerged much earlier in life compared with NHWs. Perhaps most important, though, we found significant disparities in the geographic distribution of influenza-related mortality among AI/ANs. Because these are largely vaccine-preventable deaths, these results identify an area for targeted intervention to reduce the overall deaths attributable to influenza. © 2019 Wolters Kluwer Health, Inc. All rights reserved.