UC San Diego

Cardiovascular disease (CVD) is the leading cause of death among American Indian/Alaska Native (AIAN) adults. Obesity, and other CVD risk factors such as smoking, diabetes, and hypertension, are more prevalent in many AIAN populations compared to the overall US. Osteoarthritis (OA) prevalence may be elevated as obesity is a risk factor for OA, and arthritis is present in half of adults with diabetes or hypertension. The purpose of this dissertation was to examine age and gender-specific obesity prevalence in Southern California AIAN children and adults and assess the age and gender-specific association of obesity and smoking with diabetes and hypertension and the association of these risk factors with OA in adults. Visit data from 10,000+ AIAN children and adults attending a Southern California AIAN health clinic system during 2002-2006 were used. More than one-third of AIAN children aged 6-17 years were obese with more obesity in boys than girls. In adults, obesity (54%), smoking (17%), diabetes (15%), and hypertension (34%) were very prevalent. For women, increasing obesity was associated with diabetes but for men only morbid obesity was associated with diabetes. Smoking was associated with diabetes for some age groups. Increasing overweight/obesity and smoking were associated with hypertension among men and women aged 18-65 years. Age-adjusted OA prevalence was higher in women (16.5%) than men (11.5%), and prevalence increased with age. Extreme levels of obesity were associated with higher OA prevalence in some age groups. Hypertension was strongly associated with increased OA and current smoking tended to be associated with increased OA. Diabetes was associated with more OA for women aged 35-54 years. Southern California AIAN had higher obesity, diabetes, and hypertension prevalence than the general Southern California population, and higher obesity prevalence compared to other AIAN communities. In contrast, OA prevalence may be less than overall US prevalence, with no reliable comparisons to other AIAN communities available. AIAN communities are understudied and their diversity makes it difficult to generalize health information from one location or tribe to another. Comprehensive research and interventions tailored to cultural customs and the health problems most prevalent in each tribal community are needed.