The Disproportionate Burden: Health and Economic Outcomes of COVID-19 for Native American Communities.

Background: American Indian and Alaska Native (AIAN) populations experienced disproportionate health and economic impacts during the COVID-19 pandemic. While prior research has documented elevated infection and mortality rates among Indigenous communities, less is known about the persistence of COVID-19 symptoms and their potential economic consequences. This study examines differences in COVID-19 infection, long-COVID symptoms, and pandemic-related economic hardship among AIAN populations in California. Methods: We analyzed adult responses from the California Health Interview Survey (CHIS) from 2021-2023, including the public-use files and a restricted oversample of AIAN communities. Multivariate generalized linear models were used to estimate associations between demographic, socioeconomic, and health characteristics and seven COVID-19 related outcomes, including infection, long-COVID symptoms, vaccination status, testing behavior, food insecurity, job loss, and reductions in work hours to produce survey weighted population-representative estimates. Results: AIAN respondents reported higher rates of COVID-19 infection and long-COVID symptoms than non-AIAN respondents. Estimates indicate 47% of AIAN respondents reported testing positive for COVID-19 and 40% reported long-COVID symptoms, compared with 30% among non-AIAN respondents. Obesity and poverty were positively associated with infection and long-COVID symptoms. Long-COVID symptoms were positively associated with food insecurity and job loss, while vaccination was associated with lower probabilities of job loss and reductions in hours or income. Conclusions: Persistent COVID-19 symptoms may contribute to ongoing economic vulnerability in AIAN communities. Structural factors including poverty, chronic health conditions, and limited access to healthcare amplify the long-term health and economic consequences of the pandemic.