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Health disparities among indigenous populations in Latin America: a scoping review

International Journal for Equity in Health volume 24, Article number: 119 (2025) Cite this article

Abstract

Background

Health disparities persist among Indigenous populations in Latin America, reflecting systemic inequities and historical marginalization. These disparities span infectious diseases, malnutrition, and chronic conditions, necessitating a comprehensive understanding to inform equitable public health strategies. This scoping review aims to map health disparities affecting Indigenous populations in Latin America, identify research gaps, and inform policy recommendations.

Methods

Following PRISMA-ScR guidelines, we systematically searched PubMed, Embase, and Scielo for studies with data collected between May 2014 and May 2024. Studies were included if they examined health disparities among Indigenous populations in Latin America, contained a comparator related to disparities, and presented quantitative data. We excluded studies on oral health, risk factors, genetic disparities, health system access, and ecological studies, as well as non-research articles such as commentaries and letters to the editor. Data were synthesized narratively, summarizing key themes.

Results

Of 1,116 identified articles, 35 met inclusion criteria, spanning nine Latin American countries. Most studies were cross-sectional (n = 18) or cohort-based (n = 16). Infectious diseases and malnutrition were the most studied topics, consistently showing higher incidence and mortality rates among Indigenous populations. Many papers highlighted COVID-19 disparities, with Indigenous groups experiencing higher incidence and mortality. Malnutrition, particularly stunting and anemia, was significantly more prevalent among Indigenous children and women. Studies on overweight and obesity showed mixed results. Chronic diseases, including chronic kidney disease and cardiovascular issues, showed notable disparities, while mental health and cancer were underrepresented.

Conclusion

Indigenous populations in Latin America face a dual burden of infectious and chronic diseases, compounded by structural barriers such as poverty, geographic isolation, and systemic discrimination. Addressing these disparities requires culturally tailored interventions, structural reforms, and policy prioritization. This scoping review is limited by database restrictions, search term variability, language and time frame constraints, the absence of a methodological quality assessment, inconsistencies in defining Indigenous status, exclusion of grey literature, and a focus on disease prevalence rather than disparities in risk factors, diagnosis, and treatment, which may result in an incomplete representation of Indigenous health disparities in Latin America. Future research should incorporate mental health outcomes to provide a more comprehensive understanding of Indigenous health disparities.

Introduction

Health disparities, or inequities, are preventable differences in health outcomes that disproportionately affect disadvantaged populations compared with a reference group or population. These disparities impose substantial social and economic costs on individuals and society as a whole [1, 2]. They are shaped by various social and structural factors, including education, employment, geographic context, income level, gender, race, ethnicity, and poverty [1, 8]. Additionally, experiences of racism and discrimination contribute to inequities in healthcare access and quality, further undermining the well-being of affected individuals [1].

Latin America is one of the most diverse regions in the world, both ethnically and socioeconomically [3]. The region is characterized by substantial socioeconomic inequalities between and within countries, affecting healthcare delivery, access to health services, and population health outcomes [3, 4]. The region is also home to a significant portion of the world’s Indigenous population, with an estimated 33–40 million Indigenous people residing in Latin America and the Caribbean [5,6,7].

Indigenous groups in the region are incredibly diverse and are characterized by their cultures, languages, traditions, identities, and beliefs. Despite their historical importance, they have long been excluded, facing systemic discrimination that further exacerbates the social, economic, and health inequalities they face [5, 8]. Indigenous people constitute 40% of the rural population in Central and South America [9]. These populations represent some of the most disadvantaged groups in the region; approximately 43% of the Indigenous population in Latin America lives in poverty, more than twice the population of non-Indigenous backgrounds, and 25% live in extreme poverty [8]. In addition, Indigenous populations face significant healthcare inequities, including barriers to access and systemic obstacles within the healthcare system. These disparities are often exacerbated by geographical isolation, language barriers that hinder effective communication with healthcare professionals, and concerns about discrimination and prejudice. This marginalization has resulted in Indigenous populations falling behind their non-Indigenous counterparts across nearly all social determinants of health [8, 10,11,12,13].

Indigenous health disparities are a pressing public health issue that requires immediate attention due to the underrepresented state in which they remain, considering that their health remains at the greatest risk. Given the profound impact of inequitable social systems on Indigenous populations in Latin America, understanding what types of health disparities and conditions they cause on Indigenous populations is critical to developing systems where universal health coverage is achieved [11]. This scoping review aims to comprehensively map existing health disparities affecting Indigenous populations in Latin America, identify the areas of research that have been covered, and highlight gaps in the current literature.

Methods.

Data sources and searches

The primary research question of this scoping review was ‘What are the health disparities experienced by Indigenous populations in Latin America?’ This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, which provide a widely accepted methodological framework to enhance the transparency, reproducibility, and rigor of scoping reviews [14].

A comprehensive literature search was conducted in PubMed, Embase, and Scielo between June and July 2024. Specific search strategies were tailored for each database, including all of Latin America’s countries, “health disparities” or “inequities,” and other analogous terms. To search for Indigenous populations, our search strategy included the following terms: “Indigenous populations,” “Native population,” “aboriginal population,” “tribal population,” “pueblos originarios,” “Amerindian,” or “Ethnic group” and their Spanish equivalents (see search strategies in the supplemental material). The search was restricted by date, and the search strategies were conducted in Spanish and English. During this initial search, studies were not filtered by language or study type.

Data Availability

The articles and documents supporting the conclusions of this review are available in the reference list of this article.

Inclusion and exclusion criteria

We used the screening platform Covidence to manage citations and apply our eligibility criteria. For inclusion, we considered studies published between May 2014 and May 2024 in English, Spanish, or Portuguese that examined health disparities among Indigenous populations in any Latin American country. Studies needed to include a comparator related to health disparities and present quantitative data. For exclusion, we did not include studies on oral health, risk factors, genetic disparities, or health system access, as these were beyond the scope of our review, which focused on broader population-level health disparities. Additionally, we excluded ecological studies, as they did not allow for direct individual-level comparisons, and non-research articles, such as commentaries, correspondences, and letters to the editor, as they did not contain original data.

Study selection

After the eligibility criteria were developed, we began the selection process. Covidence was then removed from any duplicate articles, and we completed level one screening, which included screening titles and abstracts on the basis of the inclusion criteria stated above. The screenings completed for this scoping review were performed in a masked, duplicate manner, in which reviewers resolved discrepancies through conflict resolution. When screening for titles and abstracts, we could vote on three options: to include, not include, or potentially include each study.

Once level one screening and conflict resolution were completed, we independently completed full-text reviews of the included abstracts. The characteristics of these studies were in accordance with the eligibility criteria. Nevertheless, we refined it so that ecological studies, geospatial studies, and genetic studies were excluded when performing the full-text reviews. Full-text reviews were successful by individually excluding studies based on an automated checklist provided by Covidence, which provides the following exclusion criteria: paper not available, wrong study design, wrong setting, wrong route of administration, wrong patient population, wrong outcomes, wrong intervention, wrong indication, wrong dose, wrong comparator, pediatric population, and adult population. After examining each article following this checklist, we identified any discrepancies in our choices for inclusion or exclusion decisions and for the specific exclusion criteria we selected.

Data extraction

After the final round of full-text screening, we created a data extraction template for Covidence to capture critical information from the selected studies. The template included 12 study characteristics. These included study information, study design, country, setting, number of subjects, health outcomes, population, definition of ethnic identification, comparator, main findings, direction of inequity, and effect measures. We categorized ethnic identification as “not specified” for studies that did not define Indigenous status. Data extraction was performed in Covidence and then exported to an Excel site; data extraction was deemed complete once each reviewer reviewed the other extraction template.

Findings

Our literature search identified a total of 1,116 studies from databases and registers, with the majority from Embase (n = 551) and PubMed (n = 520). After 70 duplicates were removed, we screened 1,046 studies by title and abstract and excluded 926 studies on the basis of predetermined criteria. This left 120 studies for full-text screening, 85 of which were further excluded for reasons such as wrong setting, outcomes, or population, among others. Ultimately, 35 studies were included in our data extraction and analysis review. The complete study selection process is illustrated in the PRISMA flow diagram (Table 1, 2).

Table 1 Search process showcased in a PRISMA flowchart for the scoping review
Full size table
Table 2 Summary of included articles
Full size table

Included studies

The included studies spanned various countries across Latin America, with research conducted in Ecuador [5], Brazil [10], Mexico [8], Chile [6], Peru [2], Suriname [1], Bolivia [1], Guatemala [1], and a multicounty study involving several Latin American nations. Table 1 summarizes characteristics for included studies.

Study designs varied, with the majority utilizing cross-sectional (n = 18), cohort (n = 16), and case‒control (n = 1) studies. Most studies (57%) have used national datasets, whereas others have relied on regional or local data sources. The highest concentration of research was between 2019 and 2021, with five studies published in 2019, 8 studies in 2020, and 6 in 2021.

The studies included a wide range of health areas, with infectious diseases and malnutrition being the most studied topics. In the case of infectious diseases, COVID-19 was the most common focus. All the included studies revealed that Indigenous populations consistently had higher COVID-19 mortality rates and prevalence rates than non-Indigenous populations did. In Brazil, Indigenous individuals had a prevalence ratio (PR) of 4.71 (95% CI: 3.65–6.08) for COVID-19 infection, with higher odds and risk of COVID-19 mortality reported in five studies: OR 1.87 (95% CI: 1.18–2.96), OR 1.42 (95% CI: 1.31–1.54), OR 1.99 (95% CI: 1.59–2.48), and HR of 3.36 (95% CI: 2.15–5.24) [15,16,17,18,19]. A study performed in Ecuador reported that Indigenous populations had an excess death factor of 2.2, compared with 1.36 for the predominant ethnic group [20]. Five studies in Mexico reported adverse outcomes for Indigenous individuals, including a 5% higher fatality rate, a higher death rate (87.1 per 100,000 vs. 13.9 per 100,000 for non-Indigenous individuals), higher odds of dying from COVID-19 (OR 1.92 [95% CI: 1.86–1.99] and OR 1.13 [95% CI: 1.03–1.24]) and a higher risk for COVID-19 fatality (HR 1.63 [95% CI: 1.34–1.98]) [21,22,23].

The incidence of tuberculosis was higher among Indigenous groups in Suriname, with an incidence rate of 280 per 100,000 people (95% CI: 187–374) [24]. In Chile, Indigenous people living with HIV had lower white cell counts at diagnosis than non-Indigenous individuals did (Mapuche: 226 cells/mm³ [95% CI: 147.1–281.6] vs. Non-Mapuche: 233 cells/mm³ [95% CI: 203–274.8]) [25]. Indigenous children in Brazil were found to have higher mortality rates from diarrhea and pneumonia than White children did, with HRs of 14.28 (95% CI: 12.25–16.65) and 6.49 (95% CI: 5.78–7.27), respectively [26]. One study from Ecuador reported that Indigenous people had lower odds of complicated dengue hospitalization than did Mestizo individuals did (OR 0.44 [95% CI: 0.34–0.55]) [27].

Thirteen studies included malnutrition, with most finding consistently higher rates of various undernutrition outcomes in Indigenous groups than in non-Indigenous groups and mixed findings for overnutrition. Many of the studies included more than one outcome. Indigenous children across multiple countries had a significantly higher prevalence of stunting and anemia. A multicountry study revealed that, on average, Indigenous populations had a 6–7% point higher incidence of anemia [28]. In Peru, anemia incidence was reported to be significantly greater among Quechua children (PR 1.11, 95% CI: 1.07–1.15), Aymara children (PR 1.35, 95% CI: 1.27–1.44), Amazonian native children (PR 1.20, 95% CI: 1.12–1.28), and other Indigenous children (PR = 1.29, 95% [CI: 1.05–1.57]) than among non-Indigenous children [29]. A study in Peru revealed that Indigenous children under 5 years of age, adolescent women, and adult women had a greater prevalence of anemia than their non-Indigenous counterparts did (PR = 1.19 [95% CI: 1.1–1.3]; PR 1.57 [95% CI: 1.1–2.2], and PR 1.28 [95% CI: 1.1–1.5], respectively) [30]. Indigenous adolescents in Brazil had a greater prevalence of underweight (3.0%, OR 1.00, 95% CI: 0.98–1.02), and in Ecuador, a study revealed that Indigenous populations had a negative coefficient for nutritional status (-0.79, 95% CI: -1.02, -0.56) [31, 32]. Indigenous children in Brazil had a significantly greater risk of mortality from malnutrition (HR 16.39, [95% CI: 12.88–20.85]) [26].

In terms of overweight and obesity, the results were mixed. For example, Indigenous children and adolescents in Brazil and Chile had higher rates of overweight/obesity (OR 1.02 [95% CI: 1.01–1.03] and RRR 1.17 [95% CI: 1.15–1.19], respectively) [31, 33]. However, in Guatemala, non-Indigenous children had a 1.3-fold greater prevalence of overweight/obesity than Indigenous children did (p < 0.05) [34].

Cardiovascular and chronic diseases were studied in Ecuador and Chile, with heart failure mortality rates being lower among Indigenous populations in Ecuador (β = 0.45, p < 0.01), whereas no difference was detected in stroke incidence in Chile (OR 0.75 [95% CI: 0.35–1.62]) [35, 36]. In Mexico, the prevalence of chronic kidney disease (CKD) was greater in the Wixárika (Huichol) Indigenous group (15%) than in the Mestizo population (4%) (OR = 14.27, p < 0.0001) [37].

Two studies included cancer outcomes. A study in Brazil revealed that compared with Indigenous women, white women had a higher mortality rate for cervical cancer (MRR = 1.80 [95% CI 1.39–2.33]) and a lower mortality rate ratio for breast cancer (MRR = 0.63 [95% CI 0.44–0.91]) [38]. A study in Indigenous groups in Chile revealed that they had a lower incidence of chronic lymphocytic leukemia (CLL) than other racial and ethnic groups did (0.09 per 100,000 person-years vs. 1.17 per 100,000 person-years) [39].

In Brazil, a mental health study revealed that Indigenous populations had a significantly greater prevalence of depressive symptoms than other ethnic groups did. Indigenous participants exhibited the highest proportion of depressive symptoms, with a prevalence of 17.1% [40]. Compared with White participants, Indigenous individuals were approximately 2.5 times more likely to have depression (PR 2.56 [95% CI: 1.24–5.30]) [40]. Maternal health was also explored in Ecuador, where no significant difference in maternal mortality was observed between Indigenous and non-Indigenous populations [41].

Discussion.

This scoping review revealed significant health disparities affecting Indigenous populations across nine countries in Latin America. Infectious diseases, particularly COVID-19 and malnutrition, are the areas of health that have been most studied. Compared with non-Indigenous populations, Indigenous populations consistently presented higher rates of COVID-19 incidence and mortality, with studies in Brazil, Mexico, and Ecuador reporting significantly worse outcomes. Similarly, malnutrition disproportionately affects Indigenous children and women, with higher rates of stunting and anemia observed across multiple studies. Chronic diseases have been less frequently studied, but notable disparities have been identified, including higher prevalence rates of chronic kidney disease and cardiovascular health issues among Indigenous groups. Mixed findings emerged in terms of overnutrition outcomes, with some studies reporting higher rates of overweight and obesity in Indigenous populations than in non-Indigenous populations.

Our findings suggest that health disparities among Indigenous populations in Latin America highlight the dual burdens of infectious and chronic diseases. While infectious diseases remain a leading cause of mortality and morbidity, the emergence of chronic diseases such as obesity and cardiovascular illnesses is becoming increasingly apparent. This double burden poses a significant challenge, as these communities navigate health systems that are ill equipped to address both communicable and noncommunicable diseases simultaneously. The trajectory of obesity, observed in wealthier countries as it transitioned from a disease of affluence to one of poverty, is evident in Indigenous populations of Latin America. In our review, studies in higher-income countries such as Brazil and Chile reported higher rates of obesity among Indigenous groups. In contrast, lower-income countries such as Guatemala presented lower rates of overnutrition but persistently high rates of undernutrition, such as stunting and anemia. Importantly, this pattern may also reflect gaps in research, as the focus has traditionally been on infectious diseases, potentially overlooking the growing impact and disparities of chronic diseases.

Our review also revealed significant disparities in COVID-19 outcomes among Indigenous populations in Latin America, mirroring patterns observed in high-income countries [42,43,44]. These findings emphasize the need to prioritize Indigenous populations in public health emergency planning and interventions. Structural factors such as poverty, geographic isolation, and systemic discrimination place Indigenous populations at increased risk for emerging infectious diseases. However, these vulnerabilities were compounded by systemic failures, as Indigenous groups were often overlooked in the allocation of health resources and interventions. Studies conducted in Mexico and Guatemala highlighted inequities in COVID-19 vaccination access and uptake, with Indigenous populations having lower odds of being vaccinated despite clear early evidence of their elevated risk for severe disease and mortality [45, 46]. These disparities underscore the need for equitable and culturally sensitive health policies to ensure that Indigenous communities are prioritized in public health responses to ongoing and emerging health crises.

Only one study on mental health was included in our review, underscoring a significant gap in research on mental health disparities among Indigenous populations in Latin America. During our screening process, we identified additional papers and reports highlighting the critical need for research in this area. However, these studies were excluded because they either predated our inclusion period or utilized study designs, such as ecological studies, that did not meet our criteria. For example, an ecological study revealed that suicide rates among Indigenous Brazilians in 2020 were more than two and a half times higher than those for the overall Brazilian population (17.57 versus 6.35 suicide deaths per 100,000 inhabitants, respectively) [47]. A systematic review conducted in 2017 on suicide among Indigenous populations in the region also identified suicide as a major concern [48, 49]. None of the studies included in that review utilized data published after 2014, making them ineligible for inclusion in our scoping review. The authors of the 2017 review also highlighted a lack of publications on Indigenous suicides from countries with the largest relative Indigenous populations, such as Bolivia, Guatemala, and Mexico, findings that mirror our own. Furthermore, a global systematic review on suicide among Indigenous peoples published in 2018 included only four studies from Latin America, all of which were conducted in Brazil [49]. These findings collectively emphasize the urgent need for more comprehensive and updated research on mental health disparities, particularly suicide, among Indigenous populations in the region.

Globally, these patterns are not unique to Latin America. Indigenous populations in high-income countries such as Canada, Australia, and New Zealand face similar systemic barriers to health equity, including exclusion from healthcare access, systemic racism, and historical marginalization [50,51,52,53]. Initiatives such as Australia’s “Closing the Gap” program aim to reduce disparities but have faced challenges due to inconsistent political commitment and underfunding [54, 55]. Similarly, fragmented healthcare systems in Canada often lead to delays and inequities for First Nations communities [56]. Resource constraints amplify these challenges in Latin America, underscoring the need for innovative, community-driven solutions.

Despite these challenges, initiatives such as Colombia’s Anas Wayúu health system demonstrate the potential of Indigenous-led healthcare models that integrate traditional medicine with modern practices, addressing geographic and linguistic barriers through culturally sensitive care [57,58,59]. These programs offer valuable lessons in bridging healthcare gaps, but their success relies on sustained funding, robust policy frameworks, and collaboration between governments, Indigenous communities, and international partners. Addressing health disparities among Indigenous populations requires structural reforms in healthcare systems and targeted interventions that respect and incorporate Indigenous knowledge and practices [60].

Despite its strengths, this scoping review has limitations. The systematic search strategy employed may not have captured all relevant studies due to database limitations, variability in search terms, and publication language restrictions. The absence of methodological quality assessment or bias evaluation limits the robustness of individual findings. The predefined time frame potentially excluded relevant older studies, such as those we experienced with mental health papers. Variations in how Indigenous status was defined across studies introduce inconsistencies, and the focus on disease prevalence excluded disparities in risk factors, diagnosis, and treatment. Another limitation is the exclusion of grey literature, such as thesis, government reports, and community-based research, which often contain valuable insights into Indigenous health disparities. Given that much research with Indigenous populations may not be published in indexed journals, this could have led to an incomplete representation of existing evidence. Future reviews may benefit from incorporating grey literature sources to provide a more comprehensive understanding of Indigenous health disparities in Latin America. Nonetheless, this review highlights critical gaps, emphasizing the need for future research to adopt a broader, more inclusive scope.

In conclusion, this review identifies health disparities experienced by Indigenous populations in Latin America, driven by systemic discrimination, socioeconomic deprivation, and structural barriers within healthcare systems. Ongoing and emerging infectious diseases and malnutrition remain significant concerns, while the growing prevalence of chronic diseases signals a troubling double burden. Addressing these disparities demands a comprehensive approach that combines targeted interventions with structural reforms to promote equity. Policymakers, researchers, and healthcare providers must collaborate to ensure that Indigenous populations are prioritized, fostering sustainable health equity and achieving universal health coverage.

Data availability

No datasets were generated or analysed during the current study.

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  1. University of Texas at Austin, Austin, TX, USA

    Mariana Garza

  2. University of California, San Francisco, CA, USA

    Lucía Abascal Miguel

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  1. Mariana Garza
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Contributions

LAM: Conceptualized the study, designed the methodology, conducted the systematic search and data extraction, and drafted the manuscript. LAM also interpreted the findings and led the overall writing process. MG: Assisted in the screening of articles, supported data analysis, contributed to drafting sections of the manuscript, and reviewed the document for intellectual content and clarity.

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Correspondence to Lucía Abascal Miguel.

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Garza, M., Miguel, L.A. Health disparities among indigenous populations in Latin America: a scoping review. Int J Equity Health 24, 119 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12939-025-02495-2

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International Journal for Equity in Health

ISSN: 1475-9276

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