April 28, 2014

American Indian and Alaska Native death rates greater than rates among non-Hispanic whites.

Death records show that American Indian and Alaska Native (AI/AN) death rates for both men and women combined were nearly 50 percent greater than rates among non-Hispanic whites during 1999-2009. The new findings were announced through a series of CDC reports released online by the American Journal of Public Health (AJPH).

Viraj A. Master, MD, PhD, Winship Cancer Institute of Emory University member and Director of Clinical Research in the Emory Department of Urology, is senior author on the study profiling kidney cancer incidence and mortality. Master points out that while overall kidney cancer incidence is rising in the U.S., the AI/AN populations are disproportionately affected by this cancer.

“For AI/AN populations, kidney cancer ranks among the top 5 cancers for both incidence and mortality, in contradistinction to the rest of the U.S. These modern day data show that AI/AN patients have a 60% higher incidence of kidney cancer, and 90% higher death rate, compared to a white population,” says Master. “Despite a decline in kidney cancer death rates for whites, AI/AN populations are stable. In other words, in this study, we’ve observed racial disparities in kidney cancer are widening."

Correct reporting of AI/AN death rates has been a persistent challenge for public health experts. Previous studies showed that nearly 30 percent of AI/AN persons who identify themselves as AI/AN when living are classified as another race at the time of death.

Key findings:
Among AI/AN people, cancer is the leading cause of death followed by heart disease. Among other races, it is the opposite.
Death rates from lung cancer have shown little improvement in AI/AN populations. AI/AN people have the highest prevalence of tobacco use of any population in the United States.
Deaths from injuries were higher among AI/AN people compared to non-Hispanic whites.
Suicide rates were nearly 50 percent higher for AI/AN people compared to non-Hispanic whites, and more frequent among AI/AN males and persons younger than age 25.
Death rates from motor vehicle crashes, poisoning, and falls were two times higher among AI/AN people than for non-Hispanic whites.
Death rates were higher among AI/AN infants compared to non-Hispanic white infants. Sudden infant death syndrome and unintentional injuries were more common. AI/AN infants were four times more likely to die from pneumonia and influenza.
By region, the greatest death rates were in the Northern Plains and Southern Plains. The lowest death rates were in the East and the Southwest.
The studies address race misclassification in two ways. First, the authors linked U.S. National Death Index records with Indian Health Services registration records to more accurately identify the race of AI/AN people who had died. Second, the authors focused their analyses on the Indian Health Services’ Contract Health Service Delivery Area counties (CHSDA) where about 64 percent of AI/AN persons live. Fewer race misclassification errors occur in CHSDA data than in death records.

The authors reviewed trends from 1990 through 2009, and compared death rates between AI/AN people and non-Hispanic whites by geographic regions for a more recent time period (1999-2009).

The report concludes that patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and health-harming social determinants. Many of the observed excess deaths can be addressed through evidence-based public health interventions.

The articles from the report are on the AJPH "First Look" early online section.

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