Traumatic brain injury among American Indians/Alaska Natives--United States, 1992-1996

Traumatic Brain Injury (TBI) is a major cause of morbidity and mortality in the United States, resulting in approximately 52,000 deaths, 230,000 hospitalizations, and 80,000 disabilities annually. Among American Indians/Alaska Natives (AI/ANs), injuries are the second leading cause of death; however, few published reports concern nonfatal injuries in this population, especially for injuries such as TBI. To describe the causes and impact of TBI among AI/ANs, CDC analyzed Indian Health Service (IHS) hospital discharge data. This report summarizes the results of this analysis, which indicate that prevention strategies should focus on the leading causes of TBI hospitalizations, including motor-vehicle crashes, assaults, and falls.     

Prevalence of selected risk factors for chronic disease and injury among American Indians and Alaska Natives--United States, 1995-1998

Since the 1950s, morbidity and mortality attributable to infectious diseases among American Indians and Alaska Natives (AIs/ANs) have declined and chronic diseases, especially diabetes, and injury have remained important determinants of poor health (1). Knowledge of the prevalence of behavioral risk factors for chronic disease and injury can be used to form policies and programs to improve the health of AIs/ANs. Based on data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 through 1996, CDC published regional estimates of the prevalence of 10 behavioral risk factors for AIs/ANs (2). This report updates data from the earlier report and focuses on three of the 10 risk factors for chronic disease and injury among AIs/ANs.     

Prevalence of selected cardiovascular disease risk factors among American Indians and Alaska Natives--United States, 1997

Heart disease and stroke, the principal causes of cardiovascular disease (CVD), are the first and fifth leading causes of death among American Indians and Alaska Natives (AI/AN) (1,2). Risk factors for CVD frequently cluster, which may increase CVD risk multiplicatively (3). To characterize the prevalence of risk factors for CVD (i.e., hypertension, current cigarette smoking, high cholesterol, obesity, and diabetes) among AI/AN, CDC analyzed data from the 1997 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicated that 63.7% of AI/AN men and 61.4% of AI/AN women who participated in the survey had one or more CVD risk factors.     

Diabetes prevalence among American Indians and Alaska Natives and the overall population--United States, 1994-2002

Diabetes affects American Indians/Alaska Natives (AI/ANs) disproportionately compared with other racial/ethnic populations and has been increasing in prevalence in AI/AN populations during the past 16 years. To examine trends in diabetes prevalence among AI/ANs and the overall U.S. population and to describe disparities among these two populations, CDC analyzed data from the Indian Health Service (IHS) and the Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the results of that analysis, which indicate that diabetes continues to affect AI/ANs disproportionately and is becoming more common among younger populations. To combat this epidemic, knowledge and interventions from clinical trials and best-practice models should be translated to community-based prevention programs within AI/AN communities.     

Alcohol-attributable deaths and years of potential life lost among American Indians and Alaska Natives--United States, 2001--2005

Excessive alcohol consumption is a leading preventable cause of death in the United States and has substantial public health impact on American Indian and Alaska Native (AI/AN) populations. To estimate the average annual number of alcohol-attributable deaths (AADs) and years of potential life lost (YPLLs) among AI/ANs in the United States, CDC analyzed 2001-2005 data (the most recent data available), using death certificate data and CDC Alcohol-Related Disease Impact (ARDI) software. This report summarizes the results of that analysis, which indicated that AADs accounted for 11.7% of all AI/AN deaths, that the age-adjusted AAD rate for AI/ANs was approximately twice that of the U.S. general population, and that AI/ANs lose 6.4 more years of potential life per AAD compared with persons in the U.S. general population (36.3 versus 29.9 years). These findings underscore the importance of implementing effective population-based interventions to prevent excessive alcohol consumption and to reduce alcohol-attributable morbidity and mortality among AI/ANs.     

Diagnosed diabetes among American Indians and Alaska Natives aged <35 years--United States, 1994-2004

Diabetes disproportionately affects American Indians/Alaska Natives (AI/ANs), and the prevalence of diabetes is increasing among young persons in certain AI/AN populations. To examine trends in the prevalence of diagnosed diabetes among AI/ANs aged <35 years, CDC analyzed patient data collected by the Indian Health Service (IHS) during 1994-2004. This report summarizes the results of that analysis, which indicated that the age-adjusted prevalence of diagnosed diabetes increased from 8.5 to 17.1 per 1,000 population among AI/ANs aged <35 years who use IHS health-care services. Because young persons with diabetes have more years of disease and greater risk for costly and disabling complications early in life, diabetes prevention programs targeting younger age groups have become increasingly important in AI/AN communities.     

Injury mortality among American Indian and Alaska Native children and youth--United States, 1989-1998

Injuries account for 75% of all deaths among American Indian and Alaska Native (AI/AN) children and youth, and AI/ANs have an overall injury-related death rate that is twice the U.S. rate for all racial/ethnic populations. However, rate disparities vary by area and by cause. To help focus prevention efforts, CDC analyzed injury mortality data by Indian Health Service (IHS) administrative area and by race/ethnicity. This report summarizes the results of these analyses, which indicate that although death rates for some causes (e.g. drowning and fire) have shown substantial improvement over time, rates for other causes have increased or remained unchanged (e.g., homicide and suicide, respectively). Prevention strategies should focus on the leading causes of injury-related death in each AI/AN community, such as motor-vehicle crashes, suicides, and violence.     

Tuberculosis among American Indians and Alaska Natives in the United States, 1993-2002

OBJECTIVES: I examined trends in and epidemiological and clinical characteristics of tuberculosis (TB) within the American Indian/Alaska Native (AIAN) population of the United States and compared TB trends and characteristics in that population with TB trends and characteristics within other racial/ethnic groups. METHODS: I analyzed all verified cases of TB reported to the US National Tuberculosis Surveillance System from January 1, 1993, to December 31, 2002. RESULTS: From 1993 through 2002, 196133 TB cases were reported, 2612 (1.3%) of which were in the AIAN population. During this period, TB case rates declined 40.4% among AIAN peoples, the smallest decrease among any US-born racial/ethnic group. In 2002, 15075 TB cases (5.2 per 100000 population) were reported, 180 of which were in the AIAN population (8.4 per 100000 population)-almost 6 times the rate for non-Hispanic Whites (1.5 per 100000 population). CONCLUSIONS: TB continues to be a significant health problem for the AIAN population. Vigilance and collaboration among local, state, federal, AIAN, and tribal TB control programs are essential to TB elimination among the AIAN population.     

Patterns in cancer incidence among American Indians/Alaska Natives, United States, 1992-1999

OBJECTIVE: Cancer is a major public health concern in American Indian and Alaska Native (AI/AN) communities. However, information on the incidence of cancer is lacking for this group. The purpose of this study is to report cancer incidence patterns for the U.S. AI/AN population. METHODS: Age-adjusted annual cancer incidence rates for 1992 through 1999 were calculated for 12 Surveillance, Epidemiology and End Results (SEER) areas, representing a sample (42%) of the U.S. AI/AN population. Trends in cancer incidence rates for the AI/AN sample were determined using standard linear regression of log-transformed rates and were compared to those of the U.S. white population. RESULTS: The top five incident cancers (from highest to lowest) among AI/AN males were prostate, lung and bronchus, colon and rectum, kidney and renal pelvis, and stomach cancers. Among AI/AN women, cancers of the breast, colon and rectum, lung and bronchus, endometrium, and ovary ranked highest. Four sites where cancer incidence rates are greater for AI/ANs than for whites include gallbladder (the AI/AN rate was 4.1 times the rate for white males and 2.6 times the rate for white females), liver and intrahepatic bile duct cancers (1.3 times for males and 2.3 times for females), stomach (1.2 times for males and 1.5 times for females), and kidney and renal pelvis (1.03 times for males and 1.07 times for females). The data show increasing trends for AI/AN males and females and declining trends for white males and females for colorectal, stomach, and pancreatic cancers and leukemia. Similar differences between AI/AN rates and white rates were found for urinary bladder cancers in males and gallbladder cancer in females. CONCLUSIONS: Analysis of SEER data allowed for the determination of disparities in cancer incidence between a sample of the U.S. AI/AN population and the white population. The findings of this study provide baseline information necessary for developing cancer prevention and intervention strategies specific to the AI/AN population to address these cancer disparities.     

Cancer incidence among American Indians and Alaska Natives, 1980 through 1987.

OBJECTIVES. This study uses Indian Health Service inpatient data to estimate cancer incidence among American Indians and Alaska Natives. METHODS. Hospital discharge data for 1980 through 1987 were used to identify cases of cancer for 21 sites in women and 18 sites in men. Estimates of incidence were directly standardized to data from the Surveillance, Epidemiology, and End Results Program for the same time frame. RESULTS. Cancers of the gallbladder, kidney, stomach, and cervix show generally high rates among many American Indian and Alaska Native communities, and cancers of the liver and nasopharynx are high in Alaska. Of the relatively common cancers in Whites, American Indians and Alaska Natives experience lower rates for cancers of the breast, uterus, ovaries, prostate, lung, colon, rectum, and urinary bladder and for leukemia and melanoma. Variation among geographic areas and among tribal groups is observed for many important cancer sites. CONCLUSIONS. This study demonstrates significant variations of cancer rates among American Indians and Alaska Natives, with important implications for Indian Health Service cancer control programs. The study also supports the potential use of hospital discharge data for estimating chronic disease among diverse American Indian and Alaska Native communities.     

Alaska native mortality, 1979-1998

OBJECTIVES: This study compares mortality patterns for the Alaska Native population and the U.S. white population for 1989-1998 and examines trends for the 20-year period 1979-1998. METHODS: The authors used death certificate data and Indian Health Service population estimates to calculate mortality rates for the Alaska Native population, age-adjusted to the U.S. 1940 standard million. Data on population and mortality for U.S. whites, aggregated by 10-year age groups and by gender, were obtained from the National Center for Health Statistics, and U.S. white mortality rates were age-adjusted to the U.S. 1940 standard million. RESULTS: Overall, 1989-1998 Alaska Native mortality rates were 60% higher than those for the U.S. white population for the same period. There were significant disparities for eight of 10 leading causes of death, particularly unintentional injury, suicide, and homicide/legal intervention. Although declines in injury rates can be documented for the period 1979-1998, large disparities still exist. Alaska Native death rates for cancer, cerebrovascular disease, chronic obstructive pulmonary disease, and diabetes increased from 1979 to 1998. Given decreases in some cause-specific mortality rates in the U.S. white population, increased rates among Alaska Natives have resulted in new disparities. CONCLUSIONS: These data indicate that improvements in injury mortality rates are offset by marked increases in chronic disease deaths.     

End-stage renal disease attributed to diabetes among American Indians/Alaska Natives with diabetes--United States, 1990-1996

Diabetes is the leading cause of end-stage renal disease (ESRD) (i.e., kidney failure requiring dialysis or kidney transplantation), and ESRD treatment has increased among American Indians/Alaska Natives (AI/ANs) (1,2). To assess trends in the incidence of ESRD attributable to diabetes mellitus (ESRD-DM) treatment among AI/ANs with diabetes, CDC and the Indian Health Service (IHS) analyzed data from the U.S. Renal Data System (USRDS). This report summarizes the findings of the analysis, which indicate that the incidence of ESRD-DM treatment is increasing among AI/ANs with diabetes, particularly young AI/ANs.     

AIDS surveillance among American Indians and Alaska natives.

To assess the human immunodeficiency virus epidemic among American Indians and Alaska Natives (AI/AN), we examined acquired immunodeficiency syndrome (AIDS) case and seroprevalence data through December 1990. While AI/AN had a low 1990 reported AIDS case rate (4.0/100,000), the increase in diagnosed cases adjusted for reporting delays from 1989 to 1990 was higher (23.1%) among AI/AN than any other racial/ethnic group. Seroprevalence data for military applicants have documented higher rates for AI/AN than for either Whites or Asian/Pacific Islanders.     

Postneonatal mortality among Alaska Native infants - Alaska, 1989-2009

Alaska's postneonatal mortality rate of 3.4 deaths per 1,000 live births during 2006-2008 was 48% higher than the 2007 U.S. rate of 2.3 per 1,000. Among American Indian/Alaska Native (AI/AN) infants, the Alaska rate of 8.0 per 1,000 was 70% higher than the U.S. rate of 4.7. The Alaska Division of Public Health analyzed a linked birth-infant death file for 1989-2009 to examine temporal trends in postneonatal mortality in Alaska, specifically in the Alaska Native (AN) population. Overall and non-Alaska Native (non-AN) rates declined during the entire period, but no significant trends in AN-specific mortality were apparent. Infant mortality review committee findings indicated a decline during 1992-2007 among all postneonatal deaths attributed to sudden infant death syndrome (SIDS) or sudden unexplained infant death (SUID), but not for other causes. Lack of progress in reducing postneonatal mortality, particularly among AN infants, indicates a need for renewed emphasis within the Alaska health-care community. Current initiatives to reduce preventable causes of postneonatal mortality should be evaluated and successful models more widely implemented.     

Hepatitis A incidence and hepatitis a vaccination among American Indians and Alaska Natives, 1990-2001

OBJECTIVES: We assessed the effect on trends in hepatitis A incidence of the 1996 recommendation for routine hepatitis A vaccination of American Indian/Alaska Native (AIAN) children. METHODS: We examined trends in hepatitis A incidence among AIAN peoples during 1990-2001 and vaccination coverage levels among children on the largest American Indian reservation. RESULTS: Hepatitis A rates among AIANs declined 20-fold during 1997-2001. Declines in hepatitis A incidence occurred among AIANs in reservation and metropolitan areas. Among 1956 children living on the Navajo Nation whose medical records were reviewed, 1508 (77.1%) had received at least one dose of hepatitis A vaccine, and 1020 (52.1%) had completed the vaccine series. CONCLUSIONS: Hepatitis A rates among AIAN peoples have declined dramatically coincident with implementation of routine hepatitis A vaccination of AIAN children.     

Invasive cervical cancer among American Indian women in the Northern Plains, 1994-1998: incidence, mortality, and missed opportunities

OBJECTIVES: Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region. METHODS: We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population. RESULTS: Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100,000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms. CONCLUSIONS: While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.     

Changing trends in mortality among New Mexico's American Indians, 1958-1987.

Health care availability and living conditions have improved substantially for American Indians in New Mexico over the past quarter century. To investigate the impact of these changes on health statistics, we examined mortality data collected from 1958 to 1987 for American Indians in the state. We analysed the data for all causes of death combined and for specific causes, and compared these data with figures for nonHispanic whites in the state. Age-adjusted mortality rates were calculated for 5-year periods for each ethnic-gender group, using denominators from US Census reports. Mortality rates for all causes combined did not improve significantly for American Indian males from 1958 to 1987, although the rates for American Indian females showed an 8% decline. Infectious disease-related mortality rates for American Indians decreased dramatically over the 30-year study period; however, mortality rates for cancer and diabetes increased over the 30-year period. Mortality rates for injuries and alcoholism among American Indians increased greatly from 1958 to 1977 and then declined later in the study period, but they were consistently higher than rates for whites. The study indicates that several chronic diseases remain of major public health importance for New Mexico's American Indian population.     

Trends in infectious disease hospitalizations among American Indians and Alaska Natives

OBJECTIVES: This study sought to describe trends in hospitalizations associated with infectious diseases among American Indians and Alaska Natives. METHODS: Infectious disease hospitalizations and rates among American Indians and Alaska Natives from 1980 through 1994 were examined via Indian Health Service hospital discharge data and compared with published trends for the general US population. RESULTS: Annual hospitalization rates for infectious diseases among American Indians and Alaska Natives decreased by 31.0% between 1980 and 1994. Infectious disease hospitalizations accounted for 16.3% of all hospitalizations in 1980 and 21.2% in 1994, an increase of 30.1%. In 1994, the age-adjusted infectious disease hospitalization rate for American Indians and Alaska Natives was 1863 per 100,000 population, approximately 21% greater than that for the general US population. CONCLUSIONS: Hospitalization trends for infectious diseases show that there has been improvement in the health status of American Indians and Alaska Natives but also indicate that this population has a higher infectious disease burden than the general US population.