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. 2014 Jun;104 Suppl 3(Suppl 3):S303-11.
doi: 10.2105/AJPH.2013.301798. Epub 2014 Apr 22.

Leading causes of death and all-cause mortality in American Indians and Alaska Natives

David K Espey  1 , Melissa A Jim, Nathaniel Cobb, Michael Bartholomew, Tom Becker, Don Haverkamp, Marcus Plescia
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Leading causes of death and all-cause mortality in American Indians and Alaska Natives

David K Espey et al. Am J Public Health. 2014 Jun.

Abstract

Objectives: We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs).

Methods: US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs.

Results: From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons.

Conclusions: AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.

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Figures

FIGURE 1—
FIGURE 1—
Annual age-adjusted all-cause death rates and Joinpoint trend lines for AI/AN and White (a) males and (b) females: Contract Health Service Delivery Area counties, United States, 1990–2009. Note. AI/AN = American Indian/Alaska Natives. Analyses are limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the IHS patient registration database. aThe annual percentage change in rates during 1990–2009 was significant at α = .05. bThe difference in average annual percentage change between AI/AN and Whites during the past 10 years (2000–2009) was significant at α = .05.
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