Lung cancer deaths among American Indians and Alaska Natives, 1990-2009

Abstract

Objectives: We examined regional differences in lung cancer among American Indians/Alaska Natives (AI/ANs) using linked data sets to minimize racial misclassification.

Methods: On the basis of federal lung cancer incidence data for 1999 to 2009 and deaths for 1990 to 2009 linked with Indian Health Service (IHS) registration records, we calculated age-adjusted incidence and death rates for non-Hispanic AI/AN and White persons by IHS region, focusing on Contract Health Service Delivery Area (CHSDA) counties. We correlated death rates with cigarette smoking prevalence and calculated mortality-to-incidence ratios.

Results: Lung cancer death rates among AI/AN persons in CHSDA counties varied across IHS regions, from 94.0 per 100,000 in the Northern Plains to 15.2 in the Southwest, reflecting the strong correlation between smoking and lung cancer. For every 100 lung cancers diagnosed, there were 6 more deaths among AI/AN persons than among White persons. Lung cancer death rates began to decline in 1997 among AI/AN men and are still increasing among AI/AN women.

Conclusions: Comparison of regional lung cancer death rates between AI/AN and White populations indicates disparities in tobacco control and prevention interventions. Efforts should be made to ensure that AI/AN persons receive equal benefit from current and emerging lung cancer prevention and control interventions.

FIGURE 1—

Trends in lung and bronchus cancer death rates in CHSDA counties by (a) overall US rates by sex, (b) rates among AI/AN men by IHS region and (c) and rates among AI/AN women by IHS region: United States, 1990–2009. Note. AI/AN = American Indian/Alaska Natives; CHSDA = Contract Health Service Delivery Area; IHS = Indian Health Service. The following states and years of data were excluded because Hispanic origin was not collected on the death certificate: LA, 1990; NH, 1990–1992; and OK, 1990–1996. IHS regions are defined as follows: Alaska;^a Northern Plains (IL, IN,^a IA,^a MI,^a MN,^a MT,^a NE,^a ND,^a SD,^a WI,^a WY^a); Southwest (AZ,^a CO,^a NV,^a NM,^a UT^a); Pacific Coast (CA,^a ID,^a OR,^a WA,^a HI); and East (AL,^a AR, CT,^a DE, FL,^a GA, KY, LA,^a ME,^a MD, MA,^a MS,^a MO, NH, NJ, NY,^a NC,^a OH, PA,^a RI,^a SC,^a TN, VT, VA, WV, DC). Percentage regional coverage of AI/AN persons in CHSDA counties to AI/AN persons in all counties: Northern Plains = 64.8%; Alaska = 100%; Southwest = 91.3%; Pacific Coast = 71.3%; East = 18.2%; total US = 64.2%. Source. AI/AN Mortality Database (1990–2009). ^aIdentifies states with ≥ 1 county designated as CHSDA.

FIGURE 2—

Correlation between (a) cigarette smoking prevalence (BRFSS 2000–2006) and lung cancer death rates (2003–2009) by IHS region and (b) changes in cigarette smoking prevalence (BRFSS 1997–2000 and BRFSS 2000–2006) and trends in lung cancer death rates (2000–2009) by IHS region for American Indians and Alaska Natives: United States. Note. BRFSS = Behavior Risk Factor Surveillance System; IHS = Indian Health Service. Pearson correlation coefficients weighted by inverse variance of mortality rate/trend. Source. Kim et al., Fay.