Cervical cancer incidence and mortality among American Indian and Alaska Native women, 1999-2009

Abstract

Objectives: We analyzed cervical cancer incidence and mortality data in American Indian and Alaska Native (AI/AN) women compared with women of other races.

Methods: We improved identification of AI/AN race, cervical cancer incidence, and mortality data using Indian Health Service (IHS) patient records; our analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. Age-adjusted incidence and death rates were calculated for AI/AN and White women from 1999 to 2009.

Results: AI/AN women in CHSDA counties had a death rate from cervical cancer of 4.2, which was nearly twice the rate in White women (2.0; rate ratio [RR] = 2.11). AI/AN women also had higher incidence rates of cervical cancer compared with White women (11.0 vs 7.1; RR = 1.55) and were more often diagnosed with later-stage disease (RR = 1.84 for regional stage and RR = 1.74 for distant stage). Death rates decreased for AI/AN women from 1990 to 1993 (-25.8%/year) and remained stable thereafter.

Conclusions: Although rates decreased over time, AI/AN women had disproportionately higher cervical cancer incidence and mortality. The persistently higher rates among AI/AN women compared with White women require continued improvements in identifying and treating cervical cancer and precancerous lesions.

FIGURE 1—

Trends in cervical cancer death rates for American Indian/Alaska Native and White Women: CHSDA Counties, United States, 1990–2009. Note. AI/AN = American Indians/Alaska Natives; CHSDA = Contract Health Service Delivery Areas. Women of Hispanic origin were excluded from the analyses. AI/AN race was reported from death certificates or through linkage with the Indian Health Service patient registration database. Rates are age-adjusted to the 2000 US standard population (11 age groups; Census P25-1130). States and years of data excluded because Hispanic origin was not collected on the death certificate: LA: 1990; NH: 1990–1992; OK: 1990–1996. Source. AI/AN Mortality Database (AMD 1990–2009).