Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States

Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S377-87. doi: 10.2105/AJPH.2013.301673. Epub 2014 Apr 22.


Objectives: We used improved data on American Indian and Alaska Native (AI/AN) ancestry to provide an updated and comprehensive description of cancer mortality and incidence among AI/AN populations from 1990 to 2009.

Methods: We linked the National Death Index and central cancer registry records independently to the Indian Health Service (IHS) patient registration database to improve identification of AI/AN persons in cancer mortality and incidence data, respectively. Analyses were restricted to non-Hispanic persons residing in Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted mortality and incidence rates for AI/AN populations with White populations using rate ratios and mortality-to-incidence ratios. Trends were described using joinpoint analysis.

Results: Cancer mortality and incidence rates for AI/AN persons compared with Whites varied by region and type of cancer. Trends in death rates showed that greater progress in cancer control was achieved for White populations compared with AI/AN populations over the last 2 decades.

Conclusions: Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alaska / epidemiology
  • Alaska / ethnology
  • Cause of Death
  • Death Certificates
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Incidence
  • Indians, North American / statistics & numerical data*
  • Inuits / statistics & numerical data*
  • Male
  • Middle Aged
  • Neoplasms / epidemiology*
  • Neoplasms / ethnology
  • Neoplasms / mortality
  • Population Surveillance
  • Registries
  • United States / epidemiology