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

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.

Methods for improving the quality and completeness of mortality data for American Indians and Alaska Natives.

OBJECTIVES: We describe methods used to mitigate the effect of race misclassification in mortality records and the data sets used to improve mortality estimates for American Indians and Alaska Natives (AI/ANs). METHODS: We linked US National Death Index (NDI) records with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Analyses excluded decedents of Hispanic origin and focused on Contract Health Service Delivery Area (CHSDA) counties. We compared death rates for AI/AN persons and Whites across 6 US regions. RESULTS: IHS registration records merged to 176,137 NDI records. Misclassification of AI/AN race in mortality data ranged from 6.3% in the Southwest to 35.6% in the Southern Plains. From 1999 to 2009, the all-cause death rate in CHSDA counties for AI/AN persons varied by geographic region and was 46% greater than that for Whites. Analyses for CHSDA counties resulted in higher death rates for AI/AN persons than in all counties combined. CONCLUSIONS: Improving race classification among AI/AN decedents strengthens AI/AN mortality data, and analyzing deaths by geographic region can aid in planning, implementation, and evaluation of efforts to reduce health disparities in this population.

Physician and nurse perspectives on implementation of universal adult HIV screening guidelines in the Indian health service: results of a randomized survey.

OBJECTIVES: We sought to determine attitudes and needs among health care providers in the Indian Health Service toward implementing routine human immunodeficiency virus (HIV) screening among 13- to 64-year-olds as per Centers for Disease Control and Prevention (CDC) guidelines. METHODS: We surveyed a random sample of Indian Health Service physicians and nurses by e-mail and telephone interview. A total of 205 eligible respondents (response rate = 70%) completed the survey. RESULTS: A majority (58%) of respondents were familiar or somewhat familiar with the 2006 CDC guidelines on HIV screening for 13- to 64-year-olds. A proportion of respondents (43%) felt that community HIV prevalence was below the 0.1% threshold the CDC recommends to initiate screening. Respondents supported routine, rather than solely risk-based HIV testing (70%) and stated that HIV screening would be realistic in their health facility (51%). Respondents felt that they needed special qualification to offer an HIV test (49%) or to notify a patient of a "reactive" HIV test result (67%). CONCLUSIONS: A majority of Indian Health Service physicians and nurses support the CDC HIV screening guidelines. Providers need more information and training on HIV screening guidelines, implementation strategies, and relevant state HIV regulations.