Heart disease mortality among Alaska Native people, 1981-2007.

OBJECTIVES: Historically, Alaska Native (AN) people have exhibited low overall rates of heart disease mortality compared with the U.S. white (USW) population. We compared AN and USW heart disease mortality rates during the 27-year period from 1981 through 2007. METHODS: We compared AN and USW heart disease mortality rates overall and by gender, age, and disease subtype. We calculated age-adjusted rates for AN people for three nine-year periods from 1981 through 2007 and compared them with the rates for USW people. RESULTS: AN people > or = 35 years of age had a significantly lower rate of heart disease mortality compared with their USW counterparts (rate ratio [RR] = 0.80). The lower overall RR was due primarily to a lower ischemic heart disease mortality RR (RR = 0.63). Overall heart disease mortality decreased during the 27-year study period for both the AN (33.1%) and USW (35.0%) populations. However, hypertensive heart disease mortality increased 155.2% for AN people and 13.7% for USW people. Age-specific heart disease mortality was about 30.0% lower for AN people > or = 75 years of age compared with their USW counterparts, while it was virtually identical for the two racial/ethnic groups among people 35-74 years of age. CONCLUSIONS: The age-adjusted AN heart disease mortality rate was consistently about 20.0% lower than the USW rate from 1981 through 2007, with similar RRs for men and women. However, combining all ages and all heart disease subgroups into a single, age-adjusted statistic obscures many important differences across ages and disease subtypes.

Cancers of the breast, uterus, ovary and cervix among Alaska Native women, 1974-2003.

OBJECTIVES: Alaska Native (AN) women have exhibited some of the highest incidence rates of cancer overall, and different patterns of site-specific incidence compared to other U.S. populations. This study compares incidence rates between AN and U.S. white women (USW) for cancers of the breast, uterus, ovary and cervix, and examines effects of time period and birth cohort as determinants of incidence trends among AN women. STUDY DESIGN: Observational, population-based study. METHODS: Cancer incidence data from the Alaska Native Tumor Registry and SEERStat, 1974-2003. Age-adjusted World Standard Population rates were calculated for a current 5-year period and over time (30 years), and compared to other populations using rate ratios with 95% confidence intervals. Log-linear regression models used to assess impact on trend of age, time period and birth cohort. RESULTS: Compared to U.S. white women, current cancer rates among AN women are not significantly different for cancer of the breast and cervix, and significantly lower for cancers of the ovary and uterus. Trends over time over a 30-year time period also differ for these cancer sites. There were significant increases in breast and uterine cancer, and in contrast, a marked decline in cervical cancer. There was no significant change for cancer of the ovary. Changes appear to be due largely to period, not birth cohort effects. CONCLUSIONS: Increases in breast cancer may be due to a combination of modifiable behaviours; increased BMI and a shift to a non-traditional diet. Increases in uterine cancer could be associated with increased BMI and diabetes. Cervical cancer rates have declined to USW levels. The marked decline is likely due to enhanced screening and control efforts within the Alaska Native Women's cancers among Alaska Natives Tribal Health System (formerly Alaska Area USPHS, Indian Health Service utilizing resources available from the Centers for Disease Control tribal and state Breast and Cervical Cancer Early Detection Programs).

Alaska native mortality rates and trends.

OBJECTIVES: This article compared mortality data (1999-2003) for Alaska Natives (AN), U.S. white residents (USW), and Alaska white residents (AKW), and examined changes in mortality rates from 1979 to 2003. METHODS: We used SEERStat* software from the National Cancer Institute to calculate age-adjusted mortality rates. RESULTS: The AN all-cause mortality rate was 40% higher (rate ratio [RR]=1.4) than the rate for both the USW and AKW populations. Based on comparisons with USW, the largest disparities in AN mortality were found for unintentional injuries (RR=3.0), suicide (RR=3.1), and homicide (RR=4.4). Disparities were also found for eight of the 10 leading causes of death, including cancer (AN/USW RR=1.3), cerebrovascular disease (RR=1.3), chronic obstructive pulmonary disease (RR=1.4), pneumonia/influenza (RR=1.6), and chronic liver disease (RR=2.0). In contrast, the mortality rate for heart disease among AN was significantly lower (RR=0.9) than for USW, and lower-though not significantly lower-for diabetes. Findings were quite similar when rates for AN were compared with AKW. AKW also had high rates of unintentional injury mortality and suicide compared with USW, but the magnitude of the difference was much less for AKW. From 1979 to 2003, mortality rates among AN declined 16% for all causes, similar to the USW decline of 15%. CONCLUSIONS: Monitoring mortality rates and their trends is essential not only to understand the health status of a population but also to target areas for prevention and evaluate the impact of policy change or the effect of interventions over time.

Disparities in cancer mortality among Alaska Native people, 1994-2003.

OBJECTIVE: To provide current data on cancer mortality among Alaska Native people for the period of 1994-2003, and to identify and quantitate cancer disparities. METHODS: Cancer mortality rates for Alaska Native (AN), U.S., White (USW) and other populations were calculated using SEERStat. Ratios of age-adjusted incidence rates with 95% confidence intervals are provided. RESULTS: Data were from SEERStat. Age-adjusted cancern mortality rates for Alaska Native exceeded those of USW population by 20%. For specific cancer sites, rates were significantly higher among AN people: oral cavity and pharynx (RR=1.9), esophagus (RR=2.0), stomach (RR=3.9), colon and rectum (RR=1.8), liver (RR=1.9), gallbladder (RR=2.6), pancreas (RR=1.3), lung and bronchus (RR=1.2), and kidney and renal pelvis (RR=2.2). In contrast, mortality rates among AN people were significantly lower than USW rates for cancers of the prostate (RR=0.7), brain and nervous system (RR=0.3), lymphoma (RR=0.6), and leukemia (RR=0.4). CONCLUSION: Marked disparities in cancer mortality exist among the Alaska Native population compared to the US White population. Excess mortality is documented for all sites combined and for many cancer specific sites. Rates for all cancers combined and for select sites are among the highest of any racial/ethnic group in the United States.

Alaska native mortality, 1979-1998.

OBJECTIVES: This study compares mortality patterns for the Alaska Native population and the U.S. white population for 1989-1998 and examines trends for the 20-year period 1979-1998. METHODS: The authors used death certificate data and Indian Health Service population estimates to calculate mortality rates for the Alaska Native population, age-adjusted to the U.S. 1940 standard million. Data on population and mortality for U.S. whites, aggregated by 10-year age groups and by gender, were obtained from the National Center for Health Statistics, and U.S. white mortality rates were age-adjusted to the U.S. 1940 standard million. RESULTS: Overall, 1989-1998 Alaska Native mortality rates were 60% higher than those for the U.S. white population for the same period. There were significant disparities for eight of 10 leading causes of death, particularly unintentional injury, suicide, and homicide/legal intervention. Although declines in injury rates can be documented for the period 1979-1998, large disparities still exist. Alaska Native death rates for cancer, cerebrovascular disease, chronic obstructive pulmonary disease, and diabetes increased from 1979 to 1998. Given decreases in some cause-specific mortality rates in the U.S. white population, increased rates among Alaska Natives have resulted in new disparities. CONCLUSIONS: These data indicate that improvements in injury mortality rates are offset by marked increases in chronic disease deaths.

Mortality trends among Alaska Native people: successes and challenges.

BACKGROUND: Current mortality rates are essential for monitoring, understanding and developing policy for a population's health. Disease-specific Alaska Native mortality rates have been undergoing change. OBJECTIVE: This article reports recent mortality data (2004-2008) for Alaska Native/American Indian (AN/AI) people, comparing mortality rates to US white rates and examines changes in mortality patterns since 1980. DESIGN: We used death record data from the state of Alaska, Department of Vital Statistics and SEER*Stat software from the National Cancer Institute to calculate age-adjusted mortality rates. RESULTS: Annual age-adjusted mortality from all-causes for AN/AI persons during the period 2004-2008 was 33% higher than the rate for US whites (RR = 1.33, 95% CI 1.29-1.38). Mortality rates were higher among AN/AI males than AN/AI females (1212/100,000 vs. 886/100,000). Cancer remained the leading cause of death among AN/AI people, as it has in recent previous periods, with an age-adjusted rate of 226/100,000, yielding a rate ratio (RR) of 1.24 compared to US whites (95% CI 1.14-1.33). Statistically significant higher mortality compared to US white mortality rates was observed for nine of the ten leading causes of AN/AI mortality (cancer, unintentional injury, suicide, alcohol abuse, chronic obstructive pulmonary disease [COPD], cerebrovascular disease, chronic liver disease, pneumonia/influenza, homicide). Mortality rates were significantly lower among AN/AI people compared to US whites for heart disease (RR = 0.82), the second leading cause of death. Among leading causes of death for AN/AI people, the greatest disparities in mortality rates with US whites were observed in unintentional injuries (RR = 2.45) and suicide (RR = 3.53). All-cause AN/AI mortality has declined 16% since 1980-1983, compared to a 21% decline over a similar period among US whites. CONCLUSION: Mortality rates and trends are essential to understanding the health of a population and guiding policy decisions. The overall AN/AI mortality rate is higher than that of US whites, although encouraging declines in mortality have occurred for many cause specific deaths, as well as for the overall rate. The second leading cause of AN/AI mortality, heart disease, remains lower than that of US whites.