Am J Public Health. 2016 May;106(5):906-14. doi: 10.2105/AJPH.2015.303033. Epub 2016 Feb 18.

Causes and Disparities in Death Rates Among Urban American Indian and Alaska Native Populations, 1999-2009.

Jacobs-Wingo JL¹, Espey DK¹, Groom AV¹, Phillips LE¹, Haverkamp DS¹, Stanley SL.

Author information

1: Jasmine L. Jacobs-Wingo, at the time of the study, was with the Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA. David K. Espey is with the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Amy V. Groom is with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Leslie E. Phillips, at the time of the study, was with the Urban Indian Health Institute, Seattle, WA. Donald S. Haverkamp is with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. At the time of study, Sandte L. Stanley was with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Abstract

OBJECTIVES:

To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations.

METHODS:

We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates.

RESULTS:

The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urban White persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions.

CONCLUSIONS:

Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities.