摘要：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. American Indians and Alaska Natives (AI/ANs) in the United States have long endured a legacy of injustice and discrimination with multiple negative manifestations, including alarming health disparities and inadequate health care. In the early decades of the Indian Health Service (IHS), improvements in the health of AI/AN populations were significant, principally as a result of sanitary water supplies, control of tuberculosis and other infectious diseases, and improved nutrition. 1 Starvation is no longer an issue in AI/AN communities; rather, the opposite is true: obesity—a different form of malnutrition—and its attendant chronic diseases. With infant and childhood mortality greatly reduced, more AI/AN people are developing cancer, diabetes, heart disease, and stroke. In the efforts to better characterize and track the health status of AI/AN populations—a critical step to address health disparities—we see a recurrent theme of inadequate and inaccurate data, most often related to race misclassification that occurs in many health-related databases. Accurate health surveillance data are essential to address health disparities and to plan, implement, and evaluate disease prevention and control activities. Previous reports have indicated less favorable health status of AI/AN people compared with the general population of US Whites. 2,3 Among health status indicators, mortality data provide essential information for measuring the health of a population. Patterns of mortality in specific demographic subpopulations, including race and ethnic groups, may reflect differences in socioeconomic status and access to medical care or the prevalence of subpopulation-specific risk factors. 4 However, the goal of producing reliable mortality estimates for AI/AN populations has been hampered by the misclassification of race that frequently occurs in vital statistics data. 5 We sought to provide an overview of leading causes of death and trends in all-cause mortality for the AI/AN population—particularly those residing in areas served by the IHS—using national mortality data that have been linked to the IHS patient registration data to improve race classification.
