摘要：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. Cancer has emerged as a leading cause of premature death among American Indian and Alaska Native (AI/AN) populations, 1 and measures of cancer mortality and incidence provide important indicators of health status for AI/AN populations. Previous analyses of cancer mortality among AI/AN populations described substantial geographic variation in death rates. 2,3 The interpretation of results from some earlier analyses were constrained, however, by the existence of racial misclassification on death certificates. 4 In recent years, our ability to examine cancer incidence in AI/AN populations was strengthened by the systematic linkage of records from central cancer registries with patient registration records from the Indian Health Service (IHS). This linkage substantially reduced misclassification of AI/AN ancestry in cancer incidence data. 5 Although imperfect, the improvement in race classification allowed a series of articles to be developed to provide a more accurate, comprehensive overview of cancer incidence among AI/AN populations from 1999 to 2004. 6–8 At the time that these articles describing cancer incidence among AI/AN populations were published, comparable cancer mortality data that addressed racial misclassification on death certificates were not available. Recent linkages between the IHS patient registration file and the National Death Index (NDI) have resulted in reduced racial misclassification in death records and the opportunity to present comparable cancer mortality and incidence data. Our study took advantage of more accurate data on AI/AN ancestry to provide an updated overview of patterns in cancer mortality across multiple cancer sites among AI/AN populations. Longer-term trends in cancer mortality, from 1990 to 2009, were also examined. In addition, information was provided on cancer incidence to provide an update to the comprehensive overview of cancer incidence among AI/AN populations that was published in 2008. 8 By examining geographic variability and disparities in cancer mortality and incidence rates and changes over time, we identified priorities for action to reduce both cancer mortality and incidence in AI/AN populations.
