摘要：Objectives. We examined regional differences in lung cancer among American Indians/Alaska Natives (AI/ANs) using linked data sets to minimize racial misclassification. Methods. On the basis of federal lung cancer incidence data for 1999 to 2009 and deaths for 1990 to 2009 linked with Indian Health Service (IHS) registration records, we calculated age-adjusted incidence and death rates for non-Hispanic AI/AN and White persons by IHS region, focusing on Contract Health Service Delivery Area (CHSDA) counties. We correlated death rates with cigarette smoking prevalence and calculated mortality-to-incidence ratios. Results. Lung cancer death rates among AI/AN persons in CHSDA counties varied across IHS regions, from 94.0 per 100 000 in the Northern Plains to 15.2 in the Southwest, reflecting the strong correlation between smoking and lung cancer. For every 100 lung cancers diagnosed, there were 6 more deaths among AI/AN persons than among White persons. Lung cancer death rates began to decline in 1997 among AI/AN men and are still increasing among AI/AN women. Conclusions. Comparison of regional lung cancer death rates between AI/AN and White populations indicates disparities in tobacco control and prevention interventions. Efforts should be made to ensure that AI/AN persons receive equal benefit from current and emerging lung cancer prevention and control interventions. Lung cancer is the leading cause of cancer death in the United States. 1 It is the most commonly diagnosed cancer among men and women combined and is associated with very low survival rates. 2 More than 90% of deaths from lung cancer are caused by cigarette smoking and exposure to secondhand smoke. 3 Efforts to reduce lung cancer mortality have focused on the primary prevention of environmental risk factors and exposures, and public health efforts to limit tobacco exposure have effectively reduced the lung cancer burden among men and women in the United States. 3 Lung cancer is a particularly important public health issue among American Indians/Alaska Natives (AI/ANs) because they typically report higher prevalence of daily cigarette use and their declines in tobacco use have lagged behind those of other racial/ethnic groups. 4 Historically, screening technologies have had limited impact on lung cancer mortality. Now, low-dose computerized tomography (CT) scans for the early detection of lung cancer in individuals with a significant history of tobacco use are an emerging cancer control strategy. 5 However, unless adequate infrastructure, technical capacity, and access to treatment are in place, lack of access to these screening methods may have a disproportionate impact on the AI/AN population as a result of the greater rural distribution and lower rates of health insurance coverage of this population. 6 Comparison of lung cancer mortality between AI/AN and White persons can serve as an important indicator of disparities in the quality of risk reduction interventions, access to care, and quality and timeliness of treatment options. However, misclassification of AI/AN race is common in both state and national databases. 7 The Indian Health Service (IHS) patient registration database contains records of individuals who are members of federally recognized tribes. Linking these data with incidence and mortality data has helped correct some of the race misclassification in these data sets. 7 In this article, we examine national, geographic, and demographic trends in AI/AN lung cancer mortality from 1990 to 2009 using a linked data set to address previous misclassification. We correlate our findings with trends in tobacco use and lung cancer mortality and discuss the implications for comprehensive tobacco control and lung cancer screening.
