摘要：Objectives. We describe rates and trends in kidney cancer incidence and mortality and identify disparities between American Indian/Alaska Native (AI/AN) and White populations. Methods. To improve identification of AI/AN race, incidence and mortality data were linked with Indian Health Service (IHS) patient records. Analysis focused on residents of IHS Contract Health Service Delivery Area counties; Hispanics were excluded. We calculated age-adjusted kidney cancer incidence (2001–2009) and death rates (1990–2009) by sex, age, and IHS region. Results. AI/AN persons have a 1.6 times higher kidney cancer incidence and a 1.9 times higher kidney cancer death rate than Whites. Despite a significant decline in kidney cancer death rates for Whites (annual percentage change [APC] = −0.3; 95% confidence interval [CI] = −0.5, 0.0), death rates for AI/AN persons remained stable (APC = 0.4; 95% CI = −0.7, 1.5). Kidney cancer incidence rates rose more rapidly for AI/AN persons (APC = 3.5; 95% CI = 1.2, 5.8) than for Whites (APC = 2.1; 95% CI = 1.4, 2.8). Conclusions. AI/AN individuals have greater risk of developing and dying of kidney cancers. Incidence rates have increased faster in AI/AN populations than in Whites. Death rates have decreased slightly in Whites but remained stable in AI/AN populations. Racial disparities in kidney cancer are widening. More than 80% of kidney cancers arise in the renal parenchyma, primarily renal cell carcinoma (RCC), and the remainder originate from the renal pelvis, called renal transitional cell carcinoma (RTCC) or urothelial carcinoma (UC). 1 An assessment of Surveillance, Epidemiology, and End Results (SEER) program data revealed that incidence rates of RCC and death rates for kidney cancer increased from 1975 to 1995. 2 Recent studies have shown that kidney cancer incidence has continued to increase in the United States for all racial/ethnic groups. 3,4 Kidney cancer is an important public health issue for American Indians and Alaska Natives (AI/ANs), ranking among the top 5 cancers for both incidence and mortality. 3,5 AI/AN persons are at greater risk for developing and dying of kidney cancers than other racial/ethnic groups. 3,5,6 Data on AI/AN persons have not been presented in many population-based studies of kidney cancer 2,7,8,9 because sample sizes were too small, even in surveillance systems that collect cancer incidence and mortality for the US population. Available information in the literature that describes demographic and geographic attributes of kidney cancer among AI/AN populations needs to be updated. 5,10,11 Accurate cancer incidence and death rates play an important role in identifying areas for etiologic research, prioritizing cancer control resources, and developing cancer control and prevention approaches. Race misclassification of AI/AN cancer cases and deaths, resulting in underestimates of the true cancer burden in this population, is another recognized issue. 12–15 To minimize the misclassification of race, the Indian Health Service (IHS) patient registration database was linked to data from the National Death Index, providing an excellent opportunity to generate more accurate cancer mortality statistics for AI/ANs. A previous linkage between IHS patient files and cancer registry data provided more accurate estimations of AI/AN cancer incidence; we present updated results. 5,11,12 The purpose of this article was to describe kidney cancer burden in AI/AN populations and characterize racial disparity by demographic, geographic, and temporal factors using Whites as a reference group.
