摘要：Objectives. We linked databases to improve identification of American Indians/Alaska Natives (AI/ANs) in determining prostate cancer death and incidence rates. Methods. We linked prostate cancer mortality and incidence data with Indian Health Service (IHS) patient records; analyses focused on residents of IHS Contract Health Service Delivery Area (CHSDA) counties. We calculated age-adjusted incidence and death rates for AI/AN and White men for 1999 to 2009; men of Hispanic origin were excluded. Results. Prostate cancer death rates were higher for AI/AN men than for White men. Death rates declined for White men (−3.0% per year) but not for AI/AN men. AI/AN men had lower prostate cancer incidence rates than White men. Incidence rates declined among Whites (−2.2% per year) and AI/ANs (−1.9% per year). Conclusions. AI/AN men had higher prostate cancer death rates and lower prostate cancer incidence rates than White men. Disparities in accessing health care could contribute to mortality differences, and incidence differences could be related to lower prostate-specific antigen testing rates among AI/AN men. Prostate cancer is the most frequently diagnosed visceral cancer and the second leading cause of cancer death among men in the United States. 1 However, the cancer burden for American Indian/Alaska Native (AI/AN) men appears to be less than for most other racial/ethnic groups. According to 2010 US Cancer Statistics data, 1 AI/AN men have the second lowest incidence rate of prostate cancer (66.8/100 000) and the 2nd lowest death rate (15.2/100 000) in the United States. The lifetime risks of prostate cancer diagnosis and death among AI/AN men are 7.59% and 2.20%, respectively. 2 By contrast, the overall US lifetime risks of prostate cancer diagnosis and death are 16.15% and 2.75%, respectively. Estimating cancer death and incidence rates for AI/AN men has, however, been problematic because race is often misclassified in vital statistics and cancer registries. 3,4 The most accurate death and incidence rates are based on Indian Health Service (IHS) Contract Health Services Delivery Area (CHSDA) counties, which generally contain federally recognized tribal lands or are adjacent to tribal lands. 5–7 However, even though some analyses using data from the Surveillance, Epidemiology, and End Results (SEER) Program and the Centers for Disease Control and Prevention’s National Program of Cancer Registries (NPCR) have been limited to CHSDA counties, 8 potential race misclassification still exists. Consequently, IHS registration records have previously been linked with NPCR and SEER registries to more accurately identify AI/AN race in calculating cancer incidence statistics. 9 In this report, we updated prostate cancer incidence data and provided the first prostate cancer mortality data based on the improved AI/AN classification using linkages between IHS and (1) cancer registry and (2) National Death Index and National Vital Statistics System public use mortality data files. 6,10 We compared age-adjusted and age-specific prostate cancer death and incidence rates between AI/AN men and White men from 1999 to 2009.
