摘要：Objectives. We used race-corrected data and comprehensive diagnostic codes to better compare HIV and tuberculosis (TB) mortality from 1999 to 2009 between American Indian/Alaska Natives (AI/ANs) and Whites. Methods. National Vital Statistics Surveillance System mortality data were adjusted for AI/AN racial misclassification through linkage with Indian Health Service registration records. We compared average annual 1990 to 2009 HIV and TB death rates (per 100 000 people) for AI/AN persons with those for Whites; Hispanics were excluded. Results. Although death rates from HIV in AI/AN persons were significantly lower than those in Whites from 1990 to 1998 (4.2 vs 7.0), they were significantly higher than those in Whites from 1999 to 2009 (3.6 vs 2.0). Death rates from TB in AI/AN persons were significantly higher than those in Whites, with a significant disparity during both 1990 to 1998 (3.3 vs 0.3) and 1999 to 2009 (1.5 vs 0.1). Conclusions. The decrease in death rates from HIV and TB was greater among Whites, and death rates remained significantly higher among AI/AN individuals. Public health interventions need to be prioritized to reduce the TB and HIV burden and mortality in AI/AN populations. HIV/AIDS and tuberculosis (TB) are among the top 10 causes of death worldwide and among the top 10 infectious disease causes of death for American Indian/Alaska Natives (AI/ANs). 1,2 Fewer deaths from HIV and TB is an important objective of HIV and TB control programs; key international targets include reducing deaths from HIV infection by 10% and halving TB deaths by 2015 compared with 1990 levels. 3,4 Monitoring trends in deaths resulting from HIV and TB is important for informing and prioritizing programmatic and research efforts and planning interventions, as well as assessing progress in reducing the burden of premature and preventable deaths. Since 1981, an estimated 1.7 million people have been infected with HIV in the United States, including more than 600 000 who have died. 5,6 Although absolute numbers of HIV infection remain small among AI/AN communities, AI/AN populations continue to feel the impact of the HIV epidemic. Surveillance data from the Centers for Disease Control and Prevention (CDC) have indicated that an estimated 3194 non-Hispanic AI/AN persons were living with HIV at the end of 2010, a rate of 141 per 100 000. 5 Although the prevalence of HIV infection among non-Hispanic AI/AN persons is lower than among most other racial and ethnic groups (with the exception of non-Hispanic Whites and Asians), non-Hispanic AI/AN individuals have the shortest survival time from AIDS diagnosis to death. 5,7 In 2012, a total of 9945 new TB cases were reported in the United States, an incidence of 3.2 cases per 100 000 population. 8 Deaths resulting from TB decreased from 1810 (0.7/100 000) in 1990 to 569 (0.2/100 000) in 2009, the most recent year for which data are available. 8 Racial and ethnic minorities, including AI/AN populations, continue to be disproportionately affected by TB in the United States. In 2012, the incidences of TB among AI/ANs and non-Hispanic Whites were 6.3 and 0.8 per 100 000 population, respectively, a decrease from 14 and 3.6 per 100 000, respectively, in 1993. 8 Although progress has been made over the past decades in reducing the morbidity and mortality of TB in AI/AN persons, during 2011 and 2012, non-Hispanic AI/AN persons were the only racial/ethnic group that experienced an increase in case rate. 7 Furthermore, previous studies have shown that AI/AN individuals are more than twice as likely as other racial/ethnic groups to die during TB treatment, 9 highlighting the need for continued and improved TB control efforts in this population. Reducing HIV-related death in communities at high risk for HIV infection 10 and reducing the burden of TB in specific racial/ethnic populations 11 are priorities of the US government. Although surveillance data are available to monitor morbidity, mortality estimates among AI/AN populations have been limited, mainly as a result of racial misclassification. 12,13 We conducted this study to better document the burden of HIV and TB mortality among AI/AN persons from 1990 to 2009 by using national mortality data linked with Indian Health Service (IHS) patient registration data to improve racial classification of AI/AN individuals.
