摘要：Objectives. We describe the burden of unintentional injury (UI) deaths among American Indian and Alaska Native (AI/AN) populations in the United States. Methods. National Death Index records for 1990 to 2009 were linked with Indian Health Service registration records to identify AI/AN deaths misclassified as non-AI/AN deaths. Most analyses were restricted to Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted death rates for AI/AN persons with those for Whites; Hispanics were excluded. Results. From 2005 to 2009, the UI death rate for AI/AN people was 2.4 times higher than for Whites. Death rates for the 3 leading causes of UI death—motor vehicle traffic crashes, poisoning, and falls—were 1.4 to 3 times higher among AI/AN persons than among Whites. UI death rates were higher among AI/AN males than among females and highest among AI/AN persons in Alaska, the Northern Plains, and the Southwest. Conclusions. AI/AN persons had consistently higher UI death rates than did Whites. This disparity in overall rates coupled with recent increases in unintentional poisoning deaths requires that injury prevention be a major priority for improving health and preventing death among AI/AN populations. Unintentional injuries (UIs) were the leading cause of death for people aged 1 to 44 years and the fifth leading cause of death for infants and all age groups combined in the United States. 1 Numerous studies have shown that American Indians and Alaska Natives (AI/ANs) have been disproportionately affected by unintentional injury, the third leading cause of death in this population. 1–5 Although UI death rates among the AI/AN population in Indian Health Service (IHS) areas decreased nearly 60% in the last 3 decades of the 20th century, disparities between AI/AN and White populations persisted. 3 From 2002 to 2004, the AI/AN unintentional injury death rate was 2.5 times higher than that for Whites. 5 The disparity may be even more pronounced because AI/AN race is frequently misreported on death certificates. An evaluation of the quality of reporting of race on death certificates performed by the National Center for Health Statistics indicated that AI/AN race is underreported in national mortality data by approximately 21%. 6 Another study that linked state death certificates with IHS patient registration files showed that approximately 9% of AI/AN persons who died from 1996 to 1998 were incorrectly classified. 7 We added to the current literature by updating UI death rates among AI/AN people from 2005 to 2009 by IHS Contract Health Service Delivery Areas (CHSDAs), injury mechanism, sex, and age. Furthermore, we provide more accurate rates by race through linkage of death records with IHS registration records and describe UI death trends from 1990 to 2009. Improved quality of surveillance data for UI deaths will better inform public health strategies to reduce and prevent UIs among the AI/AN population.
