摘要：Objectives. We determined all-cause, cardiovascular disease (CVD), and cancer mortality in western Alaska Native people and examined agreement between death certificate information and adjudicated cause of deaths. Methods. Data from 4 cohort studies were consolidated. Death certificates and medical records were reviewed and adjudicated according to standard criteria. We compared adjudicated CVD and cancer deaths with death certificates by calculating sensitivity, specificity, predictive values, and κ statistics. Results. Men (n = 2116) and women (n = 2453), aged 18 to 95 years, were followed an average of 6.7 years. The major cause of death in men was trauma (25%), followed by CVD (19%) and cancer (13%). The major cause of death in women was CVD (24%), followed by cancer (19%) and trauma (8%). Stroke rates in both genders were higher than those of US Whites. Only 56% of deaths classified as CVD by death certificate were classified as CVD by standard criteria; discordance was higher among men (55%) than women (32%; κs = 0.4 and 0.7). Conclusions. We found lower rates for coronary heart disease death but high rates of stroke mortality. Death certificates overestimated CVD mortality; concordance between the 2 methods is better for cancer mortality. The results point to the importance of cohort studies in this population in providing data to assist in health care planning. Like many other indigenous populations, western Alaska Native people (i.e., those living in the remote coastal communities of the Norton Sound and Yukon–Kuskokwim regions of southwest Alaska) have undergone rapid changes in lifestyle during the past half century. The Norton Sound communities are primarily Inupiat and the Yukon–Kuskokwim communities are primarily Central Yup’ik, although these regions also include the Cup’ik and Siberian Yup’ik ethnic subgroups. 1 Previously, life spans were shorter, and mortality resulting from infection predominated. 2,3 Although life expectancy has increased with improved access to health care under the Indian Health Service, from 46 years in the mid-1950s 4 to 70.5 years in 2008, 5,6 chronic disease has also increased, as has exposure to a Westernized diet and lifestyle. 7–9 Alaska state health data 2,3 and Indian Health Service records 10 have shown that a large proportion of nontraumatic deaths in these communities is caused by cardiovascular disease (CVD). Chronic diseases appear to be common in other comparable indigenous Arctic groups 11–17 ; however, these reports have relied on death certificate data alone rather than systematic review of medical records from population-based cohorts and, therefore, may not accurately represent disease burden in these communities. 18 Such data are essential for designing effective surveillance and prevention programs to improve health in this population. The Western Alaska Tribal Collaborative for Health (WATCH) study combines 4 major cohorts residing in the Norton Sound and Yukon–Kuskokwim Delta regions of western Alaska, providing the first consolidated cohort large enough to produce reliable data on health outcomes among Alaska Native communities in these 2 regions. We ascertained all deaths occurring after the baseline examinations and reviewed medical records for all deaths. Our objectives were to present data on all-cause, CVD, and cancer mortality; compare these data with data for the US White population; and compare adjudicated population-based CVD and cancer mortality rates with those obtained from death certificates.
