摘要：Objectives. We compared the historical method of calculating cancer incidence rates with 2 new methods to determine which approach optimally estimates the burden of cancer among the Northwest American Indian/Alaska Native (AIAN) population. Methods. The first method replicates the traditional way of calculating race-specific rates, and the 2 new methods use probabilistic record linkages to ascertain cancer cases. We indirectly adjusted all rates to the standard 2000 US population. Results. Whereas the historical cancer incidence rates for all races are more than double those for the AIAN population, this apparent gap is considerably narrower when the all-race rates are compared with AIAN-specific rates calculated with probabilistic linkage methods. Similarly, there is no meaningful difference in incidence rates for selected site- and gender-specific cancers between the AIAN population and all races combined, and, in fact, some of these rates may be higher among the AIAN population. Conclusions. Our results suggest that the burden of cancer among the AIAN population is considerably higher than was previously understood. We recommend that a standardized approach based on probabilistic linkage methods be adopted and that adequate financial and technical support be made available for conducting routine linkage studies throughout Indian communities. More than 190 000 American Indians and Alaska Natives reside in Idaho, Oregon, and Washington, representing 6.3% of the nation’s American Indian/Alaska Native (AIAN) population. 1 The 43 federally recognized tribes of the Northwest vary in population size, culture, and geographic location. Indian reservations are dispersed across vast distances in the Northwest, usually in isolated, sparsely populated areas. AIAN health care delivery faces many challenges, including the fact that AIAN communities frequently lag behind their non-AIAN neighbors in receiving basic health services. Previous efforts to characterize the burden of cancer among the AIAN population have found lower rates of cancer incidence and mortality in that population compared with other racial groups. 2, 3 However, evidence suggests that these previous estimates may undercount AIAN cancers as a result of racial misclassification in state cancer registries and other public health data sets. 4– 12 To design and target effective intervention programs and to justify increased resources to fund such activities, we must obtain health status data that are accurate and complete. This imperative demands resolution of misclassification of the AIAN population and also indicates the need for a standard method for calculating AIAN cancer estimates so that rates are comparable over time and from place to place. We conducted this analysis to compare historical methods of calculating AIAN cancer incidence with 2 new methods to determine which approach optimally describes the true burden of cancer among the Northwest AIAN population.
