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. 2005 May;95(5):838-43.
doi: 10.2105/AJPH.2004.053769.

Measuring the health status gap for American Indians/Alaska Natives: getting closer to the truth

Emily Puukka  1 , Paul Stehr-Green, Thomas M Becker
Affiliations

Measuring the health status gap for American Indians/Alaska Natives: getting closer to the truth

Emily Puukka et al. Am J Public Health. 2005 May.

Abstract

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.

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Figures

FIGURE 1—
FIGURE 1—
Derivation of numerator and denominator data, by calculation method.…Note. AIAN = American Indian/Alaska Native; NCHS = National Center for Health Statistics; n = number of cases; N = number of population. aExcludes all in situ cases except urinary bladder. bAverage population from 1996 to 1999.
FIGURE 2—
FIGURE 2—
Age-adjusted cancer incidence rates among men, by race and calculation method: Idaho, Oregon, and Washington, 1996–1999.…Note. AIAN = American Indian/Alaska Native. Rates are per 100 000 population (with 95% confidence intervals) adjusted to the 2000 US standard population, excluding all non–urinary bladder in situ cases.
FIGURE 3—
FIGURE 3—
Age-adjusted cancer incidence rates among women, by race and calculation method: Idaho, Oregon, and Washington, 1996–1999.…Note. AIAN = American Indian/Alaska Native. Rates are per 100 000 population (with 95% confidence intervals) adjusted to the 2000 US standard population, excluding all non–urinary bladder in situ cases.
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References

    1. National Center for Health Statistics. Data Files and Documentation. Bridged-race vintage 2002 post-censal population estimates for July 1, 2000–July 1, 2002, by year, county, single-year of age, bridged-race, Hispanic origin, and sex. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/datadoc.htm#vintage2002. Accessed May 20, 2004.
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