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Comparative Study
. 2014 Jun;104 Suppl 3(Suppl 3):S446-52.
doi: 10.2105/AJPH.2013.301721. Epub 2014 Apr 22.

Infectious disease mortality among American Indians and Alaska Natives, 1999-2009

James E Cheek  1 , Robert C Holman, John T Redd, Dana Haberling, Thomas W Hennessy
Affiliations
Comparative Study

Infectious disease mortality among American Indians and Alaska Natives, 1999-2009

James E Cheek et al. Am J Public Health. 2014 Jun.

Abstract

Objectives: We described death rates and leading causes of death caused by infectious diseases (IDs) in American Indian/Alaska Native (AI/AN) persons. Methods. We analyzed national mortality data, adjusted for AI/AN race by linkage with Indian Health Service registration records, for all US counties and Contract Health Service Delivery Area (CHSDA) counties. The average annual 1999 to 2009 ID death rates per 100,000 persons for AI/AN persons were compared with corresponding rates for Whites.

Results: The ID death rate in AI/AN populations was significantly higher than that of Whites. A reported 8429 ID deaths (rate 86.2) in CHSDA counties occurred among AI/AN persons; the rate was significantly higher than the rate in Whites (44.0; rate ratio [RR] = 1.96; 95% confidence interval [CI] = 1.91, 2.00). The rates for the top 10 ID underlying causes of death were significantly higher for AI/AN persons than those for Whites. Lower respiratory tract infection and septicemia were the top-ranked causes. The greatest relative rate disparity was for tuberculosis (RR = 13.51; 95% CI = 11.36, 15.93).

Conclusions: Health equity might be furthered by expansion of interventions to reduce IDs among AI/AN communities.

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Figures

FIGURE 1—
FIGURE 1—
Leading 10 infectious death groups as proportion of total infectious disease deaths for (a) American Indians/Alaska Natives and (b) Whites: Contract Health Service Delivery Area Counties, United States, 1999–2009. Note. AI/AN = American Indian/Alaska Native; CHSDA = Contract Health Service Delivery Area. AI/AN race is created using death certificate race and Indian Health Service Link. Percentage of AI/AN in CHSDA counties: Northern Plains = 64.8%; Alaska = 100%; Southern Plains = 76.3%; Southwest = 91.3%; Pacific Coast = 71.3%; East = 18.2%; total US = 64.2%. Source. AI/AN Mortality Database (AMD 1990–2009). Analyses are limited to persons of non-Hispanic origin.
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