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Comparative Study
. 2014 Jun;104 Suppl 3(Suppl 3):S368-76.
doi: 10.2105/AJPH.2013.301698. Epub 2014 Apr 22.

Trends and disparities in stroke mortality by region for American Indians and Alaska Natives

Linda J Schieb  1 , Carma Ayala, Amy L Valderrama, Mark A Veazie
Affiliations
Comparative Study

Trends and disparities in stroke mortality by region for American Indians and Alaska Natives

Linda J Schieb et al. Am J Public Health. 2014 Jun.

Abstract

Objectives: We evaluated trends and disparities in stroke death rates for American Indians and Alaska Natives (AI/ANs) and White people by Indian Health Service region.

Methods: We identified stroke deaths among AI/AN persons and Whites (adults aged 35 years or older) using National Vital Statistics System data for 1990 to 2009. We used linkages with Indian Health Service patient registration data to adjust for misclassification of race for AI/AN persons. Analyses excluded Hispanics and focused on Contract Health Service Delivery Area (CHSDA) counties.

Results: Stroke death rates among AI/AN individuals were higher than among Whites for both men and women in CHSDA counties and were highest in the youngest age groups. Rates and AI/AN:White rate ratios varied by region, with the highest in Alaska and the lowest in the Southwest. Stroke death rates among AI/AN persons decreased in all regions beginning in 2001.

Conclusions: Although stroke death rates among AI/AN populations have decreased over time, rates are still higher for AI/AN persons than for Whites. Interventions that address reducing stroke risk factors, increasing awareness of stroke symptoms, and increasing access to specialty care for stroke may be more successful at reducing disparities in stroke death rates.

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Figures

FIGURE 1—
FIGURE 1—
Age-standardized stroke death rates and trend lines for American Indian/Alaska Native and White persons, Contract Health Service Delivery Area counties: United States, 1990–2009. Note. AI/AN = American Indian/Alaska Native; CI = confidence interval. Analyses are limited to people of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the Indian Health Service patient registration database. Rates are per 100 000 people and are age-adjusted to the 2000 US standard population (6 age groups; Census P25-1130). Stroke was defined using International Classification of Diseases, Tenth Edition (codes I60–I69) and International Classification of Diseases, Ninth Edition (codes 430–434, 436–438). Source. AI/AN Mortality Database (1990–2009). Data are based on linked Indian Health Service-National Vital Statistics System mortality files. The following states and years of data were excluded because Hispanic origin was not collected on the death certificate: LA, 1990; NH, 1990–1992; OK, 1990–1996. *P < .05.
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