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Comparative Study
. 2014 Jun;104 Suppl 3(Suppl 3):S404-14.
doi: 10.2105/AJPH.2013.301654. Epub 2014 Apr 22.

Geographic variation in colorectal cancer incidence and mortality, age of onset, and stage at diagnosis among American Indian and Alaska Native people, 1990-2009

David G Perdue  1 , Donald Haverkamp, Carin Perkins, Christine Makosky Daley, Ellen Provost
Affiliations
Comparative Study

Geographic variation in colorectal cancer incidence and mortality, age of onset, and stage at diagnosis among American Indian and Alaska Native people, 1990-2009

David G Perdue et al. Am J Public Health. 2014 Jun.

Abstract

Objectives: We characterized estimates of colorectal cancer (CRC) in American Indians/Alaska Natives (AI/ANs) compared with Whites using a linkage methodology to improve AI/AN classification in incidence and mortality data.

Methods: We linked incidence and mortality data to Indian Health Service enrollment records. Our analyses were restricted to Contract Health Services Delivery Area counties. We analyzed death and incidence rates of CRC for AI/AN persons and Whites by 6 regions from 1999 to 2009. Trends were described using linear modeling.

Results: The AI/AN colorectal cancer incidence was 21% higher and mortality 39% higher than in Whites. Although incidence and mortality significantly declined among Whites, AI/AN incidence did not change significantly, and mortality declined only in the Northern Plains. AI/AN persons had a higher incidence of CRC than Whites in all ages and were more often diagnosed with late stage CRC than Whites.

Conclusions: Compared with Whites, AI/AN individuals in many regions had a higher burden of CRC and stable or increasing CRC mortality. An understanding of the factors driving these regional disparities could offer critical insights for prevention and control programs.

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Figures

FIGURE 1—
FIGURE 1—
States and Contract Health Service Delivery Area (CHSDA) Counties by Indian Health Service Region: Colorectal Cancer Mortality and Incidence in American Indian/Alaska Native Persons, 1999–2009.
See this image and copyright information in PMC

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