Mortality trends among Alaska Native people: successes and challenges

Figures & data

Table I. Leading causes of death, Alaska Native people (2004–2008) versus US whites (2004–2006)

Rank	Cause	ICD-10 definition	Deaths	Proportion (%)	Rate	USW deaths	Proportion (%)	Rate	RR	95% CI
1	Cancer	C00-C97	772	20.4	226.3	1,442,824	23.12	182.4	1.24*	1.15–1.33
2	Heart disease	I00–I09, I11, I13, I20–I51	540	14.3	169.0	1,676,390	26.9	205.1	0.82*	0.75–0.90
3	Unintentional injury	V01–X59, Y85–Y86	493	13.0	97.7	299,968	4.8	39.9	2.45*	2.23–2.69
4	Suicide	X60–X84, Y87.0	252	6.7	42.4	88,895	1.4	12.0	3.53*	3.1–4.00
5	Alcohol abuse	F10	180	4.8	38.7	18,536	0.3	2.4	16.13*	13.83–18.7
6	COPD	J40–J47	172	4.5	57.3	348,784	5.6	43.7	1.31*	1.12–1.53
7	Cerebrovascular diseases	I60–I69	164	4.3	56.7	365,596	5.9	44.5	1.27*	1.09–1.49
8	Chronic liver disease	K70, K73–K74	82	2.2	18.0	71,749	1.2	9.2	1.96*	1.57–2.44
9	Pneumonia influenza	J10–J18	77	2.0	25.5	157,366	2.5	19.0	1.34*	1.06–1.70
10	Homicide	U01–U02, X85–Y09, Y87.1	58	1.5	11.2	27,053	0.4	3.8	2.95*	2.27–3.88
	All others		999	26.4	290.3	1,734,457	27.8	214.6	1.35*	1.53–1.65
	All causes		3,789	100.00	1033.3	6,231,636	100.0	776.6	1.33*	1.29–1.38
Males
1	Cancer	C00–C97	392	18.9	258.3	748,239	24.5	222.4	1.16*	1.04–1.29
2	Unintentional injury	V01–X59, Y85–Y86	359	17.3	143.7	192,553	6.3	55.0	2.61*	2.33–2.93
3	Heart disease	I00–I09, I11, I13, I20–I51	311	15.0	219	830,291	27.2	256.5	0.85*	0.76–0.97
4	Suicide	X60–X84, Y87.0	189	9.1	62.8	70,306	2.3	19.6	3.20*	2.76–3.72
5	Alcohol abuse	F10	93	4.5	42.4	14,469	0.5	3.9	10.87*	8.80–13.55
6	COPD	J40–J47	80	3.9	59.5	164,571	5.4	51.3	1.16	0.92–1.47
7	Cerebrovascular diseases	I60–I69	72	3.5	58.9	141,685	4.6	44.9	1.31*	1.02–1.69
8	Homicide	U01–U02, X85–Y09, Y87.1	38	1.8	14.5	20,035	0.7	5.5	2.64*	1.87–3.65
9	Pneumonia influenza	J10–J18	37	1.8	33.1	70,079	2.3	22.6	1.46*	1.02–2.08
10	Chronic liver disease	K70, K73–K74	29	1.4	13.2	46,747	1.5	12.7	1.04	0.72–1.51
	All others		471	22.7	306.9	685,398	22.4	234.1	1.31*	1.61–1.77
	All causes		2,071	100.0	1212	3,057,220	100.0	928.5	1.31*	1.24–1.37
Females
1	Cancer	C00–C97	379	22.01	203.7	694,585	21.9	155.0	1.31*	1.19–1.46
2	Heart disease	I00–I09, I11, I13, I20–I51	229	13.3	129.6	846,099	26.7	164.9	0.79*	0.69–0.90
3	Unintentional injury	V01–X59, Y85–Y86	134	7.8	53.0	107,415	3.4	25.8	2.05*	1.75–2.46
4	Cerebrovascular diseases	I60–I69	92	5.46	54.9	223,911	7.1	43.6	1.26*	1.02–1.55
5	COPD	J40–J47	92	5.4	55.5	184,213	5.9	39.0	1.42*	1.15–1.75
6	Alcohol abuse	F10	87	5.1	36.4	4,067	0.1	1.0	36.10*	28.35–43.6
7	Suicide	X60–X84, Y87.0	63	3.7	21.4	18,589	0.6	5.0	4.28*	3.33–5.55
8	Chronic liver disease	K70, K73–K74	53	3.1	22.6	25,002	0.8	6.0	3.77*	2.87–4.96
9	Pneumonia influenza	J10–J18	40	2.3	22.0	87,287	2.8	16.7	1.32	0.95–1.82
10	Alzheimer's disease	G30	30	1.8	19.8	138,117	4.4	25.1	0.79	0.55–1.13
	All others		518	30.2	267.3	892,570	28.1	171.6	1.56*	1.42–1.70
	All causes		1,717	100.0	886.2	3,174,416	100.0	656	1.35*	1.29–1.42

Note: individual proportions may not sum to 100% due to rounding.

Table II. AN/AI deaths by age, sex: 2004–2008

	Male		Female			95% CI
Age	Deaths	Rate	Deaths	Rate	Rate ratio	Lower	Upper
0–4 years
Unintentional injury	23	80.6	12	44.1	1.8*	1.21	5.29
Perinatal conditions	20	70.1	13	47.8	1.5	0.69	3.21
Congenital abnormalities	12	42	16	58.8	0.7	0.31	1.61
Pneumonia and influenza	–	–	5	18.4	–	–	–
All causes	98	343.3	75	275.6	1.2*	1.27	2.37
Population	28,549	27,214
5–14 years
Unintentional	26	48.4	9	18.5	2.6*	1.72	7.88
Suicide	–	–	5	9.5	–	–	–
All causes	35	64.8	21	42.2	1.5*	1.26	3.72
Population	53,284	49,198
15–24 years
Suicide	80	145.3	26	50.2	2.9*	2.59	6.29
Unintentional injury	67	122.7	16	29.9	4.1*	3.29	9.81
Homicide	9	15.9	–	–	–	–	–
All causes	181	329.8	63	121	2.7*	2.85	5.06
Population	55,309	51,943
25–44 years
Unintentional injury	126	166.8	46	63.2	2.6*	2.93	5.78
Suicide	76	96.2	26	35.3	2.7*	2.69	6.62
Alcohol abuse	29	40.1	39	54.2	0.7	0.46	1.2
Cancer	21	29.4	26	36.5	0.8	0.7	2.23
Heart disease	24	32.9	16	21.4	1.5*	1.26	4.51
Homicide	17	23.7	10	13	1.8	0.83	4.01
Chronic liver disease	6	8.5	19	26.9	0.3	0.24	1.41
HIV	5	6.9	5	7.5	0.9	0.37	3.22
Diabetes mellitus	5	6.9	–	–	–	–	–
Cerebrovascular diseases	–	–	7	9.9	–	–	–
All causes	351	469.1	244	338.7	1.4*	1.83	2.54
Population	75,752	74,260
45–54 years
Cancer	61	184.4	45	128	1.4*	1.3	2.82
Unintentional injury	57	171.4	27	75.7	2.3*	1.91	4.78
Heart disease	46	139.8	26	74	1.9*	1.59	4.15
Alcohol abuse	28	84	28	79.3	1.1	0.61	1.86
Chronic liver disease	7	21	17	47.8	0.4	0.24	1.41
Cerebrovascular diseases	5	15.4	8	22.7	0.7	0.29	2.75
COPD	7	21.3	5	14.5	1.5	0.62	6.16
Suicide	22	66	–	–	–	–	–
HIV	5	15.1	–	–	–	–	–
Diabetes mellitus	–	–	6	17	–	–	–
Septicaemia	–	–	5	14.3	–	–	–
All causes	292	881.1	215	610.8	1.4*	1.61	2.29
Population	33,320	35,322
55–64 years
Cancer	75	391.4	89	431	0.9	0.88	1.64
Heart disease	52	267.8	25	121.4	2.2*	1.85	4.81
Unintentional injury	23	116.2	6	30	3.9*	2.09	12.65
COPD	14	77.2	12	58.5	1.3	0.8	3.78
Chronic liver disease	13	67.4	12	56.9	1.2	0.72	3.45
Cerebrovascular diseases	11	58.6	6	29.2	2	0.98	7.19
Pneumonia/Influenza	5	27.3	5	26.3	1	0.39	4.72
Diabetes mellitus	–	–	7	33.7	–	–	–
Nephritis	–	–	5	25.5	–	–	–
Septicaemia	–	–	5	23.2	–	–	–
All causes	278	1444.4	225	1099.1	1.3*	1.46	2.08
Population	19,475	20,832
65–74 years
Cancer	127	1251.8	107	918.1	1.4*	1.32	2.22
Heart disease	79	782.1	47	403.5	1.9*	1.66	3.41
COPD	29	290.9	28	240.8	1.2	0.89	2.53
Cerebrovascular diseases	15	148.7	14	121.2	1.2	0.73	3.15
Unintentional injury	15	146.5	5	42.6	3.4*	1.59	12.06
Diabetes mellitus	7	68.9	6	51.8	1.3	0.56	4.94
Nephritis	5	47.4	–	–	–	–	–
Pneumonia/Influenza	5	49.6	–	–	–	–	–
All causes	351	3460.1	265	2273.5	1.5*	1.63	2.25
Population	10,490	11,685
75+ years
Heart disease	108	1903.2	111	1240.6	1.5*	1.14	1.95
Cancer	106	1779.4	110	1272.3	1.4*	1.07	1.83
Cerebrovascular diseases	38	676.7	56	631.4	1.1	0.7	1.63
COPD	29	502.2	47	538.6	0.9	0.58	1.49
Unintentional injury	22	354	13	143.4	2.5*	1.23	4.94
Pneumonia/Influenza	21	416.1	21	235.3	1.8	0.96	3.27
Parkinson's disease	10	177.3	5	56.4	3.1*	1.06	9.33
Hypertension	8	165.8	7	75.7	2.2	0.78	6.14
Alzheimer's disease	7	144.6	28	311	0.5	0.2	1.08
Diabetes mellitus	7	125.1	10	116	1.1	0.4	2.89
Nephritis	5	93.4	10	113.7	0.8	0.27	2.47
Septicaemia	5	86.3	10	116.1	0.7	0.25	2.22
All causes	485	8619.4	609	6873.8	1.3*	1.11	1.42
Population	6,083	8,727

Results for categories with fewer than five deaths not presented. *95% Confidence Interval of RR does not contain the value one.

Table III. Current top ten causes over time for AN/AI persons , rates per 100,000

Period	Cancer	Heart disease	Unintentional injury	Suicide	Alcohol abuse	COPD	Cerebrovascular disease	Chronic liver disease	Pneumonia/influenza	Homicide	All causes
1980–1983	224.3	270.9	184.1	41.8	28.8	26.2	64.5	28.1	52.2	36.8	1234
1984–1988	243.3	288.1	174.0	49.5	23.2	44.5	65.1	20.4	60.5	22.6	1226.5
1989–1993	245.4	271.9	133.1	46.8	20.6	58.4	67.5	26.8	56.2	18.7	1202.1
1994–1998	248.9	252.0	111.7	42.8	31.7	68.3	84.1	18.3	39.6	16.1	1151.6
1999–2003	239.5	211.6	107.4	34.7	40.9	63.0	66.5	19.4	35.8	16.8	1111.6
2004–2008	226.3	169.0	97.7	42.3	38.7	57.3	56.7	18.0	25.5	11.2	1033.3
% change	NS	−38	−47	NS	34	119	NS	−36	−51	−70	−16
US whites
1980–1983	203.9	395.1	42.6	13.1	2.0	30.5	85.4	12.9	29.2	6.2	982.7
1984–1988	207.6	362.5	39.1	13.5	1.9	35.8	72.0	11.3	34.2	5.3	955.8
1989–1993	209.9	310.2	35.5	13.0	2.2	39.2	61.5	10.3	34.6	5.6	898.6
1994–1998	202.9	280.2	35.1	12.4	2.3	42.2	59.6	9.6	33.2	4.7	867.5
1999–2003	193.5	243.6	36.4	11.6	2.2	45.8	55.6	9.6	22.5	4.0	834.6
2004–2006	182.4	205.1	39.9	12.0	2.4	43.7	44.5	9.2	19.0	3.8	776.6
% change	−11	−48	−6	−8	20	43	−48	−29	−35	−39	−21

% change=(2004–2008 rate – 1980–1983 rate)/(1980–1983 rate).