Patterns of cancer mortality among Native Americans.
BACKGROUND
Native Americans have been reported to have lower cancer incidence and mortality than other racial groups in the U.S., although some have questioned whether this was due to racial misclassification. This study provides improved estimates of cancer mortality, determined from a sampling of people who live on Indian reservations.


METHODS
The authors reviewed death certificates from U.S. counties that contain Indian lands, excluding certain areas with known problems of racial misclassification. Age-adjusted mortality rates for specific types of cancer were calculated using U.S. Census population figures, and these rates were compared with rates for all races in the U.S.


RESULTS
This sample included 38% of the American Indian and Alaska Native populations. The age-adjusted annual mortality rate for all cancers combined was 148.2 per 100,000 for both genders, 133.1 for females, and 167.2 for males. The rates for males and for both genders combined, but not for females, were significantly lower than the U.S. rates for all races (P < 0.05). Females had significantly lower rates of death from carcinoma of the lung and breast and significantly higher rates of death from carcinoma of the cervix and gallbladder (P < 0.05). Males had significantly lower rates of death from carcinoma of the lung, colon, and prostate, and significantly higher rates of liver carcinoma. Both genders combined had significantly lower rates of death from lung and colon carcinoma and significantly higher rates of death from stomach, liver, kidney, and gallbladder carcinoma. Geographic differences were substantial, with the Northern and Plains regions experiencing much higher mortality from lung, colon, and breast carcinoma than the Southwest region.


CONCLUSIONS
Compared with the general U.S. population, Native Americans experience quite different patterns of cancer mortality. Cancer prevention and control programs should be designed specifically for this minority population.
Cobb
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Indian Health Service, Cancer Prevention and Control Program, Albuquerque, New Mexico 87110, USA.
Paisano
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RE
D000413:Alaska / Q000453:epidemiology; D019352:Censuses; D003644:Death Certificates; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D009369:Neoplasms / Q000401:mortality*; D011159:Population Surveillance; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology