title: Diabetes prevalence, incidence, complications and mortality among Alaska Native people 1985-2006.
abstract: OBJECTIVE
  To examine trends in diabetes prevalence, incidence, complications and mortality between 1985 and 2006 among Alaska Native people.
  
  
  METHODS
  We used data from the population-based Alaska Native Diabetes Registry, which includes all people who receive care in the Alaska Tribal Health System.
  
  
  METHODS
  We compared the periods of 1986-1990 and 2002-2006 for diabetes-related amputations, renal replacement and mortality using Poisson regression. Complications and mortality data were examined for trends using Poisson regression. Survival analyses for those diagnosed since 31 December 1985 were performed using the Cox proportional hazard model.
  
  
  RESULTS
  Age-adjusted diabetes prevalence increased from 17.3 in 1985 to 47.6/1,000 in 2006. The number of Alaska Native people living in Alaska with diabetes increased from 610 in 1985 to 3,386 in 2006. Diabetes incidence rates have also increased. Comparing age-adjusted rates for the 5-year periods 1986-1990 and 2002-2006, amputations decreased from 5.3 to 2.6/1,000, renal replacement decreased from 3.3 to 1.2/1,000 and mortality decreased from 41.7 to 33.2/1,000. Yearly analyses showed a downward trend for amputations, renal replacement and mortality rates. Survival analyses showed a significantly higher hazard ratio for any amputations, major amputations and renal replacement for the earlier time period compared to the most recent time period.
  
  
  CONCLUSIONS
  An increase in risk factors, awareness, funding and case-finding may be contributing to the increase in prevalence and incidence of diagnosed diabetes. While diabetes prevalence and incidence are increasing among Alaska Native people, our results suggest that even in remote, rural areas, complications and mortality can be reduced.
authors.affiliation: Alaska Native Medical Center Diabetes Program (ANC-DIA), Anchorage, Alaska 99508, USA. mnarayanan@anthc.org
authors.forename: Meera L
authors.initials: ML
authors.lastname: Narayanan
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Schraer
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Bulkow
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Koller
authors.forename: Elvin
authors.initials: E
authors.lastname: Asay
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Mayer
authors.forename: Terry W
authors.initials: TW
authors.lastname: Raymer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D055815:Young Adult