title: Geographic variation in colorectal cancer incidence and mortality, age of onset, and stage at diagnosis among American Indian and Alaska Native people, 1990-2009.
abstract: OBJECTIVE
  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.
authors.affiliation: David G. Perdue is with the American Indian Cancer Foundation, and Minnesota Gastroenterology PA, Minneapolis. Donald Haverkamp is with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Carin Perkins is with the Minnesota Cancer Surveillance System, Minneapolis. Christine Makosky Daley is with the Center for American Indian Community Health, University of Kansas Medical Center, Kansas City. Ellen Provost is with the Alaska Native Tribal Health Consortium, Anchorage.
authors.forename: David G
authors.initials: DG
authors.lastname: Perdue
authors.forename: Donald
authors.initials: D
authors.lastname: Haverkamp
authors.forename: Carin
authors.initials: C
authors.lastname: Perkins
authors.forename: Christine Makosky
authors.initials: CM
authors.lastname: Daley
authors.forename: Ellen
authors.initials: E
authors.lastname: Provost
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality / Q000473:pathology*; D003644:Death Certificates; D005260:Female; D006801:Humans; D015994:Incidence; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011159:Population Surveillance; D012042:Registries; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
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