title: Leading causes of death and all-cause mortality in American Indians and Alaska Natives.
abstract: OBJECTIVE
  We present regional patterns and trends in all-cause mortality and leading causes of death in American Indians and Alaska Natives (AI/ANs).
  
  
  METHODS
  US National Death Index records were linked with Indian Health Service (IHS) registration records to identify AI/AN deaths misclassified as non-AI/AN. We analyzed temporal trends for 1990 to 2009 and comparisons between non-Hispanic AI/AN and non-Hispanic White persons by geographic region for 1999 to 2009. Results focus on IHS Contract Health Service Delivery Area counties in which less race misclassification occurs.
  
  
  RESULTS
  From 1990 to 2009 AI/AN persons did not experience the significant decreases in all-cause mortality seen for Whites. For 1999 to 2009 the all-cause death rate in CHSDA counties for AI/AN persons was 46% more than that for Whites. Death rates for AI/AN persons varied as much as 50% among regions. Except for heart disease and cancer, subsequent ranking of specific causes of death differed considerably between AI/AN and White persons.
  
  
  CONCLUSIONS
  AI/AN populations continue to experience much higher death rates than Whites. Patterns of mortality are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants. Much of the observed excess mortality can be addressed through known public health interventions.
authors.affiliation: David K. Espey, Melissa A. Jim, Don Haverkamp, and Marcus Plescia are with the Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. At the time of the study, Nathaniel Cobb was with and Michael Bartholomew is currently with the Division of Epidemiology and Disease Prevention, Indian Health Service (IHS), Rockville, MD. Tom Becker is with Oregon Health and Sciences University, Portland. David K. Espey is also a guest editor for this supplement issue.
authors.forename: David K
authors.initials: DK
authors.lastname: Espey
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Jim
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Cobb
authors.forename: Michael
authors.initials: M
authors.lastname: Bartholomew
authors.forename: Tom
authors.initials: T
authors.lastname: Becker
authors.forename: Don
authors.initials: D
authors.lastname: Haverkamp
authors.forename: Marcus
authors.initials: M
authors.lastname: Plescia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D014481:United States / Q000453:epidemiology
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