title: Trends and disparities in stroke mortality by region for American Indians and Alaska Natives.
abstract: OBJECTIVE
  We evaluated trends and disparities in stroke death rates for American Indians and Alaska Natives (AI/ANs) and White people by Indian Health Service region.
  
  
  METHODS
  We identified stroke deaths among AI/AN persons and Whites (adults aged 35 years or older) using National Vital Statistics System data for 1990 to 2009. We used linkages with Indian Health Service patient registration data to adjust for misclassification of race for AI/AN persons. Analyses excluded Hispanics and focused on Contract Health Service Delivery Area (CHSDA) counties.
  
  
  RESULTS
  Stroke death rates among AI/AN individuals were higher than among Whites for both men and women in CHSDA counties and were highest in the youngest age groups. Rates and AI/AN:White rate ratios varied by region, with the highest in Alaska and the lowest in the Southwest. Stroke death rates among AI/AN persons decreased in all regions beginning in 2001.
  
  
  CONCLUSIONS
  Although stroke death rates among AI/AN populations have decreased over time, rates are still higher for AI/AN persons than for Whites. Interventions that address reducing stroke risk factors, increasing awareness of stroke symptoms, and increasing access to specialty care for stroke may be more successful at reducing disparities in stroke death rates.
authors.affiliation: Linda J. Schieb, Carma Ayala, and Amy L. Valderrama are with the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Mark A. Veazie is with the Phoenix Area Indian Health Service, AZ.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Schieb
authors.forename: Carma
authors.initials: C
authors.lastname: Ayala
authors.forename: Amy L
authors.initials: AL
authors.lastname: Valderrama
authors.forename: Mark A
authors.initials: MA
authors.lastname: Veazie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000453:epidemiology / Q000208:ethnology; D003644:Death Certificates; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D004930:Inuit / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
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