title: Disparities in Smoking-Related Mortality Among American Indians/Alaska Natives.
abstract: BACKGROUND
  Smoking-related disparities continue to be a public health problem among American Indian/Alaska Native (AI/AN) population groups and data documenting the health burden of smoking in this population are sparse. The purpose of this study was to assess mortality attributable to cigarette smoking among AI/AN adults relative to non-Hispanic white adults (whites) by calculating and comparing smoking-attributable fractions and mortality.
  
  
  METHODS
  Smoking-attributable fractions and mortality among AI/ANs (n=1.63 million AI/ANs) and whites were calculated for people living in 637 Indian Health Service Contract Health Service Delivery Area counties in the U.S., from mortality data collected during 2001-2009. Differences in smoking-attributable mortality between AI/ANs and whites for five major causes of smoking-related deaths were examined. All data analyses were carried out in 2013-2014.
  
  
  RESULTS
  Overall, from 2001 to 2009, age-adjusted death rates, smoking-attributable fractions, and smoking-attributable mortality for all-cause mortality were higher among AI/ANs than among whites for adult men and women aged ≥35 years. Smoking caused 21% of ischemic heart disease, 15% of other heart disease, and 17% of stroke deaths in AI/AN men, compared with 15%, 10%, and 9%, respectively, for white men. Among AI/AN women, smoking caused 18% of ischemic heart disease deaths, 13% of other heart diseases deaths, and 20% of stroke deaths, compared with 9%, 7%, and 10%, respectively, among white women.
  
  
  CONCLUSIONS
  These findings underscore the need for comprehensive tobacco control and prevention efforts that can effectively reach and impact the AI/AN population to prevent and reduce smoking.
authors.affiliation: Biostatistics, Inc., Sarasota, Florida. Electronic address: pzm4@cdc.gov.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Mowery
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia.
authors.forename: Shanta R
authors.initials: SR
authors.lastname: Dube
authors.affiliation: Office on Smoking and Health, CDC, Atlanta, Georgia.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Thorne
authors.affiliation: Office on Smoking and Health, CDC, Atlanta, Georgia.
authors.forename: Bridgette E
authors.initials: BE
authors.lastname: Garrett
authors.affiliation: Office on Smoking and Health, CDC, Atlanta, Georgia.
authors.forename: David M
authors.initials: DM
authors.lastname: Homa
authors.affiliation: Black Hills Center for American Indian Health, Rapid City, South Dakota.
authors.forename: Patricia
authors.initials: P
authors.lastname: Nez Henderson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska / Q000208:ethnology; D002423:Cause of Death; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D017678:Sex Distribution; D012907:Smoking / Q000208:ethnology* / Q000401:mortality*; D044465:White People / Q000706:statistics & numerical data*