The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #55992

David King Espey, MD¹, Roberta Paisano, MHSA¹, and Nathaniel Cobb, MD². (1) Indian Health Service National Epidemiology Program, 5100 Homestead NE, Albuquerque, NM 87110, 505-248-4392, david.espey@mail.ihs.gov, (2) Cancer Prevention and Control, Indian Health Service, 5300 Homestead Road NE, Albuquerque, NM 87110

Background: National estimates of cancer mortality indicate relatively low rates for AI/ANs. Racial misclassification exists in state vital records and national estimates may obscure regional disparities. We estimated cancer mortality for AI/AN for 1994-98 using a method to minimize racial misclassification.

Methods: We used death records and intercensal population estimates for the AI/AN population in counties on or near Indian reservations to calculate annualized, age-adjusted death rates (per 100,000 population) for key cancer types for the period 1994-98 for 5 geographic regions of the US: East (E), Northern Plains (NP), Southwest (SW), Pacific Coast (PC) and Alaska (AK). We compared rates to the US general population (USG) for the same time period.

Results: This population (N=1,377,880) included 60% of the US AI/AN population. Overall, cancer mortality (126.5) was lower than USG (164.2). The cancer mortality rate was 149.4 for males and 109.9 for females. Rates were higher in AK (217.9) and NP (238.6)(p<.05). In AK and NP, excess mortality was seen for colorectal, gallbladder, kidney, liver, lung, and stomach cancer. In the SW, excess mortality was seen for cancer of the liver, stomach and gallbladder. In contrast, lung cancer mortality in the SW was nearly 4-fold lower than USG. Cervical cancer mortality was higher (3.7 vs 2.6, [p<. 05]), notably in NP and E. Breast cancer mortality was lower (14.2 vs 24, [p<. 05]), notably in PC, SW and E.

Conclusion: National AI/AN cancer rates obscure important regional and cancer-specific differences in mortality. Regional data can guide local cancer prevention activities.

Learning Objectives:

• 1)List regional differences in lung, colorectal, stomach, breast and cervical cancer mortality for American Indians/Alaska Natives (AI/AN)
• 2)State the key barriers to accurate measurement of AI/AN cancer burden
• 3)Articulate how regional patterns of cancer in AI/AN might influence application of national cancer prevention guidelines

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.