Nathaniel Cobb

Annual report to the nation on the status of cancer, 1975–2004, featuring cancer in American Indians and Alaska Natives

The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate annually to provide updated information on cancer occurrence and trends in the U.S. The 2007 report features a comprehensive compilation of cancer information for American Indians and Alaska Natives (AI/AN).

Regional patterns and trends in cancer mortality among American Indians and Alaska Natives, 1990–2001†

National estimates of cancer mortality indicate relatively low rates for American Indians (AIs) and Alaska Natives (ANs). However, these rates are derived from state vital records in which racial misclassification is known to exist.

Leading Causes of Death and All-Cause Mortality in American Indians and Alaska Natives

OBJECTIVES 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.

Health Behaviors and Risk Factors Among American Indians and Alaska Natives, 2000–2010

OBJECTIVES We provided contextual risk factor information for a special supplement on causes of death among American Indians and Alaska Natives (AI/ANs). We analyzed 11 years of Behavioral Risk Factor Surveillance System (BRFSS) data for AI/AN respondents in the United States. METHODS We combined BRFSS data from 2000 to 2010 to determine the prevalence of selected risk factors for AI/AN and White respondents residing in Indian Health Service Contract Health Service Delivery Area counties. Regional prevalence estimates for AI/AN respondents were compared with the estimates for White respondents for all regions combined; respondents of Hispanic origin were excluded. RESULTS With some regional exceptions, AI/AN people had high prevalence estimates of tobacco use, obesity, and physical inactivity, and low prevalence estimates of fruit and vegetable consumption, cancer screening, and seatbelt use. CONCLUSIONS These behavioral risk factors were consistent with observed patterns of mortality and chronic disease among AI/AN persons. All are amenable to public health intervention.

Patterns of cancer mortality among Native Americans

Native Americans have been reported to have lower cancer incidence and mortality than other racial groups in the U.S., although some have questioned whether this was due to racial misclassification. This study provides improved estimates of cancer mortality, determined from a sampling of people who live on Indian reservations.

Venous thromboembolism hospitalizations among American Indians and Alaska Natives

Cardiovascular disease (CVD) has been reported to be on the increase in the American Indian/Alaska Native (AI/AN) population. The Indian Health Service (IHS) hospital discharge database was used to describe venous thromboembolism (VTE)-associated hospitalizations among patients receiving IHS-reported medical care in the United States from 1980 through 1996. The average overall VTE-associated hospitalization rate in the AI/AN population during 1980-1996 was 33.1 per 100,000, however, the rate significantly decreased from 38.4 per 100,000 AI/ANs in 1980-1982 to 33.2 in 1994-1996. The average age at hospitalization was 50.4 years, which was consistent during the 17-year period. The overall annual VTE hospitalization rate was higher for females than for males (38.0 versus 27.7 per 100,000). The female VTE hospitalization rates decreased significantly from 46.1 per 100,000 in 1980-1982 to 36.7 per 100,000 in 1994-1996 (risk ratio: RR=1.3; 95% confidence interval: CI=1.1-1.4), while the rates for males remained unchanged. The VTE hospitalization rates also varied by geographic region. The hospitalization rate was highest in the East region (52.2 per 100,000) and lowest in the Alaska region (16.1 per 100,000). These data indicate that the overall VTE rate for AI/ANs may not have only decreased, but appears lower than the reported rate for Caucasians.

Introduction to the supplement on cancer in the American Indian and Alaska Native populations in the United States.

The collection of papers in this Supplement combines cancer incidence data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results program, enhanced by record linkages and geographic factors, to provide a comprehensive description of the cancer burden in the American Indian/Alaska Native population in the United States. Cancer incidence rates among this population varied widely, sometimes more than 5‐fold, by geographic region. Cancer 2008;113(5 supp):1113–6. Published 2008 by the American Cancer Society.

Low national breast and cervical cancer-screening rates in American Indian and Alaska Native women with diabetes

Background: The cervical cancer mortality rate for American Indian and Alaska Native women is twice that of all races in the United States. To date the only published national breast and cervical cancer-screening rates for American Indian and Alaska Native women are based on self-reported data. When the Indian Health Service (IHS) conducts an annual audit on patients with diabetes, it includes cancer screening. This observational study presents national breast and cervical cancer-screening rates for American Indian and Alaska Native women with diabetes. Methods: Cancer-screening rates were extracted from the 1995 diabetic audit for the 12 IHS areas. These rates were compared with rates for women without diabetes of the same age, 50 to 69 years, by chart review, at four IHS hospitals in the Aberdeen IHS area. Results: Screening rates for women with diabetes in the 12 areas varied: mammogram (ever) 35% to 78%; clinical breast examination (last year) 28% to 70%, and Papanicolaou smear (last year) 26% to 69%. The Aberdeen IHS area women with diabetes had 51% more clinic visits per year than women without diabetes, but the groups had similar screening rates. Conclusion: Cancer-screening rates for American Indian and Alaska Native women vary by region. In the Aberdeen IHS area, women with diabetes had more visits (missed opportunities) but similar screening rates as women without diabetes. The diabetic audit could be used to monitor national IHS cancer-screening trends for women with diabetes and in the Aberdeen IHS area for all women aged 50 to 69 years.

Invasive Cervical Cancer Among American Indian Women in the Northern Plains, 1994-1998: Incidence, Mortality, and Missed Opportunities

Objectives. Cervical cancer mortality rates among the American Indian and Alaska Native (AI/AN) population in North and South Dakota were five times the national average (15.6 per 100,000 vs. 3.1 per 100,000, age adjusted) when last evaluated (from 1989 through 1993). Our goals were to update the AI/AN population cervical cancer mortality rates and to present incidence rates for AI/AN women in the region. Methods. We reviewed charts for women diagnosed with invasive cervical cancer at Indian Health Service (IHS) facilities in North and South Dakota from 1994 through 1998 and collected information about cervical cancer screening and treatment history. Incidence and mortality rates were standardized to the 1970 U.S. population. Results. Twenty-one cases of invasive cervical cancer and eight deaths were identified. Annualized incidence and mortality rates were 11.5 per 100,000 and 4.5 per 100 000. These compare with national all-race/ethnicity rates of 8.5 per 100,000 and 2.7 per 100,000 for incidence and mortality. Fifteen (71%) of 21 cases were diagnosed due to symptoms. Conclusions. While cervical cancer mortality rates have declined, incidence and mortality rates among AI/AN women remain higher than in the general U.S. population. Increased use of pap tests and careful follow-up of abnormal results should be aggressively promoted among AI/AN women in North and South Dakota.

Lung cancer incidence among American Indians and Alaska Natives in the United States, 1999–2004†‡§

Lung cancer incidence rates among American Indians and Alaska Natives (AI/ANs) in the United States have not been described well, primarily because of race misclassification and, until the 1990s, incomplete coverage of their population by cancer registries. Smoking, the predominant cause of lung cancer, is particularly prevalent among this population.