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Objectives. To characterize the leading causes of death for the urban American Indian/Alaska Native (AI/AN) population and compare with urban White and rural AI/AN populations.
Methods. We linked Indian Health Service patient registration records with the National Death Index to reduce racial misclassification in death certificate data. We calculated age-adjusted urban AI/AN death rates for the period 1999-2009 and compared those with corresponding urban White and rural AI/AN death rates.
Results. The top-5 leading causes of death among urban AI/AN persons were heart disease, cancer, unintentional injury, diabetes, and chronic liver disease and cirrhosis. Compared with urbanWhite persons, urban AI/AN persons experienced significantly higher death rates for all top-5 leading causes. The largest disparities were for diabetes and chronic liver disease and cirrhosis. In general, urban and rural AI/AN persons had the same leading causes of death, although urban AI/AN persons had lower death rates for most conditions.
Conclusions. Urban AI/AN persons experience significant disparities in death rates compared with their White counterparts. Public health and clinical interventions should target urban AI/AN persons to address behaviors and conditions contributing to health disparities. (Am J Public Health. 2016;106:906-914. doi: 10.2105/AJPH.2015.303033)
Since the 1950s, an increasing proportion of American Indian/Alaska Native (AI/AN) persons live in urban areas (71% of 5.2 million, according to the 2010 US Census).1-4 The AI/AN persons living on reservations often relocate to urban environments, seeking better prospects for education, employment, or housing.4,5
Studies have demonstrated disparities between urban AI/AN populations and corresponding non-AI/AN populations for socioeconomic, maternal and child health, sexual health, substance abuse, mental health, violence, and mortality indicators.6-8 However, these studies likely underestimate the magnitude of health disparities for urban AI/AN persons because of racial misclassification-a common issue for AI/AN populations.9-11 The AI/AN persons who die in urban environments face even greater potential for racial misclassification than those who die on reservations because of less awareness of AI/AN status outside reservation borders.10,12
We aimed to (1) characterize leading causes of death in urban AI/AN populations; (2) compare mortality patterns among urban AI/AN, urban White, and rural AI/AN populations; and (3) discuss strategies to mitigate health disparities faced by urban AI/AN populations.
METHODS
To calculate death rates, we used bridged, single-race population estimates as denominators, which were developed by the US...