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Am J Public Health. 2014 Jun;104 Suppl 3:S359-67. doi: 10.2105/AJPH.2013.301715. Epub 2014 Apr 22.

Trends and disparities in heart disease mortality among American Indians/Alaska Natives, 1990-2009.

Author information

Mark Veazie is with the Phoenix Area Indian Health Service, Flagstaff, AZ. Carma Ayala and Linda Schieb are with the Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA. Shifan Dai is with the Division for Nutrition and Physical Activity, Centers for Disease Control and Prevention. Jeffrey A. Henderson is with the Black Hills Center for American Indian Health, Rapid City, SD. Pyone Cho is with the Division of Diabetes Translation, Centers for Disease Control and Prevention.



We evaluated heart disease death rates among American Indians and Alaska Natives (AI/ANs) and Whites after improving identification of AI/AN populations.


Indian Health Service (IHS) registration data were linked to the National Death Index for 1990 to 2009 to identify deaths among AI/AN persons aged 35 years and older with heart disease listed as the underlying cause of death (UCOD) or 1 of multiple causes of death (MCOD). We restricted analyses to IHS Contract Health Service Delivery Areas and to non-Hispanic populations.


Heart disease death rates were higher among AI/AN persons than Whites from 1999 to 2009 (1.21 times for UCOD, 1.30 times for MCOD). Disparities were highest in younger age groups and in the Northern Plains, but lowest in the East and Southwest. In AI/AN persons, MCOD rates were 84% higher than UCOD rates. From 1990 to 2009, UCOD rates declined among Whites, but only declined significantly among AI/AN persons after 2003.


Analysis with improved race identification indicated that AI/AN populations experienced higher heart disease death rates than Whites. Better prevention and more effective care of heart disease is needed for AI/AN populations.

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