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Am J Public Health. 2014 Jun;104 Suppl 3:S496-503. doi: 10.2105/AJPH.2014.301968. Epub 2014 Apr 22.

Diabetes-related mortality among American Indians and Alaska Natives, 1990-2009.

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Pyone Cho, Linda S. Geiss, and Nilka Rios Burrows are with the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Diana L. Roberts is with Alaska Area Native Health Service, Indian Health Service (IHS), Anchorage. Ann K. Bullock is with Division of Diabetes Treatment and Prevention, IHS, Albuquerque, NM. Michael E. Toedt is with Cherokee Indian Hospital, Cherokee, NC.



We assessed diabetes-related mortality for American Indians and Alaska Natives (AI/ANs) and Whites.


Study populations were non-Hispanic AI/AN and White persons in Indian Health Service (IHS) Contract Health Service Delivery Area counties; Hispanics were excluded. We used 1990 to 2009 death certificate data linked to IHS patient registration records to identify AI/AN decedents aged 20 years or older. We examined disparities and trends in mortality related to diabetes as an underlying cause of death (COD) and as a multiple COD.


After increasing between 1990 and 1999, rates of diabetes as an underlying COD and a multiple COD subsequently decreased in both groups. However, between 2000 and 2009, age-adjusted rates of diabetes as an underlying COD and a multiple COD remained 2.5 to 3.5 times higher among AI/AN persons than among Whites for all age groups (20-44, 45-54, 55-64, 65-74, and ≥ 75 years), both sexes, and every IHS region except Alaska.


Declining trends in diabetes-related mortality in both AI/AN and White populations are consistent with recent improvements in their health status. Reducing persistent disparities in diabetes mortality will require developing effective approaches to not only control but also prevent diabetes among AI/AN populations.

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