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Am J Public Health. 2014 Jul;104(7):1334-40. doi: 10.2105/AJPH.2013.301614. Epub 2014 Apr 22.

All-cause, cardiovascular, and cancer mortality in western Alaska Native people: western Alaska Tribal Collaborative for Health (WATCH).

Author information

Barbara V. Howard, Hong Wang, and Jason G. Umans are with the MedStar Health Research Institute, Hyattsville, MD. Jesse S. Metzger is with the University of Alaska, Anchorage. Kathryn R. Koller, Elvin D. Asay, Abbie W. Wolfe, and Ellen M. Provost are with the Alaska Native Tribal Health Consortium Division of Community Health Services, Anchorage. Stacey E. Jolly is with the Cleveland Clinic Medicine Institute, Cleveland, OH. Scarlett E. Hopkins, Cristiane Kaufmann, and Bert B. Boyer are with the University of Alaska Fairbanks Center for Alaska Native Health Research. Terry W. Raymer and Brian Trimble are with the Alaska Native Medical Center, Anchorage. Sven O. E. Ebbesson is with the Norton Sound Health Corporation, Nome, AK. Melissa A. Austin is with the Department of Epidemiology, University of Washington, Seattle. William James Howard is with the MedStar Washington Hospital Center, Washington, DC.



We determined all-cause, cardiovascular disease (CVD), and cancer mortality in western Alaska Native people and examined agreement between death certificate information and adjudicated cause of deaths.


Data from 4 cohort studies were consolidated. Death certificates and medical records were reviewed and adjudicated according to standard criteria. We compared adjudicated CVD and cancer deaths with death certificates by calculating sensitivity, specificity, predictive values, and κ statistics.


Men (n = 2116) and women (n = 2453), aged 18 to 95 years, were followed an average of 6.7 years. The major cause of death in men was trauma (25%), followed by CVD (19%) and cancer (13%). The major cause of death in women was CVD (24%), followed by cancer (19%) and trauma (8%). Stroke rates in both genders were higher than those of US Whites. Only 56% of deaths classified as CVD by death certificate were classified as CVD by standard criteria; discordance was higher among men (55%) than women (32%; κs = 0.4 and 0.7).


We found lower rates for coronary heart disease death but high rates of stroke mortality. Death certificates overestimated CVD mortality; concordance between the 2 methods is better for cancer mortality. The results point to the importance of cohort studies in this population in providing data to assist in health care planning.

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