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Am J Public Health. 2014 Jun;104 Suppl 3:S377-87. doi: 10.2105/AJPH.2013.301673. Epub 2014 Apr 22.

Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States.

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Mary C. White, David K. Espey, and Christie Eheman are with the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Judith Swan is with the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD. Charles L. Wiggins is with the New Mexico Tumor Registry, University of New Mexico Cancer Center, Albuquerque. Judith S. Kaur is with the Native American Programs, Mayo Clinic, Rochester, MN. David K. Espey is also a guest editor for this supplement issue.



We used improved data on American Indian and Alaska Native (AI/AN) ancestry to provide an updated and comprehensive description of cancer mortality and incidence among AI/AN populations from 1990 to 2009.


We linked the National Death Index and central cancer registry records independently to the Indian Health Service (IHS) patient registration database to improve identification of AI/AN persons in cancer mortality and incidence data, respectively. Analyses were restricted to non-Hispanic persons residing in Contract Health Service Delivery Area counties in 6 geographic regions of the United States. We compared age-adjusted mortality and incidence rates for AI/AN populations with White populations using rate ratios and mortality-to-incidence ratios. Trends were described using joinpoint analysis.


Cancer mortality and incidence rates for AI/AN persons compared with Whites varied by region and type of cancer. Trends in death rates showed that greater progress in cancer control was achieved for White populations compared with AI/AN populations over the last 2 decades.


Spatial variations in mortality and incidence by type of cancer demonstrated both persistent and emerging challenges for cancer control in AI/AN populations.

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