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3 Recent Health Trends in the Native American Population
Pages 53-76

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From page 53...
... In broad terms, the recent epidemiologic history of Native American populations can be characterized by several key features: the decline but persistence of infectious diseases, stabilizing at a level still higher than that of the non-Native population; the rise in chronic diseases, especially diabetes; and the overwhelming importance of the so-called social pathologies violence, unintentional injuries, and the ill effects of alcohol and drug abuse. The rise of chronic diseases also characterizes various indigenous populations around the world that are undergoing rapid sociocultural changes.
From page 54...
... Before discussing these questions, we examine some methodological issues involved in the use and interpretation of Native American health data. This is followed by sections addressing overall health trends among Native Americans, relative risks of dying from various diseases, regional variations, and health determinants.
From page 55...
... Service population data for intercensal years are estimated by a smoothing technique; with each new revision to decennial census counts, previously estimated intercensal populations are adjusted accordingly. Rates for 1981-89 differ among the 1991, 1992, 1993, and 1994 Trends in Indian Health reports as a result of revisions of the intercensal estimates using two versions of the 1990 census counts of Native Americans and a revision of the 1980 census itself (Indian Health Service, 1994a)
From page 56...
... and a later study that linked deaths at all ages with the IHS patient registry (Frost et al., 1994~. As noted above, the IHS patient registry includes Native Americans who actually use some IHS services and hence are bonafide Native Americans according to legal/ bureaucratic criteria.
From page 57...
... national population since 1955. The substantial decline and convergence is evident, although the low rate shown for Native Americans may have to be adjusted upward to account for underenumeration of Native American infant deaths.
From page 58...
... CD (0 ~a ~o ~°) ~ ~ Year FIGURE 3-1 Trends in infant mortality rates: Native Americans and U.S.
From page 59...
... population can be determined from the agestandardized mortality rates of selected causes for the two populations. Native Americans experience excessive risk for most conditions listed in Table 3-1, with the exception of cardiovascular diseases and cancer.
From page 60...
... A national estimate of self-reported diabetes is also available from the Survey of American Indians and Alaska Natives, a special component of the 1987 National Medical Expenditures Survey, which covered Native Americans residing in IHS service areas who self-identified as being eligible for IHS services. The estimated age-adjusted prevalence of diabetes among Native Americans was 11 percent in men and 13 percent in women, more than twice the rates of the total U.S.
From page 61...
... ~ cry ~ a' ~ ~ ~ {D 0 ~ ~ ~ °) ~ ~ _ ~ ~ ~ _ _ ~ ~ _ ~ ~ TO ~ ~ ~ ~ ~ Year FIGURE 3-3 Trends in age-standardized mortality rates for tuberculosis and gastroenteritis: Native Americans and total U.S.
From page 62...
... A national survey using Medicare data indicated that the incidence of ESRD was three times higher among Native Americans than among whites, and the incidence of ESRD due specifically to diabetes was six times higher (Newman et al., 1990~. Incidence data support the lower mortality risk for cancer among Native Americans relative to the total U.S.
From page 63...
... A review of NCHS data on stroke shows that Native Americans had lower mortality rates than both blacks and whites between 1980 and 1990. Moreover, the trend has also been declining (Gillum, 1995~.
From page 64...
... REGIONAL VARIATIONS The preceding sections address disease and injury rates among Native Americans nationally. While Native Americans do share common experiences as a group, particularly as compared with the dominant North American society, they live in different ecological zones; have different genetic lineages; have different historical experiences; lead different lifestyles; and maintain different values, customs, and traditions.
From page 65...
... ~m cot Co (0 ~ of cn ~al ~Cal ~CO US ~0) ~ rat ~co co ~En ~:n ~o, ~o, ~ Year FIGURE 3-7 Trends in age-standardized mortality rates of unintentional injuries, Native Americans and total U.S.
From page 66...
... The Navajo Area tends to have low mortality rates for cardiovascular disease. A relatively low risk of ischemic heart disease has been observed for some years among the Navajo and Apache, members of the Athapaskan language family who migrated to the Southwest from the northern reaches of the continent around the tenth century (and whose kin today largely inhabit the subarctic boreal forests of Alaska and north
From page 67...
... SOURCE: Indian Health Service (1994b)
From page 68...
... ~ ALK BE~ SILL NAS MAV OKL PRE POR TUG it, ~3 Homicide IHS Area Suicide FIGURE 3-10 Regional variation in age-standardized mortality rates for injuries, 1989-1991. SOURCE: Indian Health Service (1994b)
From page 69...
... that can be applied more appropriately to Native American groups in the arctic and subarctic with a hunting tradition and a lowcarbohydrate diet. The co-occurrence of gallbladder disease, obesity, and diabetes observed among diverse Native American populations led to the proposal of a "New World Syndrome" of disorders that are likely to be genetically based and mediated through the metabolism of lipids (Weiss et al., 1984~.
From page 70...
... Another source of national survey data on health determinants is the Behavioral Risk Factor Surveillance System, a telephone survey conducted since 1984 by the Centers for Disease Control in collaboration with state health departments. Data have been reported on 1,055 Native Americans between 1985 and 1988, covering such areas as seatbelt nonuse, drinking, drinking and driving, high blood pressure, sedentary life-style, cigarette smoking, use of smokeless tobacco, and obesity.
From page 71...
... While the absolute burden of mortality and morbidity has decreased substantially in the decades since World War II, the relative contributions of various diseases and health conditions have also changed. Whether one calls this an "epidemiologic transition" in the sense intended by the theory's original proponents as well as the associated issues of what stage of the transition currently characterizes Native Americans and whether they should constitute a model distinct from that which characterizes developing countries is not as important as the utility of the theory in advancing our ability to monitor and predict trends.
From page 72...
... Kimball 1994 Correctness of racial coding of American Indians and Alaska Natives on the Washington State death certificate. American Journal of Preventive Medicine 10:290-294.
From page 73...
... Speers 1993 Cancer incidence among American Indians and Alaska Natives, 1980 through 1987. American Journal of Public Health 83:1589-1598.
From page 74...
... Lawson 1993 The effect of racial misclassification on estimates of end-stage renal disease among American Indians and Alaska Natives in the Pacific Northwest, 1988 through 1990. American Journal of Kidney Diseases 21:383-386.
From page 75...
... NikiOn lgg2 Prevalence of diagnosed diabetes in c~cumpolar indigenous populations.


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