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All-cause mortality and cardiovascular disease mortality in three American Indian populations, aged 45-74 years,
E T Lee1, L D Cowan, T K Welty
1Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA.
Insights
American Indian populations in Arizona, Oklahoma, and South/North Dakota experienced higher mortality rates than the general US population. Cardiovascular disease mortality was particularly high in South/North Dakota, indicating a need for targeted health interventions.
Area of Science:
- Epidemiology
- Public Health
- Cardiovascular Disease Research
Background:
- The Strong Heart Study investigated cardiovascular disease (CVD) in American Indian populations.
- Understanding mortality patterns is crucial for public health interventions.
Purpose of the Study:
- To determine all-cause and CVD mortality rates in three American Indian populations.
- To compare these rates with national averages and identify risk factors.
Main Methods:
- Community mortality surveillance from 1984-1988.
- Analysis of death certificate data and medical records for CVD confirmation.
- Age-adjusted mortality rate calculations.
Main Results:
- Men exhibited higher mortality rates than women across all populations.
- South/North Dakota had the highest all-cause mortality (114/1,000), followed by Arizona (107/1,000) and Oklahoma (96/1,000).
- CVD was the leading cause of death in Oklahoma and South/North Dakota; diabetes in Arizona women. CVD mortality was over two times higher in 45-64 year olds in South/North Dakota compared to US averages.
Conclusions:
- American Indians in these regions face significantly higher all-cause mortality rates.
- Elevated CVD mortality in South/North Dakota presents a critical target for community-based health promotion programs.
- Interventions focusing on healthy lifestyles and known risk factors are recommended.
Abstract:
Community mortality surveillance for 1984-1988 was conducted by researchers of the Strong Heart Study, which examined the incidence, prevalence, and risk factors of cardiovascular disease in three American Indian populations, aged 45-74 years, in Arizona, Oklahoma, and South/North Dakota. All-cause and cardiovascular disease mortality rates were determined through the use of death certificate data. Cardiovascular disease deaths were confirmed by independent systematic review of medical records. In all three populations, men had higher all-cause and cardiovascular disease mortality rates than did women. Oklahoma exhibited slightly lower 5-year, age-adjusted, all-cause mortality (96/1,000) than did Arizona (107/1,000) and South/North Dakota (114/1,000). The leading cause of death among both sexes in Oklahoma and in South/North Dakota was cardiovascular disease. Diabetes mellitus led among Arizona women. The other major causes of death were cancer, liver disease including cirrhosis, and injury. When compared with the rates in each state, average annual all-cause mortality rates were higher for the American Indian populations in almost every age group. The all-cause annual mortality rates in the three Indian populations were close to rates in the US black population and higher than the rates of the entire US population and of US whites. This trend was amplified in the 45- to 64-year age group. Only in the 65- to 74-year age group did mortality rates in the Indian population approach those of the US population. Cardiovascular disease mortality rates were close to the US averages in Arizona and Oklahoma, but they were more than two times higher in South/North Dakota among those between 45 and 64 years of age. Thus, American Indians in Arizona, Oklahoma, and South/North Dakota exhibit high all-cause mortality rates. In particular, the South/North Dakota population cardiovascular disease death rate appears to present a potential target for community-based programs to intervene on known risk factors to promote healthy lifestyles.