Project Update: Improving mortality data for American

Indians and Alaska Natives

NAPHSIS 2006 Annual ConferenceSan Diego, CA

David Espey, MDIHS/CDC

Objectives:

• Link state death records with administrative records from the Indian Health Service (IHS)

• Identify American Indian/Alaska Native (AI/AN) deaths coded as non-Native

• Report results from such linkage: • magnitude of problem and potential predictors of

misclassification• Use “improved” data to report mortality patterns of

AI/AN

Background

• Over 560 AI/AN tribes

• 2.6 million AI/AN population (3.0 bridged or 4.1 all combined)

• 1.65 million served by IHS

• Highest poverty level

Population pyramids by race, US 2003Total API Population 2003

15 10 5 0 5 10 15

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Ag

e g

rou

ps

Percentage of total population

Female

Male

Total Black Population 2003

15 10 5 0 5 10 15

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Ag

e g

rou

ps

Percentage of total population

Female

Male

Total White Population 2003

15 10 5 0 5 10 15

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Ag

e g

rou

ps

Percentage of total population

Female

Male

Total AI/AN Population 2003

15 10 5 0 5 10 15

00-04

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

Ag

e g

rou

ps

Percentage of total population

Female

Male

Background

• Race mis-classification of AI/AN occurs in cancer surveillance and vital statistics data bases

• Varies by state• Decreasing mis-classification can improve

accuracy of health indicators and program planning/resource allocation

Methods: IHS - death records linkage

• Development of proposal– Advisory committee– Presentation at NAPHSIS (04)– Funding from CDC

• Recruitment of states• Agreements/research determinations• Linkages (LinkPlus – probabilistic method)• Analysis/Publications

NV

WA

ORID

MT ND

SDMN

WIMIWY

CA

UTCO

AZNM

AK

HI

TX

NE

KS

OK

LA

ALMS

MO

IL IN

KY

TN

GA

FL

SC

NC

VAWV

PA

NY

ME

NJCT

MD

OH DL

RIMA

VT

NH

AR

IANV

IHS/state death records data linkage

Linkage completedData rec’d – linkage in progressInterest expressed – data not rec’dNot participating

Linkage of death records from State VS with administrative records from the Indian Health Service (1990-2003)

0

5000

10000

15000

20000

25000

30000

ID UT ND OR MN MT MI NC WA NM CA AZ OK

Pre-link Post-link

AI/AN mortality rates for select COD, both sexes, pre- and post-linkage, 1990-2003

020406080

100120140160180

IHD

CVDM

VA

Cance

r

Pre-link Post_link

Rates and rate ratios of all cause mortality in AI/AN and all races combined, by region,

1990-2003

Region AI/AN All races Rate Ratio

All cancer 164.7 197.5 0.83

CVD 290.7 334.6 0.87

Chronic liver dis.

28.1 9.5 2.96

Influenza & pneumonia

31.1 25.7 1.21

Limitations

• Not all AI/AN included in IHS files

• IHS coverage varies by geographic region

Conclusions

• Racial misclassification in is a problem for AI/ANs in state death records

• Linkages with IHS data can improve the quality of the data

Recommendations

• Improve reporting by funeral home directors

• Consider linkages to improve the quality of the data

– IHS

– Other data may be available (i.e. tribal rosters)

Recommendations (cont)

• Linkage with NDI? - more efficient (and expensive)

• Consensus on presenting findings – rates may differ from official reports and publications