doi: 10.1161/01.CIR.0000157735.25005.3F
(Circulation. 2005;111:1250-1256.)
© 2005 American Heart Association, Inc.
Epidemiology |
Racial Misclassification and Disparities in Cardiovascular Disease Among American Indians and Alaska Natives
From the Division of American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Denver.
Correspondence to Dorothy A. Rhoades, MD, 4034 30th Ave W, Seattle, WA 98199 (e-mail drhoades{at}myuw.net). Reprint requests to Teresa Lapp, Nighthorse Campbell Native Health Building, Mail Stop F800, PO Box 6508, Aurora, CO 80045-0508.
Received October 4, 2004; revision received January 3, 2005; accepted January 11, 2005.
Background— National vital event data suggest that cardiovascular disease (CVD) mortality rates are lower for American Indians and Alaska Natives (AIAN) than for the general US population, but these data are disproportionately flawed for AIAN because of racial misclassification.
Methods and Results— Vital event data adjusted for racial misclassification and published by the Indian Health Service were used to compare trends in CVD mortality from 1989 to 1991 to 1996 to 1998 between AIAN, US all-races, and US white populations. Without misclassification accounted for, AIAN initially had the lowest mortality rates from major CVD, but by the end of the study, their rates were the highest. Adjustment for misclassification revealed an early and rapidly growing disparity between CVD mortality rates among AIAN compared with rates in the US all-races and white populations. By 1996 to 1998, the age- and misclassification-adjusted number of CVD deaths per 100 000 among AIAN was 195.9 compared with age-adjusted rates of 166.1 and 159.1 for US all races and whites, respectively. The annual percent change in CVD mortality for AIAN was 0.5 compared with –1.8 in the other groups. Regardless of racial misclassification, the most striking and widening disparities were found for middle-aged AIAN, but CVD mortality among AIAN 
65 years of age was lower than in the other populations.
Conclusions— A previously underrecognized disparity in CVD mortality exists for AIAN, particularly among middle-aged adults. Moreover, these disparities are increasing. Efforts to reduce CVD mortality in AIAN must begin before the onset of middle age.
Key Words: cardiovascular disease • epidemiology • Indians, North American • Inuits
This article has been cited by other articles:
 |
|
 |
|
  M. L. Castor, M. S. Smyser, M. M. Taualii, A. N. Park, S. A. Lawson, and R. A. Forquera A Nationwide Population-Based Study Identifying Health Disparities Between American Indians/Alaska Natives and the General Populations Living in Select Urban Counties Am J Public Health, August 1, 2006; 96(8): 1478 - 1484. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Rhoades National Health Data and Older American Indians and Alaska Natives Journal of Applied Gerontology, February 1, 2006; 25(1_suppl): 9S - 26S. [Abstract] [PDF]
|
|
|
|
 |
|
 T. S. Harwell, C. S. Oser, N. J. Okon, C. C. Fogle, S. D. Helgerson, and D. Gohdes Defining Disparities in Cardiovascular Disease for American Indians: Trends in Heart Disease and Stroke Mortality Among American Indians and Whites in Montana, 1991 to 2000 Circulation, October 11, 2005; 112(15): 2263 - 2267. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Young Racial, ethnic minorities less likely to receive good cardiac care, studies find Am. J. Health Syst. Pharm., May 1, 2005; 62(9): 886 - 889. [Full Text] [PDF]
|
|
|
|
|
|
R. O. Bonow, A. O. Grant, and A. K. Jacobs The Cardiovascular State of the Union: Confronting Healthcare Disparities Circulation, March 15, 2005; 111(10): 1205 - 1207. [Full Text] [PDF]
|
|
|
|
|
|
C. W. Yancy, E. J. Benjamin, R. P. Fabunmi, and R. O. Bonow Discovering the Full Spectrum of Cardiovascular Disease: Minority Health Summit 2003: Executive Summary Circulation, March 15, 2005; 111(10): 1339 - 1349. [Full Text] [PDF]
|
|