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PubMed2003

Asthma prevalence among Alaska Native and nonnative residents younger than 20 years enrolled in Medicaid.

BACKGROUND: No study of childhood asthma prevalence in Alaska or among Alaska Natives has been conducted. OBJECTIVE: To determine asthma prevalence among Alaska Medicaid enrollees younger than 20 years, with an emphasis on Alaska Natives, the state's largest minority and predominant rural citizens. METHODS: A master database was obtained that included all children enrolled in Medicaid during July 1998 through June 1999. Physician, pharmacy, and hospital claims files for International Classification of Diseases codes 493.0x to 493.9x were linked to this master database. Asthma was defined as any asthma-related care or medication claim. RESULTS: Asthma prevalence among the study population was 6.9%. Alaska Natives had a lower asthma prevalence than nonnatives (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.66-0.75), but among the subgroup of children residing in the state's major urban center, Alaska Natives had a higher prevalence. Overall, 0.22% of the study population experienced an asthma-related hospitalization, with Alaska Natives having a higher risk of hospitalization than nonnatives (RR, 1.6; 95% CI, 1.2-2.3). Among hospitalized children, Alaska Natives were less likely to have received a long-term control medication (RR, 0.54; 95% CI, 0.33-0.88). CONCLUSIONS: Compared with nonnatives, Alaska Natives have a lower risk of asthma but only among nonurban residents. The increased risk of hospitalization among Alaska Natives may be related to underuse of long-term control medications.

Administration, Inhalation↗
PubMed1998

Colorectal cancer incidence and survival among Alaska Natives, 1969-1993.

BACKGROUND: Although colorectal cancer rates are low among most groups of Native Americans in North America, rates for Alaska Natives have been substantially elevated compared with US rates for all races combined. METHODS: To better describe the epidemiology of colorectal cancer incidence and survival among Alaska Natives, stratified by gender and tribal/ethnic affiliation, we examined data collected by the Alaska Native Cancer Registry 1969-1993. We calculated age-adjusted and age-specific incidence as well as actuarial survival rates, and examined histological type, site, stage at diagnosis, and treatment. We compared these data to colorectal cancer data from whites living in western Washington. RESULTS: In all, 587 colorectal cancer cases were identified among Alaska Natives over the 25-year period, for an age-adjusted annual incidence rate of 71.4/100000 in women, and 69.3/100000 in men. Compared to Alaska Indians, colon cancer rates were significantly higher in Aleuts (relative risk [RR] = 1.6, 95% CI: 1.2-2.2) and in Eskimos (RR = 1.5, 95% CI: 1.2-1.8), while rectal cancer rates did not differ by race/ethnicity. Alaska Natives experienced a 50% higher incidence rate of colorectal cancer overall compared to western Washington whites (RR = 1.5, 95% CI: 1.3-1.6), although rectal cancer rates were similar in the two populations. The highest RR were seen among Alaska Native women; Aleuts and Eskimos had colon cancer rates more than twice that of western Washington white women. No unusual qualitative features were found in the cancers occurring in Alaska Natives. Actuarial colorectal cancer survival rates for Alaska Natives overall were 74% at one year and 42% at 5 years; these rates were very similar to those observed for the western Washington population. Both one and 5-year survival rates showed a significant trend towards improvement over time. CONCLUSIONS: Alaska Natives had substantially higher colorectal cancer incidence rates compared to western Washington whites. Rates were particularly high for Aleut and Eskimo women. These data suggest a need for intensified secondary prevention strategies for this high-risk population, while further research is needed to identify modifiable risk factors.

Actuarial Analysis↗
PubMed2006

Differences in cancer incidence among Indians in Alaska and New Mexico and U.S. Whites, 1993-2002.

Cancer incidence for American Indians and Alaska Natives is typically reported as a single rate for all U.S. indigenous populations combined. Previously reported combined rates suggest that American Indians and Alaska Natives have lower cancer incidence rates compared with the U.S. population. Alaska Native people comprise three major ethnic groups: Eskimo, Indian, and Aleut people. We examined cancer incidence from only Alaska Indians and compared incidence rates with an American Indian population living in New Mexico. These data indicate striking differences in cancer patterns between two American Indian populations. Cancer data for the years 1993 to 2002 for American Indians of New Mexico and U.S. Whites are from the National Cancer Institute Surveillance, Epidemiology, and End Results Program Public-use data set. Data for Alaska Indians are from the Alaska Native Tumor Registry, which is also a Surveillance Epidemiology and End Results Program participant. Overall, cancer incidence rates for all sites combined in New Mexico Indian men and women were lower than U.S. White rates, whereas Alaska Indian men and women exceeded U.S. rates. In comparing Alaska and New Mexico Indians, we observed a 2.5-fold higher incidence of cancer among Alaska Indians. The largest differences between the two Indian populations were noted primarily in cancers associated with tobacco use, including cancers of the oral cavity/pharynx, esophagus (only in men), colon and rectum, pancreas, larynx (men), lung, prostate, and urinary bladder (men). Lung cancer rates in Alaska Indian men and women were 7 and 10 times those of New Mexico Indian men and women.

Alaska↗
PubMed2006

The Alaska Haemophilus influenzae type b experience: lessons in controlling a vaccine-preventable disease.

OBJECTIVE: Before 1991, Alaska Native children experienced one of the highest rates of invasive Haemophilus influenzae type b disease. H influenzae type b vaccine has led to a near-elimination of invasive H influenzae type b disease in the United States. We describe challenges encountered in controlling H influenzae type b disease in Alaska and update the current status of H influenzae disease and carriage in Alaska as lessons to other populations. PATIENTS AND METHODS: We reviewed data from statewide H influenzae disease surveillance conducted during 1980-2004. Vaccine coverage data were based on audits from tribal facilities and the National Immunization Survey. H influenzae type b colonization data were based on 6 carriage studies. RESULTS: After universal infant vaccination in 1991, H influenzae type b disease among Alaska Native and non-Native children < 5 years of age decreased by 94% and 96%, respectively. After a 1996 change in H influenzae type b vaccine from polyribosylribitol phosphate-outer membrane protein conjugate vaccine to H influenzae type b oligosaccharide-CRM197 vaccine, the incidence of H influenzae type b disease increased in rural Alaska Natives from 19.8 to 91.1 cases per 100000 per year < 5 years of age. During 2001-2004, with use of polyribosylribitol phosphate-outer membrane protein conjugate vaccine, the rate of H influenzae type b disease in Alaska Native and non-Native children aged < 5 years decreased to 5.4 and 0 per 100000 per year, respectively. In postvaccine studies, H influenzae type b carriage has decreased in Alaska Native children < 5 years of age. CONCLUSIONS: H influenzae type b vaccination has resulted in a dramatic decrease in invasive H influenzae type b disease in Alaska; however, despite high rates of H influenzae type b vaccine coverage, H influenzae type b disease rates among rural Alaska Native children < 5 years of age remain higher than the rates among non-Native Alaska and other US children. Equity in disease rates may not be achieved in indigenous populations with the current vaccines unless other environmental and household factors contributing to disease transmission are addressed.

Alaska↗
PubMed2004

Health care delivery for Alaska Natives: a brief overview.

OBJECTIVES: Describe the Alaska Native Health Care delivery system and some of the historical elements that shaped it. STUDY DESIGN: Retrospective program review. METHODS: Retrospective review of existing administrative and clinical programs. RESULTS: Over the last 10,000-15,000 years the Alaska Native Health System developed from at traditional tribal based self-care system to a complex system that is interdependent on local, state, federal, and private insurance payers. The Alaska Tribal Health System takes an intentional approach to planning. While the system may face an uncertain future, it is poised to continue it remarkable success. The regional health corporations are the backbone of the system and it is the regional health corporations that own the Alaska Tribal Health System. In addition, it is the Alaska Tribal Health System that is responsive to the needs and priorities of the regional health corporations and their Native constituents. The spirit of the Alaska Native has inspired their health care providers at all levels to develop innovative "work arounds" to provide state of the art care through regionalization and telemedicine. Despite the many challenges ahead, the Alaska Tribal Health System will continue to strive to increase the health of Alaska Native people to the highest status possible. CONCLUSION: The Alaska Native health care system is a dynamic system administered by and for Alaska Native peoples. This system has risen to many challenges in the past and has made great strides through both ingenuity and necessity.

Alaska↗
PubMedDate not supplied

Racial differences in birthweight-specific neonatal mortality in Alaska: 1987-1996.

OBJECTIVES: This study compared the neonatal mortality in the Alaska Native and non-native (primarily white) population in Alaska for a 10-year period (1987-1996). METHODS: Natality, mortality, and cause of death data were obtained from the State of Alaska's Bureau of Vital Statistics (BVS). Birthweight-specific and preventable birthweight-specific mortality were analyzed for babies < 1500 grams, 1500-2499 grams, and > or = 2500 grams birthweight. RESULTS: The low birthweight (LBW) and very low birthweight (VLBW) rates were similar for the Alaska Native and non-native populations. The neonatal mortality rate for the Alaska Native population was higher than for the non-native population (6.4 per 1,000 live births for Alaska Native vs. 4.1 for non-native for 1987-1991; 5.5 for Alaska Native vs. 3.5 for non-native for 1992-1996). Birthweight-specific mortality was higher in the Alaska Native population for all birthweight groups. The exclusion of non-preventable conditions accentuated the differences in mortality rates between the Alaska Native and non-native population for infants < 2500 grams birthweight. CONCLUSION: The higher neonatal mortality in the Alaska Native population is associated with a higher overall and preventable birthweight-specific neonatal mortality. The differences are therefore likely to reflect differences in access to and quality of perinatal care.

Alaska↗
PubMedDate not supplied

Infant mortality in Alaska: evidence of high postneonatal mortality rate.

Improvements in infant mortality (death less than 1 year of age) have been experienced by the United States and Alaska over the past decade. The decline in the Alaska neonatal mortality (death less than 28 days of age) rate has been the major factor in our improved infant mortality rate. Alaska's neonatal mortality rate is one of the lowest in the U.S. However, postneonatal mortality (28 days to 1 year of age) rate has not declined and is one of the highest in the U.S. In this study we used vital statistics records to examine socio-demographic and inter-regional factors that may help to explain Alaska's apparently high postneonatal mortality rate. The study population consisted of all live born infants in Alaska for 1975 to 1985, who died in infancy. The Alaska neonatal mortality rate has been lower, but postneonatal mortality rate has been higher than the U.S. average for the period under consideration (p less than .05). Comparison of alaska postneonatal mortality rate from 1975 to 1985 with the U.S. found Alaska Non-natives have higher postneonatal mortality rates than U.S. White, and Alaska Native have higher postneonatal mortality rates than other U.S. minorities. The rural areas of Alaska have a higher postneonatal mortality rate than urban areas, a phenomenon also observed for the U.S. as a whole.

Alaska↗
PubMed2003

Establishing a culturally sensitive palliative care program in rural Alaska Native American communities.

End-of-life programs that provide an option for patients to die at home are available in most U.S. communities. However, Alaska Natives living in remote Alaska villages often die alone in hospitals and nursing homes hundreds of miles away from home. The Bristol Bay Area Health Corporation (BBAHC), a tribal organization, is the sole provider of comprehensive primary care services to 34 Alaska Native villages located within a 46,000 square mile area in southwest Alaska. The closest tertiary care hospital is 329 air miles away in Anchorage. Because of the high cost of, and difficulties encountered in trying to deliver end-of-life care services to remote communities, a village-focused, culturally sensitive, volunteer and primary care program combined with a regionally based physician and home health nurse to deliver multi-disciplinary palliative care was developed. The Helping Hands Program blends cultural practices with contemporary palliative care medicine to allow Alaska Natives and others living in remote communities to be cared for at home through the end of life. Since the program was implemented in 1999, the percentage of home deaths for selected causes has changed from 33% in 1997 to 77% in 2001. The Anchorage-based Alaska Native Tribal Health Consortium (ANTHC) and the Alaska Native Medical Center (ANMC) have recognized the importance and success of the BBAHC program and are investigating expanding the program to other parts of Alaska. Centralizing the program in Anchorage will allow staff trained in palliative care to travel to regional Alaska Native hospitals to help train health care professionals.

Alaska↗
PubMed2005

Comparative overwintering physiology of Alaska and Indiana populations of the beetle Cucujus clavipes (Fabricius): roles of antifreeze proteins, polyols, dehydration and diapause.

The beetle Cucujus clavipes is found in North America over a broad latitudinal range from North Carolina (latitude approximately 35 degrees N) to near tree line in the Brooks Range in Alaska (latitude, approximately 67 degrees 30' N). The cold adaptations of populations from northern Indiana (approximately 41 degrees 45' N) and Alaska were compared and, as expected, the supercooling points (the temperatures at which they froze) of these freeze-avoiding insects were significantly lower in Alaska insects. Both populations produce glycerol, but the concentrations in Alaska larvae were much higher than in Indiana insects (approximately 2.2 and 0.5 mol l(-1), respectively). In addition, both populations produce antifreeze proteins. Interestingly, in the autumn both populations have the same approximate level of hemolymph thermal hysteresis, indicative of antifreeze protein activity, suggesting that they synthesize similar amounts of antifreeze protein. A major difference is that the Alaska larvae undergo extreme dehydration in winter wherein water content decreases from 63-65% body water (1.70-1.85 g H2O g(-1) dry mass) in summer to 28-40% body water (0.40-0.68 g H2O g(-1) dry mass) in winter. These 2.5-4.6-fold reductions in body water greatly increase the concentrations of antifreeze in the Alaska insects. Glycerol concentrations would increase to 7-10 mol l(-1) while thermal hysteresis increased to nearly 13 degrees C (the highest ever measured in any organism) in concentrated hemolymph. By contrast, Indiana larvae do not desiccate in winter. The Alaska population also undergoes a diapause while insects from Indiana do not. The result of these, and likely additional, adaptations is that while the mean winter supercooling points of Indiana larvae were approximately -23 degrees C, those of Alaska larvae were -35 to -42 degrees C, and at certain times Alaska C. clavipes did not freeze when cooled to -80 degrees C.

Adaptation, Physiological↗
PubMed2001

Alaska's model program for occupational injury prevention: applying surveillance for effective public health practice.

BACKGROUND: NIOSH established its Alaska Field Station in Anchorage, Alaska, in 1991, after identifying Alaska as America's highest-risk state for traumatic worker fatalities. Since then, NIOSH established comprehensive occupational injury surveillance in Alaska, and formed and facilitated interagency working groups (of state and federal agencies) and industry, labor, and professional organizations to address major factors leading to occupational death and injury in the state. STUDY DESIGN: Descriptive epidemiologic study of registry surveillance data obtained via direct on-site investigation of incidents and data-sharing with jurisdictional agencies. METHODS: We established a surveillance system, obtaining information via data-sharing with jurisdictional agencies and from direct on-site investigation of incidents. Also, we collaborate with state and regional government agencies, industry, workers, and non-governmental organizations to develop interventions. RESULTS: During 1991-1999, Alaska experienced a 50-percent overall decline in work-related deaths, including a substantial decline in commercial fishing deaths, and a very sharp decline in helicopter logging-related deaths. These efforts have lead to major national and international government-industry collaborative efforts in improving the safety of helicopter lift operations, and a concomitant improvement in fishing industry mortality rates among workers fishing Alaskan seas. CONCLUSIONS: Using surveillance data as information for action, these collaborative efforts have contributed to reducing Alaska's high occupational fatality rate. This reduction has been most clearly demonstrated in the rapidly expanding helicopter logging industry. The application of surveillance data also has played an important supportive role in the substantial progress made in reducing the mortality rate in Alaska's commercial fishing industry--historically, Alaska's (and America's) most dangerous industry, and the worst killer of Alaskan workers. Results suggest that extending Alaska's approach to occupational injury surveillance and prevention to other parts of the country, and application of these strategies to the entire spectrum of occupational injury hazards, could have a broad impact on reducing occupational injuries.

Accidents, Occupational↗
PubMedDate not supplied

The prevalence of tobacco use among Alaska adults.

The Alaska Division of Public Health monitors the prevalence of smoking and other tobacco use among Alaska adults through the Alaska Behavioral Risk Factor Surveillance System, a telephone survey performed in cooperation with the U.S. Centers for Disease Control and Prevention (CDC). A total of approximately 1530 interviews are completed each year in Alaska by specially trained interviewers. The prevalence of smoking among Alaska adults in 1994 (28.9%) was second highest in the U.S. Alaska Natives have higher smoking rates (42.9%). Overall, smoking rates have declined in the last three decades nationally. However, in recent years, little change has been found in the prevalence of smoking among adults. Alaska's rate of smokeless tobacco use has also been higher than the national rate of use. The majority of Alaska smokers (83.7%) began smoking between 10 and 20 years of age. In 1994, an estimated 121,000 Alaska adults aged 18 and older were current smokers.

Adolescent↗
PubMed1997

Comparison of atherosclerosis in alaska Natives and nonnatives.

OBJECTIVE: To test the hypothesis that Alaska Natives have fewer atherosclerotic lesions in the coronary arteries and aorta than nonnative Alaska residents. DESIGN: Systematic standardized collection and evaluation of coronary arteries and aortas collected at autopsy. SETTING: Forensic autopsy service in Alaska. SUBJECTS: One hundred thirty Alaska Natives and 115 Alaska nonnatives who underwent forensic autopsy between February 1989 and December 1993. INTERVENTION: None. MAIN OUTCOME MEASURES: Prevalence and extent of atherosclerotic lesions in the aortas and coronary arteries in both populations studied. RESULTS: Alaska Natives had significantly lower prevalence and extent of raised atherosclerotic lesions in the abdominal aorta and coronary arteries than nonnative Alaska residents. CONCLUSIONS: Differences in coronary heart disease mortality between Alaska Natives and nonnatives are, at least in part, the result of fewer atherosclerotic lesions in Alaska Natives.

Adolescent↗
PubMed1994

The epidemiology of invasive pneumococcal disease in Alaska, 1986-1990--ethnic differences and opportunities for prevention.

To assess prevention strategies for pneumococcal disease in Alaska, prospective surveillance during 1986-1990 identified 672 invasive pneumococcal infections, including 315 among Alaska Natives. Age-adjusted annual incidence was 74 per 100,000 for Alaska Natives and 16 per 100,000 for nonnatives. The annual incidence in Alaska Native children < 2 years old was 624 per 100,000; rates of 84 per 100,000 for meningitis and 290 per 100,000 for bacteremic pneumonia were 8-10 times higher than for other US groups. By age 75, cumulative incidence (7%) and mortality (1%) in Alaska Natives were almost 4 times higher than for nonnatives. Only 17% of Alaska Native adults with predisposing conditions and invasive infections previously received pneumococcal vaccine. For Alaska Natives, a proposed heptavalent conjugate pneumococcal vaccine will include serotypes responsible for 85% of invasive isolates from children < 2 years but only 32% of those from adults. The 23-valent polysaccharide pneumococcal vaccine, which contains > 94% of serotypes identified in Alaska Native toddlers and adults, should be used more widely.

Adolescent↗
PubMed2000

Prevalence of diabetes among Native Americans and Alaska Natives, 1990-1997: an increasing burden.

OBJECTIVE: To determine trends in diabetes prevalence among Native Americans and Alaska Natives. RESEARCH DESIGN AND METHODS: From 1990 to 1997, Native Americans and Alaska Natives with diabetes were identified from the Indian Health Service (IHS) national outpatient database, and prevalence was calculated using these cases and estimates of the Native American and Alaskan population served by IHS and tribal health facilities. Prevalence was age-adjusted by the direct method based on the 1980 U.S. population. RESULTS: Between 1990 and 1997, the number of Native Americans and Alaska Natives of all ages with diagnosed diabetes increased from 43,262 to 64,474 individuals. Prevalence of diagnosed diabetes increased by 29%. By 1997, prevalence among Native Americans and Alaska Natives was 5.4%, and the age-adjusted prevalence was 8.0%. During the entire 1990-1997 period, prevalence among women was higher than that among men, but the rate of increase was higher among men than women (37 vs. 25%). In 1997, age-adjusted prevalence of diabetes varied by region and ranged from 3% in the Alaska region to 17% in the Atlantic region. The increase in prevalence between 1990 and 1997 ranged from 16% in the Northern Plains region to 76% in the Alaska region. CONCLUSIONS: Diabetes is common among Native Americans and Alaska Natives, and it increased substantially during the 8-year period examined. Effective interventions for primary, secondary, and tertiary, prevention are needed to address the substantial and rapidly growing burden of diabetes among Native Americans and Alaska Natives.

Adult↗
PubMed2003

Cardiovascular disease among Alaska Natives: a review of the literature.

BACKGROUND: We reviewed the literature of population-based studies regarding heart disease and stroke occurrence among Alaska Natives. The existing literature suggests that differences in cardiovascular mortality rates and risk factors exist in Alaska Natives by ethnicity and residence. However, data sources are largely limited to mortality data and small community-based studies. OBJECTIVES: Because cardiovascular disease occurrence has not been well studied among Alaska Natives, it is important to avoid sweeping generalizations about the increasing or decreasing prevalences of cardiovascular disease and risk factors. RESULTS: Recent mortality rates from heart disease (of all types) among Alaska Natives are similar to rates for U.S. whites, and mortality rates from stroke among Alaska Natives are higher than rates for U.S. whites. Mortality rates from ischemic heart disease have been relatively constant among Alaska Natives over the past 20 years, while over the same time period, rates declined dramatically among U.S. Whites. The ischemic heart disease mortality rates among Alaska Native males are now comparable to rates among U.S. White males. CONCLUSIONS: Although available data indicate no increase in mortality from ischemic heart disease in Alaska Natives, the relatively constant death rates over the recent 20 years, compared with declining rates elsewhere in the U.S, and the high prevalence of risk factors for ischemic heart disease calls for increased descriptive epidemiologic studies of the incidence and prevalence of cardiovascular disease outcomes. In addition, analytic epidemiologic studies are needed to examine the relationship between lifestyle, especially subsistence and traditional lifestyles, and cardiovascular disease outcomes.

Alaska↗
PubMed2000

Alaska Native drug users and sexually transmitted disease: results of a five-year study.

Although Alaska has one of the highest rates of alcohol consumption in the U.S., there are very few reports of other drug use in Alaska. This five-year NIDA-funded study sampled out-of-treatment injection drug users (IDUs) and crack cocaine smokers in Anchorage, Alaska. This paper is a summary of results comparing risk behavior for HIV and sexually transmitted disease infection among Alaska Natives (n=216) to non-Natives (primarily Blacks n=394 and Whites n=479) from this study. IDUs and crack cocaine smokers were recruited using a targeted sampling plan. All subjects tested positive to cocaine metabolites, or morphine, using urinalysis, or had visible track marks. Several analyses of this database have indicated that Alaska Native women are at high risk for gonorrhea infection. They are also at risk for HIV infection due to high rates of behavior related to blood-borne disease transmission. We have also found that White men who have sex with both White and Alaska Native women are significantly less likely to use condoms with the Alaska Native women. HIV preventive education efforts aimed at Alaska Native women need to be implemented on a major scale.

Alaska↗
PubMed1998

Effective injury prevention using surveillance data: helicopter logging, Alaska, 1992-1995.

BACKGROUND AND PURPOSE: To reduce the fatality rate in helicopter sling-load logging in Alaska. These operations--on rugged terrain, due to environmental restrictions and economics--are an emerging technology application worldwide. During 1992 and 1993, crashes during these operations in Alaska resulted in multiple fatalities. METHODS: During 1992, comprehensive surveillance for these events was established, combining electronic media and interagency notification with active investigation to identify preventable risk factors. These data were applied in mid-1993 by an interagency working group, which included representatives of the Alaska Department of Health and Social Services, Alaska Department of Labor, Federal Aviation Administration, National Transportation, Safety Board, U.S. Coast Guard, Occupational Safety and Health Administration, U.S. Forest Service, and National Institute for Occupational Safety and Health. In response to surveillance data, consensus safety recommendations were developed. Working closely with industry, immediate improvements were made in worker training, work/rest cycles, and oversight. Surveillance results are being used to evaluate the effectiveness of interventions. On March 1-2, 1995, an international workshop was convened in Ketchikan, Alaska, to involve industry and government agencies in planning for durable prevention in this industry. RESULTS: In Alaska between January 1, 1992, and June 30, 1993, there were 6 helicopter crashes, with 9 fatal (4 in pilots) and 10 severe nonfatal injuries, out of only 25 helicopters flying in helicopter logging operations. Alaska logging helicopters thus had the extraordinarily high annual crash rate of 16% and a catastrophic pilot fatality rate of 5,000/100,000/year. Investigation revealed that all crashes involved improper operational and/or maintenance practices. Since these recommendations were implemented in July 1993, there have been no additional helicopter logging fatalities in Alaska through 1995. The 1995 meeting resulted in further recommendations, including more vigorous oversight; development of rigorous voluntary industry standards for equipment, maintenance, and training; exclusive use of multi-engine rotocraft; and more vigorous controls on alcohol and drug use in this industry.

Accidents, Occupational↗
PubMedDate not supplied

Cancer mortality among Alaska natives, 1994-1998.

Although overall cancer mortality rates in the U.S. declined throughout the 1990s, Alaska Native rates increased. This study compares mortality patterns of Alaska Natives for the period, 1994-1998, and U.S. Whites, and examines changes in rates since 1960-1969. We used death certificate data and Indian Health Service population estimates to create age-adjusted mortality rates for Alaska Natives. We compared these rates to NCHS mortality for U.S. Whites. In all, 597 Alaska Natives died of cancer over the five-year period, 1994-1998, their age-adjusted average annual mortality rate (224.5 per 100,000) was thirty percent higher than that of U.S. Whites (166.7 per 100,000), a statistically significant excess (OR = 1.3, 95% CI: 1.2-1.4). Alaska Natives were forty percent more likely to die of lung cancer than U.S. Whites (OR = 1.4, 95% CI: 1.2-1.6). This population also demonstrated elevated mortality rates for several other smoking-related cancers. Also, Alaska Natives are at excess risk for nearly all cancers of the digestive system. Alaska Natives experienced the same or lower mortality rates for genitourinary cancers excluding cancer of the kidney. Smoking related cancers, and particularly, lung cancer, were the major contributors to the excess mortality rates. These data suggest that the burden of cancer on the Alaska Native healthcare system will continue to increase as the population ages. Intensified efforts to modify behavioral risk factors are needed.

Alaska↗