Article

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

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Abstract

Although several recent studies have documented a high incidence of end-stage renal disease (ESRD) among American Indians (AI) and Alaska Natives (AN), racial misclassification of AI/AN as members of other races on disease registries has not been accounted for. We conducted a study to link the Northwest Renal Network (NRN) ESRD database, which includes persons known to have begun dialysis in Idaho, Oregon, and Washington, and the Indian Health Service (IHS) patient registration file, which includes AI/AN enrolled for health care provided or paid for by IHS in the same states, for the period January 1, 1988 to December 31, 1990. Among the 3,356 persons included on the NRN ESRD database, 68 (2.0%) were coded as AI/AN. Of the 68 listed as AI/AN, 54 (79.4%) were identified on the IHS patient registration file. In addition to the 68 cases coded on the NRN as AI/AN, we identified 12 cases that were definitively matched to the IHS patient registration file but not coded AI/AN on the NRN. The age-adjusted annual incidence of ESRD treatment initiation among AI/AN in Idaho, Oregon, and Washington was 267.5 per million according to original racial coding on the NRN, but it increased to 311.6 per million after correction for racial misclassification. Among IHS-registered AI/AN, the annual incidence increased from 394.1 per million to 474.3 per million. Racial misclassification of AI/AN in ESRD registries may result in underestimates of AI/AN ESRD incidence for the United States.

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... Misclassification of American Indian race on death certificates has been well documented 1-6 and has contributed to underestimation of health disparities in this population. [7][8][9][10][11] To support tribal prevention efforts to reduce mortality related to cardiovascular disease (CVD), we collaborated with Maine American Indian tribes and bands to evaluate declines in CVD-related mortality over a 20year period and to address the hypothesis that CVD-related mortality among American Indians might be underestimated. Our investigation revealed a previously unreported source of race misclassification and a potential link between misclassification and changes in quality control procedures with regard to vital record processing in Maine as a result of budget reductions. ...
... Previous reports of misclassification of American Indian race are from states with larger relative and absolute numbers of American Indians. 3,[5][6][7][8][9][10] The small size of the American Indian population in many states, like Maine, may present unique barriers and opportunities. State health departments should consider collaborative approaches to developing standardized data quality control procedures to evaluate the quality of race-specific data that include American Indian tribal health departments in the management of their own vital records. ...
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Article
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Article
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Article
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... 30 Racial misclassification among AIAN has resulted in substantial underestimation of cancer mortality, 31 injury rates, 32 and prevalence of end-stage renal disease. 33 Furthermore, mortality from "signs, symptoms, and ill-defined conditions" was a disproportionately leading cause of death among American Indians in New Mexico, 34 likely leading to underestimation in rates of death from CVD. ...
Article
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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. 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 > or =65 years of age was lower than in the other populations. 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.
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Article
Objectives: We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. Methods: Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). Results: Our study included 510,666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. Conclusions: Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival.
... self-reporting or observation), otherwise other important biases could occur if assumptions are made about the reporting method (Commission for Racial Equality, 2002;Buescher et al, 2005). Sugarman and Lawson (1993) demonstrated that racial disparity varied according to the method of collection, and the incidence of renal disease in American Indians/Alaska Natives increased from 268 per million to 312 per million after corrections to the coding. ...
Article
There is an identified need for the collection of ethnicity data in the healthcare setting. Accurate data on ethnicity are essential for informing policy makers, funders and public health experts about the incidence, prevalence and outcomes of specific conditions in population subgroups. There is emerging evidence that some ethnic groups are associated with an increased incidence of certain cancers, and disparities in access to services have been documented. Government initiatives are in place to collect ethnicity data in the healthcare setting, but the accuracy of the data needs to be validated. Cancer Research UK commissioned the Cancer Ethnicity (CanEth) project to gather robust evidence and identify solutions to improve the collection of ethnicity data for cancer. The project set out to review current literature focusing on methods, interventions and barriers addressing the collection of ethnicity data. The review identified a paucity of published evidence on ethnicity data collection. Many clinical articles used ethnicity data, but few discussed the methodology of data collection. In general, however, self-reported ethnicity is recognised as the best method of data collection, and is preferable to observer assessment. Training is needed to raise awareness of the importance of ethnicity data and its use to facilitate the reduction of inequalities.
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Article
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... [63][64][65][66] Neither the validity nor the reliability of racial/ethnic assignment can be assumed. 43,[67][68][69][70][71][72][73][74][75][76][77][78][79] Individuals are frequently assigned to racial/ethnic categories by researchers, interviewers, hospital admitting clerks, clinicians, undertakers, and medical examiners. 43,76,79 These assignments are made according to the assumptions and biases of the observer, based on factors such as appearance, surname, language spoken, and neighborhood of residence. ...
Article
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The purpose of this study was to describe the consistency of coding of American Indians on Montana death certificates and to identify the characteristics of American Indians in Montana associated with consistent classification on death certificates. The Billings Area Indian Health Service (IHS) patient registration file was linked with Montana Department of Health and Human Services death certificate files for 1996-1998. A total of 769 Montana residents who had died in 1996-1998 were matched to the IHS registration file. Of these decedents, 696 (91%) were consistently classified as American Indian on the death certificate. Seventy-two (99%) of the 73 decedents not classified as Indian were classified as white. American Indians living in counties on or near the seven Montana reservations were more likely to be consistently classified than Indians living in other counties (95% vs. 70%); those with less than 12 years of education (93% vs. 88%) were more likely to be consistently classified than those with 12 or more years of education. Decedents whose cause of death was suicide were less likely than those with other causes of death to be consistently classified (72% vs. 95%). In contrast, a higher percentage of those with an alcohol-related cause of death than of those with other causes of death were consistently classified, although this difference was not statistically significant. The mortality rates for Montana American Indians are underestimated overall, and are differentially under- and overestimated for selected conditions.
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We compared the prevalence of, and reasons for, perceived discrimination in health care among American Indian/Alaska Natives (AI/ANs) and persons of AI/AN + White heritage to African Americans, Asian Americans, and Whites. Data on perceived discrimination were collected by the 2001 California Health Interview Survey (CHIS). We used chi-square tests to evaluate the prevalence of perceived discrimination and the reasons for perceived discrimination across racial groups. The 2001 CHIS, a telephone survey, one of the largest cross-sectional surveys ever conducted in the United States. Participants in this analysis were adults > or = 18 years of age, interviewed from 55,000 households that took part in the survey. Participants in the 2001 CHIS were asked "Thinking of your experiences with receiving health care in the past 12 months, have you felt you were discriminated against for any reason?" Respondents who endorsed this item were asked about possible reasons for the discrimination. 1) Does the prevalence of perceived discrimination in health care differ between AI/ANs, AI/AN + Whites, African Americans, Asian Americans, and Whites? and 2) Do the reasons for perceived discrimination in health care vary by race or ethnicity? Discrimination was perceived by 7.1% of the AI/AN alone group, 8.8% of AI/AN + White respondents, 5.6% of African Americans, 4.3% of Whites, and 2.6% of Asian Americans. After adjusting for covariates, the odds of perceived discrimination were different for AI/AN + White (odds ratio [OR] =2.0, 95% confidence interval [CI] 1.5-2.5) and Asian American (OR = .5, 95% CI .4-.7) when compared to Whites. AI/ANs, and especially those who identify as AI/AN + White, were the most likely among racial groups to report discrimination in health care.
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The burden of sexually transmitted diseases (STDs) is high in American Indian/Alaska Native (AI/AN) populations. In addition, race is often misclassified in surveillance data. This study examined potential racial misclassification of American Indians in STD surveillance data in Oklahoma. Oklahoma State STD surveillance data for 1995 were matched with the Oklahoma State Indian Health Service Patient Registry to determine the number of AI/AN women who had one of three STDs but were not listed in Oklahoma surveillance data as AI/AN. Accounting for racial misclassification increased the rate of chlamydia for AI/AN women in Oklahoma by 32% (342/100,000 vs. 452/100,000) in the overall population. For gonorrhea, the rate increased by 57% (94/100,000 vs. 148/100,000) and for syphilis by 27% (15/100,000 vs. 19/100,000). Misclassified AI/AN women most often were classified as "White," and the likelihood of misclassification increased with a lower percentage of AI/AN ancestry. These findings indicate that STD rates may be underestimated for AI/AN populations nationwide. Racial misclassification in state surveillance data causes inaccuracies in characterizing the burden of infectious diseases in minorities.
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This study examined effects of racial/ethnic misclassification of American Indians and Alaskan Natives on Washington State death certificates. Probabilistic record linkage were used to match the 1989-1997 state death files to the Northwest Tribal Registry. We identified matches for 2819 decedents, including 414 (14.7%) who had been misclassified as non-American Indians and Alaskan Natives on the death certificates. The likelihood of being correctly classified increased 3-fold for each higher level of American Indian and Alaskan Native ancestry (odds ratio = 2.88; 95% confidence interval [CI] = 2.51, 3.30) and decreased by 6.9% per calendar year (95% CI = 2.0, 11.5). Systematic biases on death certificates in Washington State persist. Methods to reduce misclassification can improve data quality and enhance efforts to measure and reduce racial/ethnic health disparities.
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To describe severe injury among American Indians in a large metropolitan county given that most previous studies of the high Indian injury morbidity and mortality rates have been conducted primarily in rural areas. A retrospective analysis of a hospital trauma registry was conducted for the years 1986-92 at the Harborview Medical Center, the only Level I trauma center in King County, Washington, metropolitan county with the seventh largest number of urban American Indians in the United States. Of 14,851 King County residents included in the registry, 593 (4%) were classified as American Indian. With King County whites as the reference, the age-standardized incidence ratio for inclusion of American Indians in the registry was 4.4 (95% confidence interval 4.1, 4.8). The standardized incidence ratios and proportional incidence ratios showed significant differences in mechanism and whether it was intentional or unintentional among Indians compared with whites. Hospitalizations for stab wounds, bites, and other blunt trauma were all significantly more frequent among Indians. Trauma admissions among Indians were disproportionately associated with assaults. A high proportion (72.3%) of American Indians tested had blood alcohol levels exceeding 0.1%. Urban American Indians experience high rates of trauma, differing from those among whites. Efforts to reduce injury in urban areas should include collaboration with representative urban American Indian organizations.
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We assessed the extent to which injury rates among American Indians in Oregon are underestimated owing to misclassification of race in a surveillance system. The Oregon Injury Registry, a population-based surveillance system, was linked with the Indian Health Service patient registration file from Oregon, and injury rates for American Indians were calculated before and after correcting for racial misclassification. In 1989 and 1990, 301 persons in the Oregon registry were coded as American Indian. An additional 89 injured persons who were coded as a race other than American Indian in the registry were listed as American Indian in the Indian Health Service records. The age-adjusted annual injury rate for health service-registered American Indians was 6.9/1000, 68% higher than the rate calculated before data linkage. American Indian ancestry, female sex, and residence in metropolitan counties were associated with a higher likelihood of concordant racial classification in both data sets. Injury rates among American Indians in an Oregon surveillance system are substantially underestimated owing to racial misclassification. Linkage of disease registries and vital records with Indian Health Service records in other states may improve health-related data regarding American Indians.
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The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Prospective observational study. Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. The major outcome of interest was mortality. In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics. Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.
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Objectives The purpose of this study was to describe the consistency of coding of American Indians on Montana death certificates and to identify the characteristics of American Indians in Montana associated with consistent classification on death certificates. Methods The Billings Area Indian Health Service (IHS) patient registration file was linked with Montana Department of Health and Human Services death certificate files for 1996–1998. Results A total of 769 Montana residents who had died in 1996–1998 were matched to the IHS registration file. Of these decedents, 696 (91%) were consistently classified as American Indian on the death certificate. Seventy-two (99%) of the 73 decedents not classified as Indian were classified as white. American Indians living in counties on or near the seven Montana reservations were more likely to be consistently classified than Indians living in other counties (95% vs. 70%); those with less than 12 years of education (93% vs. 88%) were more likely to be consistently classified than those with 12 or more years of education. Decedents whose cause of death was suicide were less likely than those with other causes of death to be consistently classified (72% vs. 95%). In contrast, a higher percentage of those with an alcohol-related cause of death than of those with other causes of death were consistently classified, although this difference was not statistically significant. Conclusions The mortality rates for Montana American Indians are underestimated overall, and are differentially under- and overestimated for selected conditions.
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The burden of sexually transmitted diseases (STDs) is high in American Indian/Alaska Native (Al/AN) populations. In addition, race is often misclassified in surveillance data. This study examined potential racial misclassification of American Indians in STD surveillance data in Oklahoma. Oklahoma State STD surveillance data for 1995 were matched with the Oklahoma State Indian Health Service Patient Registry to determine the number of Al/AN women who had one of three STDs but were not listed in Oklahoma surveillance data as Al/AN. Accounting for racial misclassification increased the rate of chlamydia for Al/AN women in Oklahoma by 32% (342/100,000 vs. 452/100,000) in the overall population. For gonorrhea, the rate increased by 57% (94/100,000 vs. 148/100,000) and for syphilis by 27% (15/100,000 vs. 19/100,000). Misclassified Al/AN women most often were classified as White, and the likelihood of misclassification increased with a lower percentage of Al/AN ancestry. These findings indicate that STD rates may be underestimated for Al/AN populations nationwide. Racial misclassification in state surveillance data causes inaccuracies in characterizing the burden of infectious diseases in minorities.
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We conducted a systematic review of published studies on stroke epidemiology in American Indians and Alaska Natives (AI/ANs). We used MeSH terms and strict inclusion criteria to search PubMed, identifying a relevant sample of 57 refereed publications. We report a consensus view in which prevalent stroke is more common, and estimates of cerebrovascular risk factors are higher, among AI/ANs than among other US populations. Like other minority groups, AI/ANs suffer stroke at younger ages than do non-Hispanic Whites. However, data on AI/AN stroke mortality are significantly compromised by racial misclassification and nonrepresentative sampling. Studies correcting for these problems have found that stroke mortality rates among AI/ANs are among the highest of all US racial and ethnic groups. As with Black and non-Hispanic White stroke mortality, AI/AN stroke mortality varies by geographic region, with the highest rates in Alaska and the Northwest and the lowest in the Southwest. Our results underscore the need for a concerted national effort to collect accurate cross-sectional and longitudinal data on stroke in AI/ANs. (Am J Public Health. Published online ahead of print June 11, 2015: e1-e11. doi:10.2105/AJPH.2015.302698).
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Public health policy relies on accurate data, which are often unavailable for small populations, especially indigenous groups. Yet these groups have some of the worst health disparities in the United States, making it an ethical imperative to explore creative solutions to the problem of insufficient data. We discuss the limits of widely applied methods of data aggregation and propose a mixed-methods approach to data borrowing as a way to augment sample sizes. In this approach, community partners assist in selecting related populations that make suitable "neighbors" to enlarge the data pool. The result will be data that are substantial, accurate, and relevant to the needs of small populations, especially for health-related policy and decision-making at all levels. (Am J Public Health. Published online ahead of print July 16, 2015: e1-e4. doi:10.2105/AJPH.2015.302783).
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The US population has experienced tremendous growth in the last century, with much of the growth contributed by what are considered minority populations. The US Census has projected that, by the year 2050, one of every two persons in the United States will belong to one of the following racial and ethnic groups: American Indian, Asian and Pacific Islander, Black, or Hispanic (1). In California, the proportion of these racial and ethnic groups had already reached 43 percent in 1990 (2) and was 48 percent in 1997 (3). For these reasons, national health surveillance systems and large, ongoing, federally funded, …
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To examine assumptions underlying federal health statistics on racial and ethnic groups in the United States. Studies conducted by federal agencies and other investigators, and technical appendices of published vital statistics and census reports. Several assumptions underlying federal health statistics on racial and ethnic groups are not well supported. Conceptual (as opposed to operational) definitions of race and ethnicity are not available, and scientific grounds for definition are not considered. Procedures for the ascertainment of race and ethnicity vary within and among data-collection agencies. Miscounting and misclassification may vary by an order of magnitude between whites and other races. The responses of individuals to questions of racial and ethnic identity differ for different indicators, in different surveys, and at different times. As a result, counts, rates, and rate ratios may not be meaningful or accurate. Particularly for Hispanics and for races other than whites or blacks, there are inconsistencies in statistical information that may hinder health research and program development. Improvement of federal health statistics for racial and ethnic groups requires (1) clarification of goals for classification, (2) adoption of scientific principles for the validation and definition of the categories "race" and "ethnicity," (3) assessment of perceived social identity in the population, and (4) periodic evaluation.
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We used data reported to Medicare from 1983 through 1986 to determine the incidence of end-stage renal disease (ESRD) among Native Americans and Whites in the United States. The 1,075 Native American cases represented an annual incidence, age-adjusted to the White population, of 269 per million, 2.8 times the rate for Whites. Fifty-six percent of Native American cases and 27 percent of the White cases were attributed to diabetes, indicating that ESRD is a major problem. Diabetes control provides the greatest opportunity for prevention.
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Analysis of data from the Canadian National Renal Failure Register indicates that Canadian Natives are at much higher risk for end-stage renal disease (ESRD) than the Canadian population in general. Using two population estimates for the total Native population, the age-standardized incidence rate of newly registered ESRD cases between 1981 and 1986 among Natives was at least 2.5 times (and may be as high as four times) the national rate. Natives were particularly at higher risk for ESRD to diabetes, glomerulonephritis, and pyelonephritis, whereas for the other causes the risk was no different from that of other Canadians. As technologically sophisticated treatment facilities are only available in major urban centers, Native ESRD patients and their families living in remote areas of Canada are faced with major psychosocial disruptions of relocation.
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The rates of end-stage renal disease are much increased in American Indians, but no longitudinal study of its rates and causes has been undertaken in any tribe. This 15-year study of rates and causes of treated end-stage renal disease in the Navajo, the largest Indian tribe, supplies an important model on which to base projections and plan interventions. Treated end-stage renal disease in Navajos has increased to an age-adjusted incidence 4 times that in whites in the United States. Diabetic nephropathy accounted for 50% of all new cases in 1985, with an incidence 9.6 times that in US whites, and was due entirely to type II disease. Glomerulonephritis caused end-stage renal disease in Navajos at a rate at least 1.8 times that in US whites and afflicted a much younger population. The predominant form was mesangial proliferative glomerulonephritis associated with an immune complex deposition. Renal disease of unknown etiology, which probably includes much silent glomerulonephritis, accounted for 20% of all new cases. The aggregate Navajo population with end-stage renal disease was 9 years younger than its US counterpart. These observations reflect the genesis of the epidemic of diabetic nephropathy afflicting many tribes. Urgent measures are needed to contain this. In addition, the etiology and control of mesangiopathic, immune-complex glomerulonephritis of unusual severity, a previously unrecognized problem, need to be addressed.
Article
Objective. —To ascertain the consistency of the racial and ethnic classification of US infants between birth and death and its impact on infant mortality rates.Subjects. —All US infants born from 1983 through 1985 who died within a year.Design. —We used the national linked birth/infant-death computer tape, augmented with information on infants' race and ethnicity at death, to compare the coding of race and Hispanic ethnicity at birth and at death. We also assessed infant mortality rates by race and ethnicity as defined (1) by the standard algorithm and (2) by the rule that, beginning in published tabulations for 1989, assigns newborns the race of their mothers. Finally, we estimated infant mortality rates based on consistent coding of race and ethnicity at birth and death.Results. —Inconsistency in the coding of race is low for whites (1.2%), greater for blacks (4.3%), and greatest for races other than white or black (43.2%). Most infants reclassified at death (87.3%) are classified as white at death. Inconsistency in coding is lower for non-Hispanic whites (3.5%) and non-Hispanic blacks (3.3%) than for Hispanic populations (30.3%). Compared with the standard algorithm for calculation of infant mortality, consistent definition at birth and death produces rates 2.1% lower for whites, and higher for all other groups—3.2% for blacks, 46.9% for American Indians, 33.3% for Chinese, 48.8% for Japanese, 78.7% for Filipinos, and 8.9% for Hispanics.Conclusions. —The coding of race and ethnicity of infants at birth and death is remarkably inconsistent, with substantial impact on the estimation of infant mortality rates. A need exists to reconsider the nature and definition of race and ethnicity in public health.(JAMA. 1992;267:259-263)
Article
The cancer incidence for all sites has been reported to be lower in Native Americans than in White Americans. Concerns have been expressed, however, that the observed low incidence may be a result of inaccurate reporting of race. The objective of this study was to investigate the extent to which racial misclassification may contribute to the observed low cancer incidence among Native Americans. A registry of individuals eligible to receive medical services funded by the Indian Health Service was linked by computer to the Puget Sound Surveillance, Epidemiology, and End Results (SEER) cancer registry. Only 137 (60%) of the patients with invasive cancer registered with the Indian Health Service and for whom race was recorded were identified as Native Americans in the SEER registry. Similarly, 55 (69%) of 80 in situ cervical cancer case patients were classified as Native American. A strong association was observed between Native-American blood quantum level and racial misclassification. The results of this study indicate that the observed low cancer incidence in Native Americans relative to Whites in the northwest United States is at least partially attributable to racial misclassification in the SEER cancer registry.
Article
The prevalence of diabetes among 29,000 American Indians living on or near 10 reservations in the Pacific Northwest was established from clinical data sources. The age- and sex-adjusted prevalence rate in 1987 was three times higher [95% confidence interval (CI) 2.8-3.1] than the comparable United States rate in 1980. The age-adjusted prevalence for women was 1.3 times that for men (95% CI 1.2-1.4). The prevalence varied by culture area. Reservation communities whose principal tribe came from the Great Basin culture area had 3.6 times more diabetes than found in the U.S. as a whole. Reservation communities whose principal tribe was from the Plateau culture had 3.0 times more diabetes than found in the U.S., and those from the Northwest Coast culture had 1.9 times more diabetes than found in the U.S. The reasons for these variations are unknown and warrant investigation.
Article
Norsted T L (Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, Washington 98104, USA) and White E. Cancer incidence among Native Americans in Western Washington. International Journal of Epidemiology 1989, 18: 22–27. The incidence of cancer among Native Americans in Alaska, Canada, and the south western United States has been reportedly low relative to the Caucasian populations in these areas. We investigated the incidence of cancer among the Native Americans of Western Washington for the time period 1974–1983 and compared it to that of the Caucasian population using two types of analyses, age-standardized incidence ratios (SIR) and proportional cancer incidence ratios (PIR). Native Americans of this area were found to be at lower risk of cancer than Caucasians at almost all ages. The age-standardized incidence ratio (SIR) for all cancer sites was 0.4 (p<0.01) for males and 0.6 (p<0.01) for females. A relative excess of cancer of the cervix (SIR=1.6, PIR=2.1, p<0.05) was found among Native American females. Significant deficits were found for corpus uterine cancer among females (SIR=0.2, PIR=0.5, p<0.05) and cancer of the prostate among males (SIR=0.2, PIR=0.5, p<0.05). A suggestive increase in the risk of cancer of the gallbladder was discovered for males and females. This is the first report on cancer incidence among Native Americans in Western Washington.
Article
The incidence of end-stage renal disease was determined in the Pima Indians of the Gila River Indian Community in Arizona, a population with a high prevalence of Type 2 (non-insulin-dependent) diabetes mellitus. Between 1975 and 1986, from a study population of 5059 subjects, end-stage renal disease occurred in 80 persons, 76 (95%) of whom had Type 2 diabetes. A review of the cases with end-stage renal disease indicated that among the diabetic subjects only two cases could be attributed to nondiabetic renal disease; all other cases were attributable to diabetic nephropathy. In diabetic Pima Indians the incidence rate of end-stage renal disease did not change during the study period, was similar in men and women, and was not effected by age at diagnosis of diabetes or by attained age, but did increase significantly with hypertension (p less than 0.05). The incidence of end-stage renal disease attributed to diabetic nephropathy increased from 0 cases/1000 person-years at 0-5 years to 40.8 cases/1000 person-years at greater than or equal to 20 years duration of diabetes. In these subjects with Type 2 diabetes, the incidence rate of end-stage renal disease was similar to that in subjects with Type 1 (insulin-dependent) diabetes who were followed at the Joslin Clinic in Boston, Massachusetts when those with similar duration of diabetes were compared.
Article
We retrospectively reviewed the medical records of the Zuni Indians with end-stage renal disease from July 1973 through December 1983. Thirty-eight cases of end-stage renal disease were compiled. We report a prevalence of 2902/10(6) for 1983 and an average annual incidence over the study period of 722/10(6)/y. This prevalence is 10.9 times the rate for all whites of Arizona and New Mexico and 3.6 times the rate for all Indians of Arizona and New Mexico. The Zuni incidence is 8.6 times the incidence for Arizona and New Mexico. The most frequent causes were chronic glomerulonephritis (40%) and diabetic nephropathy (24%). In 21% of the cases no cause could be assigned. The cause for these high rates of end-stage renal disease is unknown. Hypotheses with preliminary clinical findings are presented. Further comprehensive study is recommended.
Printing Office, 1981 II. Hahn RA: The state of federal health statistics on racial and ethnic groups
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Washington, DC, US Government Printing Office, 1981 II. Hahn RA: The state of federal health statistics on racial and ethnic groups. JAMA 267:268-271, 1992