TABLE 1—
Pneumonia and Influenza Death Rates by Age Group and Indian Health Service Region for American Indians/Alaska Natives Compared with Whites: Contract Health Service Delivery Areas, United States, 1990–1998 and 1999–2009
| 1990–1998 |
1999–2009 |
|||||||||
| IHS Region/Age Range | AI/AN Count | AI/AN Rate | White Count | White Rate | AI/AN:White RR (95% CI) | AI/AN Count | AI/AN Rate | White Count | White Rate | AI/AN:White RR (95% CI) |
| Northern Plains | ||||||||||
| < 1 y | 32 | 69.9 | 108 | 12.6 | 5.55* (3.62, 8.30) | 15 | 22.0 | 48 | 4.9 | 4.49* (2.34, 8.16) |
| 1–4 y | … | 2.1 | 46 | 1.3 | 1.63 (0.40, 4.40) | … | 2.4 | 37 | 0.9 | 2.64 (0.90, 6.29) |
| 5–19 y | … | 0.6 | 47 | 0.3 | 1.86 (0.48, 5.12) | … | 0.8 | 53 | 0.3 | 2.50 (0.96, 5.52) |
| 20–49 y | 73 | 10.6 | 454 | 1.6 | 6.68* (5.13, 8.57) | 81 | 7.4 | 512 | 1.4 | 5.17* (4.03, 6.54) |
| 50–64 y | 81 | 46.1 | 965 | 9.9 | 4.67* (3.68, 5.87) | 94 | 27.9 | 1041 | 6.5 | 4.26* (3.41, 5.26) |
| 65–74 y | 85 | 145.1 | 2523 | 49.2 | 2.94* (2.30, 3.60) | 75 | 78.1 | 1734 | 27.6 | 2.83* (2.21, 3.57) |
| ≥ 75 y | 238 | 785.3 | 19 978 | 450.5 | 1.74* (1.50, 1.90) | 206 | 419.9 | 16 509 | 249.7 | 1.68* (1.45, 1.93) |
| All ages | 517 | 69.7 | 24 121 | 32.9 | 2.12* (1.92, 2.33) | 484 | 38.5 | 19 934 | 18.7 | 2.06* (1.85, 2.27) |
| Alaska | ||||||||||
| < 1 y | 15 | 75.1 | … | 11.8 | 6.38* (2.45, 18.49) | 15 | 64.1 | … | 7.8 | 8.22* (2.84, 28.92) |
| 1–4 y | … | 3.6 | … | 0.4 | 9.00 (0.72, 472.45) | … | 2.2 | … | 0.8 | 2.84 (0.20, 39.13) |
| 5–19 y | … | 0.7 | … | 0.1 | 6.25 (0.32, 385.74) | … | 1.6 | … | 0.2 | 8.37* (1.50, 86.13) |
| 20–49 y | 22 | 6.5 | 14 | 0.7 | 9.77* (4.70, 20.79) | 17 | 3.7 | 17 | 0.7 | 5.31* (2.54, 11.08) |
| 50–64 y | 19 | 23.9 | 32 | 7.5 | 3.19* (1.71, 5.82) | 26 | 18.3 | 37 | 4.1 | 4.52* (2.62, 7.68) |
| 65–74 y | 19 | 70.6 | 43 | 35.9 | 1.96* (1.07, 3.45) | 23 | 50.8 | 33 | 15.4 | 3.30* (1.84, 5.82) |
| ≥ 75 y | 80 | 558.5 | 139 | 267.4 | 2.09* (1.56, 2.77) | 104 | 431.3 | 209 | 170.5 | 2.53* (1.97, 3.22) |
| All ages | 160 | 46.2 | 237 | 20.1 | 2.29* (1.82, 2.87) | 193 | 35.1 | 305 | 12.5 | 2.83* (2.31, 3.44) |
| Southern Plains | ||||||||||
| < 1 y | … | 24.9 | … | 6.4 | 3.90 (0.63, 18.28) | … | 12.2 | 24 | 6.4 | 1.90 (0.74, 4.38) |
| 1–4 y | … | 0 | … | 0 | NA | … | 1.6 | 21 | 1.4 | 1.10 (0.27, 3.25) |
| 5–19 y | … | … | … | 0.2 | NA | … | 0.7 | 29 | 0.5 | 1.56 (0.61, 3.50) |
| 20–49 y | 12 | 5.0 | 87 | 2.7 | 1.87 (0.93, 3.43) | 72 | 5.1 | 352 | 2.7 | 1.91* (1.46, 2.47) |
| 50–64 y | 15 | 20.9 | 155 | 12.6 | 1.66 (0.91, 2.82) | 85 | 17.6 | 760 | 12.3 | 1.43* (1.13, 1.79) |
| 65–74 y | 29 | 107.1 | 385 | 61.1 | 1.75* (1.15, 2.55) | 85 | 54.0 | 1030 | 39.5 | 1.37* (1.08, 1.70) |
| ≥ 75 y | 95 | 544.9 | 2437 | 448.5 | 1.21 (0.97, 1.49) | 366 | 379.4 | 7123 | 294.5 | 1.29* (1.15, 1.43) |
| All ages | 154 | 45.6 | 3073 | 34.3 | 1.33* (1.11, 1.56) | 628 | 31.8 | 9339 | 23.7 | 1.34* (1.23, 1.45) |
| Southwest | ||||||||||
| < 1 y | 44 | 54.0 | 115 | 17.8 | 3.03* (2.09, 4.32) | 28 | 27.8 | 77 | 9.1 | 3.04* (1.90, 4.74) |
| 1–4 y | … | 2.7 | 39 | 1.6 | 1.70 (0.72, 3.57) | … | 2.1 | 26 | 0.8 | 2.69* (1.05, 6.10) |
| 5–19 y | 11 | 1.0 | 47 | 0.5 | 2.00 (0.93, 3.90) | 17 | 1.1 | 49 | 0.4 | 2.95* (1.59, 5.22) |
| 20–49 y | 135 | 10.3 | 590 | 2.9 | 3.54* (2.90, 4.29) | 208 | 10.3 | 747 | 2.6 | 4.02* (3.43, 4.70) |
| 50–64 y | 102 | 32.0 | 876 | 11.9 | 2.69* (2.17, 3.31) | 176 | 28.8 | 1473 | 10.4 | 2.77* (2.35, 3.24) |
| 65–74 y | 158 | 140.9 | 2099 | 50.2 | 2.80* (2.36, 3.30) | 159 | 79.3 | 2275 | 37.2 | 2.13* (1.80, 2.50) |
| ≥ 75 y | 576 | 743.8 | 10 936 | 406 | 1.83* (1.68, 1.99) | 699 | 561.0 | 12 327 | 243.6 | 2.30* (2.13, 2.48) |
| All ages | 1035 | 64.6 | 14 702 | 31.3 | 2.06* (1.92, 2.20) | 1295 | 48.7 | 16 974 | 20.1 | 2.42* (2.28, 2.56) |
| Pacific Coast | ||||||||||
| < 1 y | … | 22.1 | 158 | 10.2 | 2.16 (0.85, 4.55) | … | 17.6 | 50 | 3.1 | 5.64* (2.31, 12.00) |
| 1–4 y | … | 2.1 | 48 | 0.8 | 2.80 (0.55, 8.69) | … | 0 | 27 | 0.4 | 0.00 (0.00, 5.34) |
| 5–19 y | … | 1.0 | 82 | 0.4 | 2.97* (1.06, 6.73) | … | 0.5 | 73 | 0.3 | 2.09 (0.55, 5.55) |
| 20–49 y | 44 | 4.9 | 1224 | 2.3 | 2.11* (1.52, 2.85) | 54 | 4.2 | 1071 | 1.6 | 2.55* (1.90, 3.36) |
| 50–64 y | 52 | 22.4 | 2141 | 12.6 | 1.78* (1.32, 2.34) | 66 | 14.3 | 2236 | 7.5 | 1.91* (1.47, 2.44) |
| 65–74 y | 63 | 83.1 | 5271 | 56.6 | 1.47* (1.12, 1.88) | 53 | 41.6 | 3042 | 27.4 | 1.52* (1.13, 1.99) |
| ≥ 75 y | 199 | 519.4 | 37 227 | 503.5 | 1.03 (0.89, 1.18) | 200 | 299.5 | 26 894 | 227.8 | 1.31* (1.13, 1.51) |
| All ages | 374 | 43.0 | 46 151 | 37.3 | 1.15* (1.02, 1.28) | 385 | 25.2 | 33 393 | 17.5 | 1.44* (1.28, 1.59) |
| East | ||||||||||
| < 1 y | … | 29.1 | 119 | 7.8 | 3.73 (0.76, 11.16) | … | 10.0 | 61 | 3.8 | 2.65 (0.31, 9.99) |
| 1–4 y | … | 2.1 | 49 | 0.8 | 2.66 (0.6, 15.50) | … | 4.3 | 32 | 0.5 | 8.86* (1.73, 28.33) |
| 5–19 y | … | … | 79 | 0.3 | NA | … | … | 72 | 0.3 | NA |
| 20–49 y | … | 2.9 | 1120 | 2.1 | 1.38 (0.63, 2.62) | 10 | 2.1 | 1048 | 1.6 | 1.32 (0.63, 2.42) |
| 50–64 y | … | 11.2 | 2193 | 11.5 | 0.97 (0.45, 1.85) | 21 | 12.5 | 2279 | 7.7 | 1.61 (1.00, 2.47) |
| 65–74 y | 18 | 66.9 | 5341 | 50.4 | 1.33 (0.78, 2.09) | 20 | 44.5 | 3852 | 31.9 | 1.40 (0.84, 2.15) |
| ≥ 75 y | 67 | 454.6 | 35 684 | 409.7 | 1.11 (0.85, 1.40) | 67 | 242.6 | 33 058 | 255.3 | 0.95 (0.73, 1.20) |
| All ages | 107 | 35.3 | 44 585 | 30.9 | 1.14 (0.92, 1.38) | 123 | 20.8 | 40 402 | 19.5 | 1.06 (0.87, 1.27) |
| All regions | ||||||||||
| < 1 y | 104 | 51.7 | 513 | 10.9 | 4.76* (3.82, 5.89) | 76 | 23.5 | 265 | 4.8 | 4.86* (3.71, 6.29) |
| 1–4 y | 20 | 2.4 | 183 | 0.9 | 2.49* (1.48, 3.95) | 23 | 1.9 | 145 | 0.7 | 2.89* (1.77, 4.50) |
| 5–19 y | 23 | 0.8 | 259 | 0.4 | 2.15* (1.34, 3.31) | 42 | 0.8 | 278 | 0.3 | 2.89* (2.04, 4.01) |
| 20–49 y | 295 | 7.8 | 3489 | 2.2 | 3.57* (3.15, 4.03) | 442 | 6.6 | 3747 | 1.8 | 3.69* (3.33, 4.07) |
| 50–64 y | 278 | 29.0 | 6362 | 11.6 | 2.50* (2.21, 2.82) | 468 | 21.3 | 7826 | 8.1 | 2.62* (2.38, 2.88) |
| 65–74 y | 372 | 113.6 | 15 662 | 52.3 | 2.17* (1.95, 2.41) | 415 | 61.7 | 11 966 | 31.2 | 1.98* (1.79, 2.18) |
| ≥ 75 y | 1255 | 653.8 | 106 401 | 446.6 | 1.46* (1.38, 1.54) | 1642 | 423.5 | 96 120 | 246.9 | 1.72* (1.63, 1.80) |
| All ages | 2347 | 55.7 | 132 869 | 33.4 | 1.67* (1.59, 1.74) | 3108 | 36.3 | 120 347 | 19.1 | 1.90* (1.82, 1.97) |
Note. AI/AN = American Indian/Alaska Native; CI = confidence interval; CHSDA = Contract Health Service Delivery Area; IHS = Indian Health Service; NA = not applicable/able to be calculated; RR = rate ratio. Ellipses indicate that counts less than 10 were suppressed; if no cases reported, then rates and RRs could not be calculated. Analyses are limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the IHS patient registration database. Rates are per 100 000 persons and are age-adjusted to the 2000 US standard population (11 age groups; Census P25-113045). Rate ratios are calculated in SEER*Stat before rounding of rates and may not equal rate ratios calculated from rates presented in the table. IHS regions are defined as follows: Alaskaa; Northern Plains (IL, IN,a IA,a MI,a MN,a MT,a NE,a ND,a SD,a WI,a WYa); Southern Plains (OK,a KS,a TX,a); Southwest (AZ,a CO,a NV,a NM,a UTa); Pacific Coast (CA,a ID,a OR,a WA,a HI); East (AL,a AR, CT,a DE, FL,a GA, KY, LA,a ME,a MD, MA,a MS,a MO, NH, NJ, NY,a NC,a OH, PA,a RI,a SC,a TN, VT, VA, WV, DC). Percentage of AI/AN persons in CHSDA counties: Northern Plains = 64.8%; Alaska = 100%; Southern Plains = 76.3%; Southwest = 91.3%; Pacific Coast = 71.3%; East = 18.2%; total US = 64.2%. States and years of data excluded because Hispanic origin was not collected on the death certificate: LA: 1990; NH: 1990–1992; OK: 1990–1996.
Source. AI/AN Mortality Supplement Database (AMD 1990–2009).
aIdentifies states with at least 1 county designated as CHSDA.
*P < .05.