TABLE 2—

Trends in Rates of Diabetes as Underlying Cause of Death Among Adult American Indians and Alaska Natives: Contract Health Service Delivery Area Counties, United States, 1990–2009

	Observed Death Rate		Trend 1		Trend 2
Category and Classification	1990	2009	Year	APC (95% CI)	Year	APC (95% CI)
Overall
Crude	50.1	63.4	1990–1997	6.5* (3.0, 10.1)	1997–2009	−0.3 (−1.3, 0.7)
Age adjusted	87.9	89.6	1990–1997	5.2* (1.5, 9.1)	1997–2009	−1.4* (−2.5, −0.2)
Age group, y
20–44	3.7	9.2	1990–2009	4.8* (1.4, 8.2)
45–54	39.2	38.5	1990–2009	−0.4 (−1.6, 0.8)
55–64	139.9	92.9	1990–2004	−0.3 (−1.8, 1.2)	2004–2009	−7.2* (−12.5, −1.7)
65–74	244.1	224.8	1990–1997	7.9* (2.8, 13.3)	1997–2009	−3.7* (−5.2, −2.1)
≥ 75	427.8	512.3	1990–1999	4.3* (1.5, 7.3)	1999–2009	−0.6 (−2.3, 1.1)
Sex
Male	79.1	100.7	1990–1997	7.1* (2.6, 11.9)	1997–2009	−0.2 (−1.5, 1.1)
Female	93.6	80.2	1990–1996	5.2* (0.4, 10.2)	1996–2009	−2.1* (−3.1, −1.0)
Region
Northern Plains	131.2	118.6	1990–2009	0.1 (−1.4, 1.5)
Alaskaa	. . .	36.5	1990–2009	−0.7 (−3.5, 2.1)
Southern Plainsa	. . .	101.7	1997–2009	−0.2 (−1.9, 1.4)
Southwest	102.9	109.0	1990–1997	3.3* (0.1, 6.6)	1997–2009	−1.8* (−2.9, −0.6)
Pacific Coast	65.9	65.6	1990–2005	3.3* (1.1, 5.6)	2005–2009	−8.1 (−19.1, 4.5)
East	59.2	68.3	1990–1994	27.2* (0.4, 61.0)	1994–2009	−3.2* (−5.4, −1.0)

Note. APC = annual percentage change; CI = confidence interval. Analyses are limited to people of non-Hispanic origin aged 20 years and older. American Indian/Alaska Native race is reported from death certificates or through linkage with the IHS patient registration database. Rates are per 100 000 people and were age adjusted to the 2000 US standard population (19 age groups; Census P25-1130²⁶). Trends are given as APC between joinpoints. Indian Health Service regions are defined as follows: Alaska^b; Northern Plains (IL, IN,^b IA,^b MI,^b MN,^b MT,^b NE,^b ND,^b SD,^b WI,^b WY^b); Southern Plains (OK,^b KS,^b TX^b); Southwest (AZ,^b CO,^b NV,^b NM,^b UT^b); Pacific Coast (CA,^b ID,^b OR,^b WA,^b HI); East (AL,^b AR, CT,^b DE, FL,^b GA, KY, LA,^b ME,^b MD, MA,^b MS,^b MO, NH, NJ, NY,^b NC,^b OH, PA,^b RI,^b SC,^b TN, VT, VA, WV, DC).

Source. AI/AN Mortality Database (1990–2009). Data are based on linked Indian Health Service–National Vital Statistics System mortality files. The following states and years of data were excluded because Hispanic origin was not collected on the death certificate: LA, 1990; NH, 1990–1992; and OK, 1990–1996.

^aAlaska had < 10 deaths in 1990, so the rate was suppressed because it was unstable. The Southern Plains region did not have reliable data before 1997; thus, the trend was plotted from 1997 onward.

^bIdentifies states with ≥ 1 county designated as Contract Health Service Delivery Area.

*P < .05.