TABLE 4—

Leading Rankable Causes of Pediatric Deaths and Average Annual Death Rates for American Indians/Alaska Natives, Compared With Whites, 1–19 years: Contract Health Service Delivery Area Counties, United States, 1999–2009

	AI/AN			White
Age, Years/Cause of Deatha	Rank	Count	Rate	Count	Rate	AI/AN:White RR (95% CI)
1–4
Unintentional injuries	1	358	29.3	2257	10.2	2.88* (2.57, 3.22)
Homicide	2	73	5.9	378	1.7	3.48* (2.67, 4.48)
Congenital malformations	3	66	5.4	630	2.8	1.88* (1.44, 2.43)
Malignant neoplasms	4	32	2.7	588	2.7	1.00 (0.68, 1.43)
Diseases of heart	5	28	2.3	173	0.8	2.91* (1.88, 4.36)
Influenza and pneumonia	6	23	1.9	145	0.7	2.87* (1.76, 4.48)
Septicemia	7	22	1.8	104	0.5	3.79* (2.27, 6.04)
5–9
Unintentional injuries	1	244	15.6	1518	5.2	2.98* (2.60, 3.42)
Malignant neoplasms	2	33	2.1	708	2.4	0.86 (0.59, 1.22)
Congenital malformations	3	28	1.8	257	0.9	2.02* (1.32, 3.00)
Homicide	4	16	1.0	149	0.5	2.00* (1.11, 3.36)
Influenza and pneumonia	5	14	0.9	58	0.2	4.52* (2.33, 8.20)
Diseases of heart	6	11	0.7	114	0.4	1.78 (0.86, 3.31)
Septicemia	7	–	0.6	37	0.1	4.49* (1.91, 9.48)
10–14
Unintentional injuries	1	309	17.7	2198	6.9	2.57* (2.27, 2.89)
Intentional self-harm/suicide	2	101	5.7	412	1.3	4.50* (3.58, 5.61)
Homicide	3	31	1.8	178	0.6	3.15* (2.08, 4.64)
Malignant neoplasms	4	30	1.7	705	2.2	0.77 (0.52, 1.11)
Congenital malformations	5	22	1.3	272	0.9	1.48 (0.91, 2.29)
Diseases of heart	6	16	0.9	189	0.6	1.56 (0.87, 2.60)
Septicemia	7	13	0.7	58	0.2	4.06* (2.04, 7.50)
15–19
Unintentional injuries	1	1435	84.6	10 797	32.7	2.59* (2.45, 2.73)
Intentional self-harm/suicide	2	564	33.2	2994	9.1	3.65* (3.33, 4.00)
Homicide	3	232	13.8	878	2.7	5.17* (4.46, 5.99)
Malignant neoplasms	4	76	4.4	1091	3.3	1.34* (1.05, 1.69)
Diseases of heart	5	44	2.6	451	1.4	1.89* (1.35, 2.58)
Congenital malformations	6	27	1.6	343	1.0	1.51 (0.98, 2.23)
Influenza and pneumonia	7	15	0.9	130	0.4	2.22* (1.21, 3.80)

Note. AI/AN = American Indian/Alaska Native; CHSDA = Contract Health Service Delivery Area; CI = confidence interval; RR = rate ratio. Dashes indicate that counts less than 10 are suppressed; if no cases reported, then rates and RRs could not be calculated. Patients ages 0–24 y are included in overall totals, but rows have been suppressed because of the small number of cases. Analyses limited to persons of non-Hispanic origin. AI/AN race is reported from death certificates or through linkage with the Indian Health Service patient registration database. Rates are per 100 000 persons and are age-adjusted to the 2000 US standard population (11 age groups; Census P25-1130).²⁷ RRs are calculated in SEER*Stat before rounding of rates and may not equal RRs calculated from rates presented in table. Indian Health Service regions are defined as follows: AK^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). Percent regional coverage of AI/AN persons in Contract Health Service Delivery Area counties to AI/AN persons in all 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%.

Source. AI/AN Mortality Database (AMD 1990–2009).

^aLeading causes of death created using the National Center for Health Statistics list of 130 selected causes of infant death based on the International Classification of Diseases, 10th Revision.¹⁷

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

*P < .05.