N orthwest P ortland A rea I ndian H ealth B oard Indian Leadership for Indian Health Risky Business: Setting the stage with regional data Improving Data & Enhancing Access (IDEA-NW) Project Sujata Joshi, Project Director Portland, OR 5/21/2013

Rank these health events in order of importance for American Indians/Alaska Natives in the Northwest Northwest Portland Area Indian Health Board 2 Cancer STDs Diabetes Suicide Unintentional injuries Sexual Assault Quiz IT DEPENDS!

Northwest Portland Area Indian Health Board 3 Same data, different story? Data source: CDC WISQARS (

Northwest Portland Area Indian Health Board 4

Incidence New cases in a population during a specific time period Often expressed as a rate (i.e. “per 100,000” population per year) Useful for measuring health events that happen at one point in time, or measuring how many “new” people could be at risk Examples: Injury, mortality, suicide, stroke, STDs, new tobacco users, etc. Prevalence Existing cases in a population at a given point in time or time period Often measured as “percent” Useful for measuring chronic conditions or getting a “snapshot” of how many people are affected Combines both incidence and survival Examples: Chronic conditions such as cancer, diabetes, heart disease, STDs, smoking, etc. Incidence and Prevalence Northwest Portland Area Indian Health Board 5

New cases of breast cancer among AI/AN in Washington in 2009  Incidence Mortality rate from car crashes in Umatilla County in 2011  Incidence Number of AI/ANs currently living with HIV in Idaho  Prevalence Number of highschoolers at Chemawa Indian School who started smoking during the school year  Incidence Which is it…? 6 Northwest Portland Area Indian Health Board

REGIONAL DATA 7 Northwest Portland Area Indian Health Board

Cancer 8 Data source: OR, WA, and ID Cancer Registries & IDEA-NW Project Second leading cause of death for AI/ANs in ID and WA; leading cause in OR In all three states, AI/AN had lower cancer incidence rates (all sites combined) compared to non-Hispanic Whites Leading cancer sites: Breast (in women) Prostate (in men) Lung and bronchus Colorectal Blood Cancers In OR and WA, AI/AN had higher mortality rates compared to non- Hispanic Whites Disparities in lung/bronchus cancer and colorectal cancer mortality rates compared to non- Hispanic Whites Northwest Portland Area Indian Health Board

Major cause of heart disease and stroke; leading cause of kidney failure, nontraumatic amputations, new cases of blindness AI/AN death rate due to diabetes 1.6 times higher than general US population 3 20% of AI/ANs aged 15 years or older had pre-diabetes in Affects 12-14% of AI/AN in the Northwest (vs. 6-7% of non- Hispanic Whites) Major modifiable risk factors:  Physical activity  Maintaining healthy weight Diabetes 9 Data sources: 1 CDC 2010 BRFSS Data (accessed through Web-Enabled Analysis Tool). 2 WADOH. Washington State Diabetes Disparities, Indian Health Service Special Diabetes Program for Indians (SDPI). 4 CDC National Diabetes Fact Sheet, Northwest Portland Area Indian Health Board

10 STDs and HIV/AIDS Data source: 1 CDC WONDER, Sexually Transmitted Diseases Interactive Data; 2 CDC Division of HIV/AIDS Prevention. HIV Surveillance Report, STDs 1  3x higher rates for some STDS  Higher burden among women HIV/AIDS 2  HIV infection rate 1.3 times higher for AI/ANs compared to whites in 2011 (9.3 vs. 7.0 per 100,000 population)  Higher burden among males Northwest Portland Area Indian Health Board

11 Unintentional Injuries Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, Leading cause of death for AI/AN between the ages of 1-54 Higher unintentional injury mortality rates in Washington compared to Oregon and Idaho; largest disparity when compared to white population Driven by: Motor Vehicle Crashes Accidental Poisonings Falls (among elderly) Northwest Portland Area Indian Health Board

12 Suicide Data source: NPAIHB. Northwest American Indian and Alaska Native Mortality Report, Majority of AI/AN suicides occurred in the young adult range (20-39 years old) Largest disparities seen among the youngest age categories Nearly half of all AI/AN suicides were completed using firearms, followed by suffocation (primarily hanging), then poisoning (primarily drug overdose) Higher burden among males Northwest Portland Area Indian Health Board

13 got risk?

A characteristic that increases (or decreases) a person’s chances of getting a disease or outcome An association, but not necessarily a cause Risk and preventive factors 14 Northwest Portland Area Indian Health Board

15 Risk factors Smoking Physical activity Alcohol & drug use Genetics Helmet use Fruit & vegetable intake Condom use Obesity Gender Cancer screening Seatbelt & child safety seat use Health Outcomes Diabetes STDs Unintentional injuries Cardiovascular disease Cancer Suicide Northwest Portland Area Indian Health Board

Leading Causes vs. Actual Causes 16 Northwest Portland Area Indian Health Board

The biggie... Tobacco In Oregon, Idaho, and Washington… AI/AN adults are more likely to be current smokers than other racial/ethnic groups Higher rates of tobacco use among youth More mothers who smoke before or during pregnancy  Oregon: 24% of AI/AN births vs 12% of all births in state in Data sources: Oregon Tobacco Prevention and Education Program. American Indian/Alaska Native Data Report – 2007 CDC 2010 BRFSS Data (accessed through Web-Enabled Analysis Tool) Northwest Portland Area Indian Health Board

Lip cancer Tongue cancer Gum cancer Larynx cancer Lung cancer Peptic ulcer Bladder cancer Bronchitis Emphysema Coronary Heart Disease Cirrhosis of the liver Low birth-weight babies SIDS Miscarriage Cardiovascular disease Pneumonia Impotence and Infertility

The CDC and the American College of Sports Medicine recommend that adults accumulate at least 30 minutes of moderate physical activity on at least five days per week or at least 20 minutes of vigorous activity on at least three days per week. Physical Activity 35.3% of NW Tribal respondents report an activity level meeting recommendations Data source: Health of Washington State Report: Physical Activity (2007) Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Northwest Portland Area Indian Health Board

Five to nine servings of fruits and vegetables per day are recommended to reduce the risk of heart disease, diabetes, and certain types of cancers. --American Cancer Society 2001 Northwest Tribal BRFSS 6.1% Diet & nutrition Data source: Health of Washington State Report: Nutrition (2007) Data source: NPAIHB, 2001 NW Tribal BRFSS Project, Aggregate Final Report Northwest Portland Area Indian Health Board

For certain cancers, lack of appropriate screening is a big risk factor  Breast & cervical screening can detect pre- cancerous and cancerous conditions early  Colorectal screening can both detect cancer early and prevent cancer by removal of polyps (colonoscopy) Screening and preventive care IHS goal: 90% 2010 IHS goal: 70% 2010 IHS goal: 50% 2010 Portland Area GPRA, IHS Northwest Portland Area Indian Health Board

Data inform our prevention/intervention efforts  Helps us understand: The incidence/prevalence of health events in our communities Which risk factors are associated with which health outcomes The prevalence of modifiable risk factors in our communities  Prioritize our programs, policies, and dollars  Measure the impact of interventions Data are a powerful tool to share with policymakers, community advocates, and funders Hooray for data! 22 Northwest Portland Area Indian Health Board

Surveillance data is collected at the state or national level May not apply to every tribe or community American Indians and Alaska Natives are not always classified correctly Racial misclassification under-reports the impact of health events for AI/AN You are the experts! Data are not perfect Northwest Portland Area Indian Health Board235/8/2012

IDEA-NW Project Staff Sujata Joshi, Project Director, Jenine Dankovchik, Biostatistician, Kristyn Bigback, Biostatistician, Project Website: access_northwest_idea_nw/ Contact Us! Northwest Portland Area Indian Health Board24