1. N orthwest P ortland A rea I ndian H ealth B oard Indian Leadership for Indian Health Unintentional injury and motor vehicle crash mortality in the Northwest With a focus on Washington data and trends, 1990-2009 IDEA-NW Project and Injury Prevention Program NW Tribal EpiCenter

2. AI/ANs are often misclassified as another race on death certificates Surveillance data (death, cancer, hospitalization) may range from 30-70% misclassified In general, AI/AN misclassified as another race (in NW, usually White), rather than the other way around Net result: Mortality rates underestimated for AI/AN Improving Data & Enhancing Access (IDEA-NW) Project works to correct inaccurate race data at state level & provide improved health data for NW tribes AI/AN Mortality Data 2

3. Unintentional injury death rates are approx. twice as high for AI/ANs compared to whites Unintentional injury mortality rates by state and race, 2006-2009 Data source: Idaho, Oregon, and Washington death certificates matched with Northwest Tribal Registry

4. Motor vehicle crash death rates are approx. 2.5 - 3 times higher for AI/ANs than whites Motor vehicle crash mortality rates by state and race, 2006-2009 Data source: Idaho, Oregon, and Washington death certificates matched with Northwest Tribal Registry

5. Washington State Mortality Data

6. Methods Data source: Washington death certificate data, 1990-2009 (Center for Health Statistics, Washington State Department of Health) Linked with “Northwest Tribal Registry”, clinic registration data from IHS, tribal, and urban Indian facilities  All records known to be AI/AN  Matches with death certificates reclassified as AI/AN race Unintentional injury and motor vehicle crash (MVC) deaths selected using ICD-9 and ICD-10 underlying cause of death codes  AI/AN in analysis = AI/AN race on death certificate and/or matched with tribal/urban registry  White race selected for comparison NCHS bridged-race population estimates used as population denominators Rates age-adjusted and presented per 100,000 population

7. About 9% of AI/ANs were misclassified as another race on Washington death certificates 7 * Northwest Tribal Registry = clinic registration data from Northwest IHS and tribal facilities plus Seattle Indian Health Board urban clinic

8. AI/ANs of both sexes have higher rates of unintentional injury death compared to whites. The male rate is about twice as high as the female rate for each race group. Unintentional injury mortality rates, 1990-2009, by sex and race, Washington State Data source: Washington death certificates matched with Northwest Tribal Registry

9. Motor vehicle crash mortality rates, 1990-2009, by sex and race, Washington State Data source: Washington death certificates matched with Northwest Tribal Registry AI/ANs have a 3 times higher rate of dying in motor vehicle crashes compared to whites. The rate for AI/AN males is about 80% higher than the rate for females.

10. AI/AN unintentional injury mortality rates increased from 1990-2009, at an average of 1.7% per year Coding change in 1999 Data source: Washington death certificates matched with Northwest Tribal Registry

11. White unintentional injury mortality rates also increased from 1990-2009, at an average of 1.4% per year Data source: Washington death certificates

12. AI/AN injury mortality rates were consistently higher than whites Data source: Washington death certificates matched with Northwest Tribal Registry

13. AI/AN motor vehicle crash mortality rates did not change significantly from 1990-2009 Data source: Washington death certificates matched with Northwest Tribal Registry

14. White motor vehicle mortality rates decreased by 2.7% per year from 1990-2009 Data source: Washington death certificates

15. AI/AN motor vehicle crash mortality rates were consistently higher than whites; the gap has grown in recent years Data source: Washington death certificates matched with Northwest Tribal Registry

16. Motor vehicle crash mortality risk higher for younger AI/ANs, lower for older AI/ANs Data source: Washington death certificates matched with Northwest Tribal Registry

17. AI/AN motor vehicle crash mortality is 2.6 times higher in counties east of the Cascades Data source: Washington death certificates matched with Northwest Tribal Registry

18. Alcohol as a contributing cause in MVC deaths decreased from 1990-2009, and the disparity gap between AI/ANs and whites is closing Data source: Washington death certificates matched with Northwest Tribal Registry

19. Megan Hoopes IDEA-NW Project Director mhoopes@npaihb.org 503-416-3261 Erik Kakuska (Zuni Pueblo) IDEA-NW Project Coordinator ekakuska@npaihb.org Victoria Warren-Mears IDEA-NW P.I. vwarrenmears@npaihb.org Jenine Dankovchik Biostatistician jdankovchik@npaihb.org 503-416-3265 Meena Patil Biostatistician mpatil@npaihb.org IDEA-NW Contact Information Northwest Portland Area Indian Health Board 2121 SW Broadway, Suite 300 Portland, OR 97211 www.npaihb.org

20. Luella Azule (Yakama/Umatilla) IPP Project Coordinator lazule@npaihb.org 503-416-3263 Bridget Canniff IPP Project Director bcanniff@npaihb.org 503-416-3302 IPP Contact Information 20 Northwest Portland Area Indian Health Board 2121 SW Broadway, Suite 300 Portland, OR 97211 www.npaihb.org