1. Project Update: Improving mortality data for American Indians and Alaska Natives NAPHSIS 2006 Annual Conference San Diego, CA David Espey, MD IHS/CDC

2. Objectives: Link state death records with administrative records from the Indian Health Service (IHS) Identify American Indian/Alaska Native (AI/AN) deaths coded as non-Native Report results from such linkage: magnitude of problem and potential predictors of misclassification Use “improved” data to report mortality patterns of AI/AN

3. Background Over 560 AI/AN tribes 2.6 million AI/AN population (3.0 bridged or 4.1 all combined) 1.65 million served by IHS Highest poverty level

4. Population pyramids by race, US 2003

6. Background Race mis-classification of AI/AN occurs in cancer surveillance and vital statistics data bases Varies by state Decreasing mis-classification can improve accuracy of health indicators and program planning/resource allocation

7. Methods: IHS - death records linkage Development of proposal –Advisory committee –Presentation at NAPHSIS (04) –Funding from CDC Recruitment of states Agreements/research determinations Linkages (LinkPlus – probabilistic method) Analysis/Publications

8. NV WA OR ID MT ND SD MN WI MIWY CA UT CO AZ NM AK HI TX NE KS OK LA AL MS MO ILIN KY TN GA FL SC NC VA WV PA NY ME NJ CT MD OH DL RI MA VT NH AR IA NV IHS/state death records data linkage Linkage completed Data rec’d – linkage in progress Interest expressed – data not rec’d Not participating

9. Linkage of death records from State VS with administrative records from the Indian Health Service (1990-2003)

10. AI/AN mortality rates for select COD, both sexes, pre- and post-linkage, 1990-2003

11. Rates and rate ratios of all cause mortality in AI/AN and all races combined, by region, 1990-2003 RegionAI/ANAll racesRate Ratio All cancer164.7197.50.83 CVD290.7334.60.87 Chronic liver dis. 28.19.52.96 Influenza & pneumonia 31.125.71.21

12. Limitations Not all AI/AN included in IHS files IHS coverage varies by geographic region

13. Conclusions Racial misclassification in is a problem for AI/ANs in state death records Linkages with IHS data can improve the quality of the data

14. Recommendations Improve reporting by funeral home directors Consider linkages to improve the quality of the data –IHS –Other data may be available (i.e. tribal rosters)

15. Recommendations (cont) Linkage with NDI? - more efficient (and expensive) Consensus on presenting findings – rates may differ from official reports and publications