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ARIZONA AMERICAN INDIAN HEALTH STATUS SUMMARY REPORT FOR DATA YEAR 2015

JUNE 2017

American Indian Health Status Summary, 2015

Page 1 of 24

Table of Contents Page Acknowledgments/Contributions ................................................................................................................. 2

Background ................................................................................................................................................... 3

Executive Summary ....................................................................................................................................... 4

Demographics ............................................................................................................................................... 5

American Indian Health Status Compared to the Rest of Arizona ................................................................ 7

Leading Causes of Death ............................................................................................................................. 23


Page 2 of 24

Acknowledgments/Contributions

Arizona Department of Health Services Native American Liaison Michael Allison

Arizona Department of Health Services Public Health Statistics

Marguerite L. Sagna, Ph.D Sanhita Gupta Clare Torres

Arizona Department of Health Services Health Disparities Center

Alexandria Drake Michelle Sandoval-Rosario Teresa Aseret-Manygoats


Page 3 of 24

Background Arizona Tribal Lands and Reservations The state of Arizona is home to 22 sovereign American Indian Tribes. The American Indian/Alaska Native (AI/AN) community represents a vital and significant part of Arizona’s population. In 2015, 5.3% of residents in Arizona identified as AI/AN, representing nearly 362,000 persons1. This is the 3rd largest AI/AN population in the United States with only California and Oklahoma having a larger population of AI/AN individuals2. Tribal lands comprise 28% of Arizona’s land base. The map below illustrates tribal lands across the state.

1 United States Census Bureau Quick Facts,2015 2 United States Census, Census Brief, 2010


Page 4 of 24

Executive Summary Compared to other race and ethnicity, AI/AN have a lower life expectancy and are disproportionally impacted by many chronic diseases such as diabetes and chronic liver disease. AI/AN are more likely to live in poverty, suffer from tobacco-related deaths, have a greater risk for developing alcohol disorders, and a high prevalence of obesity. This health status summary report highlights some of the health disparities and major causes of death faced by the AI/AN community in Arizona. The purpose of this report is to inform tribal leaders and organizations on health disparities impacting AI/AN, identify health priorities, and serve as a guide to develop programs and interventions aimed at improving the health of AI/AN in Arizona. This report includes tables and graphs, with information on chronic diseases, causes of death, and behavioral risk factors, comparing AI/AN to all groups in Arizona. Data from the Arizona Department of Health Services Health Status Profile of American Indians in Arizona 2015 Data Book and United States Census Bureau was utilized to compile the information presented in this summary report. IN 2015, AMERICAN INDIAN RESIDENTS OF ARIZONA:

• Ranked worse than the statewide average on 49 of 65 health indicators; • Had high mortality from alcohol-induced causes, chronic liver disease and cirrhosis, motor

vehicle accidents, nephritis, unintentional injuries, diabetes, assault, septicemia, incidence of congenital anomalies, influenza and pneumonia, and sudden infant death syndrome: all contributing to the premature death rate of 77.4 percent;

• Ranked poorly on measures of maternal lifestyle and health, as well as in utilization of prenatal care;

• On average, age of deaths was 16 years younger compared to all racial/ethnic groups; • Ranked better than average on a number of health indicators including mortality rates for

several chronic diseases (lung cancer, chronic lower respiratory diseases, Alzheimer’s disease, breast cancer, coronary heart disease, cervical cancer, heart disease, all malignant neoplasms, and cardiovascular disease), tobacco use during pregnancy, drug induced deaths, and injury by firearms.


Page 5 of 24

17.4%

9.6%

18.5%

23.3%

9.0% 7.3%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Arizona White Non-Hispanic

Hispanic AmericanIndian/Alaska

Native

Black Asian/PacificIslander

Pere

nt o

f Pop

ulat

ion

Race/Ethnicity

Demographics

Figure 1. Race/Ethnicity Population Distribution, 20153

Figure 2. Percentage of Arizona Adults in Poverty, 20154

3 Arizona Quick Facts, United States Census Bureau, 2015 4 American Community Survey, United States Census Bureau 2015

55.8%

30.7%

5.3% 4.8% 3.1% 0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

White Non-Hispanic


Native


Pere

nt o

f Pop

ulat

ion

Race/Ethnicity


Page 6 of 24

15.0% 13.6%

24.5% 26.1%

14.1% 12.5%

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Arizona White Non-Hispanic


Native


Pere

nt o

f Pop

ulat

ion

Race/Ethnicity

14.0%

33.5%

23.3%

12.3.% 11.8% 11.5%

58.5% 55.2%

23.3% 33.5%

59.1% 65.6%

27.5%

11.2%

26.1%

54.2%

29.1%

22.9%

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

Arizona Hispanic AmericanIndian/Alaska

Native

Asian White Non-Hispanic

Black

Axis

Titl

e

Race/Ethnicity

Less Than High School High School Diploma/Some College Bachelor's Degree or Higher

Figure 3. Percentage of Arizona Adults Uninsured, 20155

Figure 4. Education Attainment by Race and Ethnicity, 20155


Page 7 of 24

American Indian Health Status Compared to the Rest of Arizona

Figure 5. Teen Pregnancy Rate among American Indians Compared to all Groups in Arizona, 2015

Figure 6. Maternal Lifestyle and Health Characteristics among American Indians

Compared to all Groups in Arizona, 2015

0.9

27.3

90.8

0.3

14.1

58.4

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

≤14 years old 15-17 years old 18-19 years old

Rate

per

1,0

00 F

emal

es

Age

American Indians

Average Rate for All Groups

79.6

3.4 1.4

14.5 10.3

23.3

46.7 45.3

5.2 1.1

7.5 6.0

22.2

46.1

0.010.020.030.040.050.060.070.080.090.0

100.0

Unmarriedmothers

Tobacco useduring

pregnancy

Pre-existinghypertension

Gestationaldiabetes

Gestationalhypertension

Gestationalweight gain -Inadequate

Gestationalweight gain -

Excessive

Per 1

00 Li

ve B

irths

Health Characteristics

American Indians Average Rate for all Groups


Page 8 of 24

Figure 7. Utilization of Prenatal Care Services among American Indians


Figure 8. Newborn’s Birth Characteristics among American Indians Compared to all Groups in Arizona, 2015

9.6

7.3

1.3

9.0

7.2

1.1

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Born too early (pretermor < 37 weeks)

Born too small: low-birthweight (<2,500

grams)

Born too small: very low-birthweight (<1,500

grams)

Per 1

,000

Live

Birt

hs

Newborns

AmericanIndians

Average Rate forall Groups

41.5

14.6

4.3

32.1

6.6 2.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

No care in the 1st trimester Fewer than five prenatalvisits

No prenatal care

Per 1

00 Li

ve B

irths

Prenatal Care

AmericanIndians

Average Ratefor all Groups


Page 9 of 24

6.0

0.9

7.8

0.4

3.2 4.6

6.9

0.4

5.6

0.2

3.5 2.1

0.0

2.0

4.0

6.0

8.0

10.0

12.0

Newbornrequiring

intensive care

Birth Defects Infantmortality

Sudden InfantDeath

Syndrome

Neonatalmortality

Postneonatalmortality

Per 1

,000

Live

Birt

hs

Newborns

AmericanIndians


167.0

119.9

83.3

31.6 13.0

189.0

141.3

104.6

31.1 11.1

0.020.040.060.080.0

100.0120.0140.0160.0180.0200.0

Cardiovasculardisease

Diseases of theheart

Coronary heartdisease

Cerebrovasculardisease

Hypertension

Per 1

00,0

00 P

opul

atio

n

Condition

AmericanIndians


Figure 9. Newborn’s Health among American Indians Compared to all Groups in Arizona, 2015

Figure 10. Age-Adjusted Mortality Rate from Heart Disease and Stroke Related Causes among

American Indians Compared to all Groups in Arizona, 2015


Page 10 of 24

124.4

8.1 12.8

1.9 13.3 26.0

144.0

35.1 19.2

2.3 12.9 17.6

0.020.040.060.080.0

100.0120.0140.0160.0180.0200.0

All cancers Lung cancer Breast cancer Cervicalcancer

Colorectalcancer

Prostatecancer

Per 1

00,0

00 P

opul

atio

n

Condition

American Indians


23.8

73.9 77.6

2.1 14.0 21.3 18.3 9.4 25.7 14.9

1.6 5.4

37.3

6.3 0.0

20.040.060.080.0

100.0120.0140.0160.0180.0200.0

Influenza andpneumonia

Diabetes Chronic liverdisease and

cirrhosis

HIV disease Septicemia Alzheimer'sdisease

Kidneydisease

Per 1

00,0

00 P

opul

atio

n

Condition

AmericanIndiansAverage Ratefor all Groups

Figure 11. Age-Adjusted Mortality Rate from Cancer Related Causes among American Indians Compared to all Groups in Arizona, 2015

Figure 12. Age-Adjusted Mortality Rate from Other Chronic and Infectious Related Causes among American Indians Compared to all Groups in Arizona, 2015


Page 11 of 24

139.0

54.3

15.6 1.4

11.4 15.8

111.5

19.0 15.7

48.1

12.6 12.6 1.2

13.7 19.8 17.5 17.8 5.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

Unintentionalinjuries

Motor vehicle Falls Drowning Firearms Drugs Alcohol Sucide Assault

Per 1

00,0

00 P

opul

atio

n

Condition

AmericanIndians

AverageRate for allGroups

50.3 97.1

423.9

1108.3

15.4 47.5 146.6

641.0

0.0

200.0

400.0

600.0

800.0

1000.0

1200.0

1-14 15-19 20-44 45-64

Per 1

00,0

00 P

erso

ns

Age Group

American Indians


Figure 13. Age-Adjusted Mortality Rate from Injury Related Causes among American Indians Compared to all Groups in Arizona, 2015

Figure 14. Premature Age-Adjusted Mortality Rate among American Indians



Page 12 of 24

60.0 56.0 66.0

77.4 76.0 73.0

79.0

54.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Median age at deathfrom all causes

Median age at deathfrom all causes among

males

Median age at deathfrom all causes among

females

Total deaths beforeexpected years of life

reached

Per 1

00,0

00 P

erso

ns

Characteristic

AmericanIndians


14.6

183.3

846.7

18.5 14.1

122.4

481.1

10.9 0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

900.0

Early syphilis Gonorrhea Clamydia HIV/AIDS

Per 1

00,0

00 P

erso

ns

Condition

American Indians


Figure 15. Age-Adjusted Median Age Mortality Rate From all Causes among American Indians Compared to all Groups in Arizona, 2015

Figure 16. Sexually Transmitted Diseases and HIV/AIDS Rate among American Indians Compared to all Groups in Arizona, 2015

*Median age refers to the age in the middle


Page 13 of 24

67.9

65.9

65.9

65.1 66.0

69.4 68.6 68.2

68.7

58.4 58.5

0.0

20.0

40.0

60.0

80.0

100.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Perc

ent

Year

8.3

6.4

8.1

8.2

8.4

8.1

7.4

7.4

6.6

8.7

7.8

0.01.02.03.04.05.06.07.08.09.0

10.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

,000

Live

Birt

hs

Year

Figure 17. Percentage of American Indian Women Giving Birth Who Received Prenatal Care (2005-2015)

Figure 18. Infant Death Rates among American Indians (2005-2015)


Page 14 of 24

4.0

2.4

3.9

3.6

4.2

4.3 4.1 3.6

2.9 3.7

4.6

0.01.02.03.04.05.06.07.08.09.0

10.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

,000

LIve

Birt

hs

Year

117.8

97.2 95.0

92.6 92.6

99.2 100.6

94.8 104.5

85.4

139.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

Figure 19. Postneonatal Death Rates among American Indians (2005-2015)

Figure 20. Age-Adjusted Mortality Rate due to Unintentional Injuries among American Indians (2005-2015)

Postneonatal: at least 28 days of age But less than one year of age


Page 15 of 24

Figure 21. Age-Adjusted Mortality Rate due to Motor Vehicle Crashes among American Indians (2005-2015)

Figure 22. Age-Adjusted Mortality Rate due to Suicides among American Indians (2005-2015)

62.6 56.9

49.0

41.9 36.9 41.7

44.2 37.8

31.7 35.6

54.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

17.5

13.7 9.8

13.5

15.9

18.7

14.9

17.9

21.9

13.9

19.0

0.0

5.0

10.0

15.0

20.0

25.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year


Page 16 of 24

14.0

13.2 9.8

12.8 13.2

18.0

11.9

17.3 17.7

7.3

19.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

138.9

100.2

107.2 108.1

111.4

130.4

105.3

155.7

146.4

129.5

171.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

Figure 23. Age-Adjusted Mortality Rate due to Homicides among American Indians (2005-2015)

Figure 24. Age-Adjusted Mortality Rates due to Diabetes among American Indians (2005-2015)

*Diabetes reported as underlying or multiple cause of death


Page 17 of 24

51.2

43.6

36.8 40.7

54.0

64.6

43.6

59.2 62.0

52.7

77.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

Figure 25. Age-Adjusted Mortality Rate due to Chronic Liver Disease or Cirrhosis among American Indians (2005-2015)

Figure 26. Age-Adjusted Morality Rate due to Cancer of the Uterine Cervix

among American Indians (2005-2015)

3.4

5.8

2.3

4.8

4.1

3.0 3.1

2.8

2.0

0.0

1.1

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Per 1

00,0

00 P

erso

ns

Year

*Chronic Liver Disease or Cirrhosis reported as underlying or multiple cause of death

*Cancer of the Uterine Cervix reported as underlying or multiple cause of death


Page 18 of 24

Figure 27. Median Age at Death from all Causes among American Indians

Compared to the Rest of Arizona (2005-2015)

Figure 28. Birth Rates to Unmarried Mothers among American Indians Compared to the rest of Arizona (2005-2015)

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015American Indian 59 57 59 59 59 58 60 59 60 61 60Arizona 77 76 76 77 76 77 77 77 76 76 76

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0M

edia

n Ag

e at

Dea

th

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015American Indian 72.9 74.8 75.9 75.8 76.9 77.7 77.1 78.5 79.2 78.9 79.6Arizona 42.8 43.9 45.0 45.1 45.2 44.7 44.3 45.2 45.1 44.7 45.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Per 1

00 L

ive

Birt

hs


Page 19 of 24

Figure 29. Incidence of Gonorrhea among American Indians Compared to the rest of Arizona (2005-2015)

Figure 30. Low-Birthweight Rate among American Indians Compared to the rest of Arizona (2005-2015)


0.0

50.0

100.0

150.0

200.0

250.0

IPer

100

,000

Per

sons


0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

Per 1

00 L

ive

Birt

hs


Page 20 of 24

Figure 31. Births Rate to Teenage Mothers among American Indians Compared to the Rest of Arizona (2005-2015)

Figure 32. Congenital Anomalies (Birth Defects) Rate among American Indians Compared to all of Arizona (2005-2015)


0.0

5.0

10.0

15.0

20.0

25.0

Rate

per

100

Liv

e Bi

rths

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015American Indian 1.5 1.2 1.4 0.9 0.8 0.6 1.4 0.9 0.8 0.8 0.9All Arizonans 1.0 0.9 0.8 0.9 0.6 0.6 1.1 0.8 0.7 0.5 0.4

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

Per 1

00 L

ive

Birt

hs


Page 21 of 24

Figure 33. Gestational Hypertension Rate among American Indians Compared to the Rest of Arizona (2005-2015)

Figure 34. Gestational Diabetes Rate among American Indians

Compared to the Rest of Arizona (2005-2015)

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015American Indian 58.2 58.8 57.9 58.9 55.4 61.2 62.8 64.6 74.1 85.9 102.7Arizona 30.9 28.8 31 35.3 36.1 39.1 41.9 45.2 55.8 52.4 59.9

0.0

20.0

40.0

60.0

80.0

100.0

120.0

per 1

,000

Birt

hs

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015American Indian 82.5 72 80.4 82 82.2 77.9 93.3 99.3 111.4 121.5 144.7Arizona 29.7 31.6 34.3 38.9 38.7 41.8 46.4 51.2 57.2 61.3 75.5

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Per 1

,000

Birt

hs


Page 22 of 24

Figure 35. Age-Adjusted Mortality Rate for Selected Causes of Death among American Indians (2005-2015)

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015Heart Disease 179.1 129.4 115.2 114.6 125.8 135.9 111.1 122.7 122.9 107.5 119.9Cancer 122.2 83.1 113.9 106.7 113.3 106.4 100.8 100.8 118.2 97.1 124.4Accidents (Unintentional Injury) 117.8 97.2 95.0 92.6 92.6 99.2 100.6 94.8 104.5 85.4 139.0Diabetes 69.9 43.9 51.1 50.8 54.2 79.3 61.3 80.2 65.7 63.2 73.9Chronic Liver Disease 51.2 43.6 36.8 40.7 54.0 64.6 43.6 59.2 62.0 52.7 77.6Suicide 17.5 13.7 9.8 13.5 14.9 18.7 14.9 17.9 21.9 13.9 19.0Chronic Lower Respiratory Disease 12.0 8.4 13.0 15.8 19.2 21.7 14.4 18.0 15.5 12.4 14.8

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0

Per 1

00,0

00 P

opul

atio

n


Page 23 of 24

Leading Causes of Death

Table 1. Five Leading Causes of Death by Gender among American Indians (2015)

Rank Female Male Both

1 Cancer 112.4

Accidents (unintentional injury)

203.9

Accidents (unintentional injury)

139.0

2 Diseases of heart 89.1

Diseases of heart 158.9

Cancer 124.4

3 Accidents

(unintentional injury) 82.7

Cancer 142.1


4 Chronic liver disease and

cirrhosis 66.1

Chronic liver disease and cirrhosis

91.8

Chronic liver disease and cirrhosis

77.6

5 Diabetes 65.3

Diabetes 85.6

Diabetes 73.9

Notes: * Based on age-adjusted mortality rates: Number of deaths per 100,000 population, age-adjusted to the 2000 U.S. standard.

Table 2. Five Leading Causes of Death among American Indians by Gender and Residence On or Off Reservation (2015)

Rank Female, resided

on reservation Female, resided off reservation

Male, resided on reservation

Male, resided off reservation

1 Alzheimer's

disease 12.7

Cancer 16.0

Accidents (unintentional

injury) 20.4


injury) 20.3

2 Cancer 12.2


injury) 11.4


Cancer 11.6

3


injury) 9.8


Cancer 9.9


4 Diabetes 5.8

Chronic liver disease and

cirrhosis 7.9


cirrhosis 9.2


cirrhosis 8.7

5

Chronic lower respiratory

diseases 2.1

Diabetes 7.3

Diabetes 7.4

Diabetes 6.8

Note: * Percent of total deaths in specified group


Page 24 of 24

Table 3. Mortality Percent by Type of Cancer and Gender among American Indians Compared to the rest of Arizona (2005-2015)

Rank Arizona maleb American Indian

male Arizona femaleb American Indian female

1 Trachea, bronchus,

lung 26.3

Liver 12.1

Trachea, bronchus, lung 25.0

Breast 12.2

2 Lymphoma 10.8

Prostate 11.3

Breast 15.3

Lymphoma 11.0

3 Prostate 10.1

Lymphoma 10.0

Lymphoma 9.2

Colon, rectum, anus 8.1

4 Colon, rectum,

anus 9.0



Ovary 7.8

5 Pancreas 6.6


Pancreas 6.8


6 Liver 4.8

Kidney 7.8

Ovary 5.8

Liver 7.6

Notes: a. Percent of cancer deaths in specified group in 2005-2015 b. All race/ethnic groups combined

Table 4. Mortality Percent by Mechanism of Unintentional Injury and Gender among American Indians Compared to the rest of Arizona (2005-2015)

Rank Arizona maleb American Indian male Arizona femaleb American Indian

female

1 Motor vehicle

accidents 32.8

Motor vehicle-related

46.8

Falls 36.6


53.6

2 Poisoning by drugs 25.5

Poisoning by gases 12.8

Poisoning by drugs 24.5

Falls 12.7

3 Falls 19.8



22.9


4

Accidental discharge of

firearms 7.4

Falls 6.8

Accidental discharge of

firearms 2.4

Poisoning by gases 6.6

5 Accidental drowning

3.3

Exposure to cold 5.0

Choked on other objects

2.0

Exposure to cold 2.2

6 Poisoning by gases 3.1

Accidental drowning

3.1

Accidental drowning

1.9

Choked on other objects

1.5 Notes: a. Percent of unintentional injury deaths in specified group in 2005-2015 b. All race/ethnic groups combined

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