American Journal of Epidemiology Vol. 147, No. 11: 995-1008
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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All-Cause Morality and Cardiovascular Disease Mortality in Three American Indian Populations, Aged 45–74 Years, 1984–1988
The Strong Heart Study
1Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, OK.
2Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center Oklahoma City, OK.
3Epidemiology Program, Aberdeen Area Indian Health Service Rapid City, SD.
4National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases Phoenix, AZ.
5Medlantic Research Institute Washington, DC.
6Deceased February 24,1994, in a tragic plane crash in Minot, ND, while serving Indian patients.
7Department of Medicine, Cornell Medical Center New York, NY.
8College of Medicine, University of Oklahoma Health Sciences Center Oklahoma City, OK
9Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute Bethesda, MD
10Reprint requests to Dr. Elisa T. Lee, Center for American Indian Health Research, College of Public Health, University of Oklahoma Health Sciences Center, P.O. Box 26901, Oklahoma City, OK 73190.
Community mortality surveillance for 1984–1988 was conducted by researchers of the StrongHeart Study, which examined the incidence, prevalence, and risk factors of cardiovascular disease in three American Indian populations, aged 45–74 years, in Arizona, Oklahoma, and South/North Dakota. All-cause and cardiovascular disease mortality rates were determined through the useof death certificate data. Cardiovascular disease deaths were confirmed by independent systematic review of medical records. In all three populations, men had higher all-cause and cardiovascular disease mortality rates than did women. Oklahoma exhibited slightly lower 5-year, age-adjusted, all-cause mortality (96/1,000) than did Arizona (107/1,000) and South/North Dakota (114/1,000). The leading cause of death among both sexes in Oklahoma and in South/North Dakota was cardiovascular disease. Diabetes mellitus led among Arizona women. The other major causes of death were cancer, liver disease including cirrhosis, and injury. When compared with the rates in each state, average annual all-cause mortality rates were higher for the American Indian populations in almost every age group. The all-cause annual mortality rates in the three Indian populations were close to rates in the US black population and higher than the rates of the entire US population and of US whites. This trend was amplified in the 45-to 64-year age group. Only in the 65- to 74-year age group did mortality rates in the Indian population approach those of the US population.Cardiovascular disease mortality rates were close to the US averages in Arizona and Oklahoma, but they were more than two times higher in South/North Dakota among those between 45 and 64 yearsof age. Thus, American Indians in Arizona, Oklahoma, and South/North Dakota exhibit high all-cause mortality rates. In particular, the South/North Dakota population cardiovascular disease death rate appears to present a potential target for community-based programs to intervene on known risk factors to promote healthy lifestyles. Am J Epidemiol 1998; 147:995–1008.
cardiovascular diseases; Indians; North American; mortality
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