Return to Cancer Incidence in American Indians and Alaska Natives
Incidence Rates and Rate Ratios of the Top 25 Cancers for American Indian/Alaska Natives compared with non–Hispanic Whites by Indian Health Service Region, CHSDA Counties, United States, Both Sexes, 1999–2004
All Regions Combined and Northern Plains Region | Alaska and Southern Plains Regions |
Pacific Coast and East Regions | Southwest Region
All Regions Combined and Northern Plains Region
Type of Cancer
All regions combined
Northern Plains
AI/AN NHW Ratio AI/AN to NHW AI/AN NHW Ratio AI/AN to NHW
Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI
All Sites / Types
None
368.4
None
476.0
0.77b
0.76–0.78
None
538.1
None
464.8
1.16b
1.12–1.20
Prostate
1
105.6
1
154.4
0.68b
0.66–0.71
1
174.6
1
162.2
1.08
0.97–1.19
Female Breast
2
85.3
2
134.4
0.63b
0.61–0.66
2
115.9
2
130.3
0.89b
0.81–0.97
Lung and Bronchus
3
57.4
3
70.3
0.82b
0.79–0.85
3
104.3
3
65.5
1.59b
1.47–1.72
Colon and Rectum
4
46.3
4
50.8
0.91b
0.87–0.95
4
72.5
4
52.3
1.39b
1.26–1.52
Kidney / Renal Pelvis
5
18.2
10
12.6
1.45b
1.36–1.54
5
24.1
10
12.9
1.88b
1.61–2.17
Corpus / Uterus, not otherwise specified
6
18.1
6
23.6
0.77b
0.71–0.83
6
19.5
5
26.6
0.74b
0.58–0.92
Non-Hodgkin Lymphoma
7
14.1
8
19.4
0.73b
0.67–0.78
7
18.5
7
19.4
0.95
0.79–1.14
Ovary
8
11.5
9
14.4
0.80b
0.72–0.88
14
11.0
9
14.0
0.79
0.57–1.04
Stomach
9
10.9
18
5.8
1.88b
1.72–2.05
11
13.2
18
5.6
2.35b
1.86–2.91
Pancreas
10
9.9
13
10.8
0.91b
0.83–1.00
13
11.1
13
10.2
1.10
0.86–1.38
Urinary Bladder
11
9.6
5
23.9
0.40b
0.37–0.44
8
14.8
6
22.9
0.65b
0.51–0.80
Cervix Uteri
12
9.4
15
7.4
1.28b
1.15–1.42
12
12.5
15
7.4
1.69b
1.29–2.18
Leukemia
13
9.4
11
12.6
0.75b
0.69–0.81
10
13.5
11
12.7
1.06
0.85–1.30
Liver / Intrahepatic Bile Ducts
14
9.0
21
4.3
2.11b
1.92–2.32
15
10.9
22
3.7
2.97b
2.29–3.78
Oral Cavity / Pharynx
15
8.5
12
11.0
0.77b
0.70–0.84
9
13.9
12
10.5
1.32b
1.06–1.62
Myeloma
16
6.2
20
4.9
1.27b
1.14–1.42
18
7.2
20
5.1
1.41b
1.04–1.85
Thyroid
17
5.6
14
8.3
0.67b
0.61–0.74
17
7.3
14
7.9
0.92
0.71–1.18
Melanoma–Skin
18
4.8
7
21.7
0.22b
0.20–0.25
21
4.6
8
15.9
0.29b
0.20–0.41
Esophagus
19
4.4
19
5.1
0.87b
0.76–0.99
16
8.2
19
5.3
1.55b
1.14–2.05
Testis
20
4.1
17
6.7
0.61b
0.53–0.70
19
5.1
17
6.6
0.77
0.53–1.11
Brain
21
3.6
16
6.9
0.53b
0.46–0.59
22
3.7
16
6.6
0.55b
0.38–0.78
Gallbladder
22
3.3
32
0.9
3.59b
3.04–4.22
25
2.6
31
1.1
2.48b
1.49–3.86
Larynx
23
3.1
22
3.8
0.81b
0.69–0.94
20
5.0
21
3.8
1.33
0.92–1.84
Other Biliary
24
2.2
29
1.5
1.48b
1.21–1.80
33
1.0
27
1.5
0.67
0.22–1.47
Soft Tissues including Heart
25
2.1
23
3.0
0.70b
0.59–0.84
24
2.8
24
2.7
1.02
0.61–1.58
Alaska and Southern Plains Regions
Type of Cancer
Alaska
Southern Plains
AI/AN NHW Ratio AI/AN to NHW AI/AN NHW Ratio AI/AN to NHW
Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI
All Sites / Types
None
511.0
None
486.8
1.05
1.00–1.11
None
492.6
None
461.2
1.07b
1.04–1.10
Prostate
4
78.3
1
180.7
0.43b
0.35–0.53
1
156.7
1
146.5
1.07
0.99–1.15
Female Breast
1
134.9
2
136.5
0.99
0.87–1.12
2
115.7
2
129.7
0.89b
0.83–0.96
Lung and Bronchus
3
93.2
3
71.6
1.30b
1.14–1.48
3
87.1
3
82.2
1.06
1.00–1.13
Colon and Rectum
2
102.6
4
50.6
2.03b
1.78–2.31
4
60.2
4
51.8
1.16b
1.08–1.25
Kidney / Renal Pelvis
6
19.6
10
13.5
1.46b
1.10–1.91
6
21.5
10
13.0
1.66b
1.46–1.87
Corpus / Uterus, not otherwise specified
9
13.6
6
22.8
0.60b
0.39–0.88
5
22.4
6
19.4
1.16
0.98–1.36
Non-Hodgkin Lymphoma
11
11.7
7
21.6
0.54b
0.39–0.74
7
20.9
7
18.5
1.13
0.99–1.28
Ovary
16
7.3
9
13.5
0.54b
0.29–0.92
8
14.7
9
14.0
1.05
0.86–1.28
Stomach
5
24.5
20
5.3
4.61b
3.34–6.38
15
9.0
18
5.1
1.77b
1.44–2.15
Pancreas
8
16.0
13
10.2
1.57b
1.13–2.15
13
11.0
13
10.6
1.04
0.87–1.24
Urinary Bladder
10
13.5
5
26.9
0.50b
0.35–0.69
9
14.6
5
19.7
0.74b
0.64–0.86
Cervix Uteri
14
8.5
17
6.2
1.37
0.77–2.29
10
14.1
14
9.2
1.54b
1.25–1.87
Leukemia
17
6.9
11
13.1
0.53b
0.35–0.78
11
13.2
11
12.5
1.06
0.91–1.23
Liver / Intrahepatic Bile Ducts
12
11.0
19
5.5
2.02b
1.33–2.99
16
8.1
22
4.3
1.88b
1.51–2.31
Oral Cavity / Pharynx
7
16.3
12
10.6
1.53b
1.12–2.05
12
11.4
12
11.7
0.98
0.83–1.15
Myeloma
20
5.2
21
5.2
1.01
0.58–1.66
17
7.4
19
4.6
1.62b
1.29–2.00
Thyroid
15
7.4
14
8.5
0.87
0.60–1.23
19
5.5
16
5.6
0.98
0.78–1.22
Melanoma–Skin
30
1.3
8
14.5
0.09b
0.03–0.20
14
9.6
8
15.8
0.61b
0.50–0.72
Esophagus
13
9.5
18
5.7
1.66b
1.05–2.51
21
4.4
21
4.3
1.01
0.76–1.32
Testis
18
6.2
15
7.1
0.86
0.50–1.48
22
3.4
17
5.6
0.62b
0.42–0.89
Brain
24
2.9
16
7.0
0.41b
0.22–0.73
18
6.1
15
6.9
0.88
0.70–1.08
Gallbladder
19
5.6
35
0.8
6.65b
2.94–55.85
26
2.1
34
0.8
2.48b
1.54–3.78
Larynx
22
3.5
23
3.3
1.07
0.56–1.92
20
5.0
20
4.5
1.13
0.87–1.44
Other Biliary
21
4.9
29
1.4
3.47b
1.63–7.23
25
2.1
28
1.4
1.55
1.00–2.30
Soft Tissues including Heart
27
1.8
24
3.1
0.57
0.23–1.23
23
3.0
25
2.4
1.24
0.89–1.69
Pacific Coast and East Regions
Type of Cancer
Pacific Coast
East
AI/AN NHW Ratio AI/AN to NHW AI/AN NHW Ratio AI/AN to NHW
Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI
All Sites / Types
None
312.7
None
488.0
0.64b
0.62–0.66
None
286.1
None
492.9
0.58b
0.54–0.62
Prostate
1
83.2
1
160.8
0.52b
0.47–0.57
1
83.9
1
155.9
0.54b
0.44–0.65
Female Breast
2
74.7
2
142.6
0.52b
0.48–0.57
2
71.4
2
133.6
0.53b
0.45–0.63
Lung and Bronchus
3
51.8
3
70.1
0.74b
0.68–0.80
3
46.8
3
74.2
0.63b
0.53–0.75
Colon and Rectum
4
38.7
4
48.5
0.80b
0.72–0.88
4
36.0
4
55.2
0.65b
0.53–0.79
Kidney / Renal Pelvis
7
12.5
11
12.2
1.02
0.86–1.20
6
14.4
10
13.4
1.07
0.78–1.43
Corpus / Uterus, not otherwise specified
5
16.7
7
23.6
0.71b
0.58–0.85
5
15.2
6
25.4
0.60b
0.40–0.86
Non-Hodgkin Lymphoma
6
12.6
8
20.1
0.62b
0.53–0.74
9
7.7
8
20.0
0.38b
0.24–0.57
Ovary
8
10.0
9
14.9
0.67b
0.52–0.85
14
5.9
9
14.8
0.40b
0.19–0.72
Stomach
13
7.9
18
5.6
1.40b
1.11–1.75
13
6.1
16
6.9
0.88
0.52–1.38
Pancreas
9
9.3
13
11.1
0.84
0.68–1.02
10
7.5
12
11.6
0.65b
0.38–1.00
Urinary Bladder
11
8.6
6
24.0
0.36b
0.29–0.44
7
11.9
5
25.8
0.46b
0.32–0.64
Cervix Uteri
15
6.9
17
7.0
0.98
0.74–1.27
12
7.1
15
7.3
0.97
0.53–1.62
Leukemia
12
8.6
10
12.8
0.67b
0.55–0.82
8
8.1
11
13.0
0.62b
0.40–0.92
Liver / Intrahepatic Bile Ducts
10
9.2
21
4.5
2.06b
1.68–2.49
15
5.7
22
4.4
1.29
0.76–2.03
Oral Cavity / Pharynx
14
7.7
12
11.6
0.66b
0.54–0.80
10
7.5
13
11.0
0.68
0.44–1.00
Myeloma
17
4.5
20
5.0
0.90
0.66–1.19
16
4.4
20
5.1
0.87
0.48–1.45
Thyroid
18
4.4
14
7.6
0.57b
0.44–0.73
18
4.2
14
9.3
0.45b
0.26–0.74
Melanoma–Skin
16
4.9
5
26.6
0.19b
0.14–0.24
21
2.8
7
20.5
0.14b
0.07–0.24
Esophagus
19
3.9
19
5.2
0.76
0.55–1.02
17
4.4
19
5.2
0.84
0.45–1.42
Testis
20
3.8
16
7.2
0.53b
0.38–0.72
25
1.5
18
6.5
0.23b
0.06–0.69
Brain
21
3.2
15
7.3
0.43b
0.32–0.57
20
3.4
17
6.9
0.50b
0.28–0.84
Gallbladder
25
1.5
33
0.9
1.72
0.95–2.79
24
1.6
31
1.0
1.65
0.42–4.06
Larynx
22
2.5
22
3.4
0.76
0.51–1.07
19
3.8
21
4.5
0.84
0.43–1.46
Other Biliary
24
1.6
29
1.5
1.11
0.63–1.78
34
0.6
27
1.6
0.37
0.04–1.33
Soft Tissues including Heart
26
1.5
23
3.1
0.46b
0.29–0.70
27
0.9
24
3.0
0.29b
0.05–0.86
Southwest Region
Type of Cancer
AI/AN NHW Ratio AI/AN to NHW
Rank
Ratea
Rank
Ratea
Rate Ratio
95% CI
All Sites / Types
None
232.9
None
445.1
0.52b
0.51–0.54
Prostate
1
65.7
1
133.8
0.49b
0.44–0.54
Female Breast
2
50.8
2
125.2
0.41b
0.37–0.44
Lung and Bronchus
6
14.9
3
65.6
0.23b
0.20–0.26
Colon and Rectum
3
21.0
4
46.8
0.45b
0.40–0.50
Kidney / Renal Pelvis
4
18.0
10
11.7
1.53b
1.37–1.72
Corpus / Uterus, not otherwise specified
5
16.7
7
19.6
0.86b
0.74–0.99
Non-Hodgkin Lymphoma
9
9.8
8
17.3
0.57b
0.48–0.66
Ovary
7
12.5
9
13.6
0.92
0.76–1.10
Stomach
8
11.5
18
4.9
2.37b
2.02–2.76
Pancreas
11
7.9
14
9.8
0.80b
0.66–0.95
Urinary Bladder
19
3.2
5
23.8
0.13b
0.10–0.18
Cervix Uteri
12
7.8
15
7.3
1.07
0.85–1.32
Leukemia
14
6.3
11
11.5
0.55b
0.46–0.66
Liver / Intrahepatic Bile Ducts
10
9.0
20
4.2
2.15b
1.80–2.54
Oral Cavity / Pharynx
18
3.3
12
10.4
0.32b
0.24–0.40
Myeloma
13
6.5
21
4.1
1.60b
1.30–1.95
Thyroid
15
5.8
13
9.9
0.59b
0.49–0.70
Melanoma–Skin
22
2.4
6
22.6
0.11b
0.08–0.14
Esophagus
23
2.4
19
4.7
0.51b
0.36–0.70
Testis
17
4.3
17
6.3
0.68b
0.52–0.89
Brain
21
2.5
16
6.6
0.37b
0.28–0.49
Gallbladder
16
5.5
32
0.8
6.98b
5.40–8.89
Larynx
26
1.0
22
3.5
0.27b
0.15–0.44
Other Biliary
20
2.9
29
1.4
2.15b
1.53–2.92
Soft Tissues including Heart
24
1.9
23
2.9
0.64b
0.45–0.88
Source: Cancer registries in the Centers for Disease Control and Prevention's National Program of Cancer Registries and/or the National Cancer Institute's Surveillance, Epidemiology, and End Results Program.
CHSDA indicates Contract Health Service Delivery Areas of the Indian Health Service; AI/AN indicates American Indians/Alaska Natives; NHW, non-Hispanic whites; CI, confidence interval.
a Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population (19 age groups – Census P25-1130).b P -Value for rate ratio ≤ 0.05.
Years of data and registries used: 1999–2004 (41 states and the District of Columbia): Alaska,* Alabama,* Arkansas, Arizona,* California,* Colorado,* Connecticut,* the District of Columbia, Delaware, Florida,* Georgia, Hawaii, Iowa,* Idaho,* Illinois, Indiana,* Kentucky, Louisiana,* Massachusetts,* Maine,* Michigan,* Minnesota,* Missouri, Montana,* North Carolina,* Nebraska,* New Hampshire, New Jersey, New Mexico,* Nevada,* New York,* Ohio, Oklahoma,* Oregon,* Pennsylvania,* Rhode Island,* Texas,* Utah,* Washington,* Wisconsin,* West Virginia, and Wyoming*; 1999 and 2002–2004: North Dakota*; 2001–2004: South Dakota*; 2003–2004: Mississippi* and Virginia; 2004: Tennessee. (*Asterisks indicate states with at least one county designated as a Contract Health Service Delivery Area (CHSDA).)
Percentage regional coverage of AI/AN in CHSDA counties to AI/AN in all counties: Alaska, 100%; East, 13.1%; Northern Plains, 59.0%; Southern Plains, 64.1%; Pacific Coast, 55.6%; Southwest, 87.5%.
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Page last reviewed: August 22, 2008Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention
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