BACKGROUND: Alaska Native/American Indian (ANAI) people are disproportionately affected by unintentional injury (UI). During 1999–2008, UI was the third leading cause of ANAI death and rates were 1.3 times higher than those of U.S. Whites and over twice those of Alaska Whites (AKW). We compared the 5 UI leading causes by race and rural/urban status to assess the effect of distance, roadlessness, and access to definitive healthcare in rural Alaska.
METHODS: We included State of Alaska Bureau of Vital Statistics UI mortality data for resident ANAI and AKW who died in Alaska during 1999–2008. To reduce variability in the smaller ANAI population, we aggregated deaths for the ten year period. We calculated age-adjusted rates and rate ratios for leading causes by race and rural/urban status. We used the U.S. Census urban area definition of ≥50,000 people to delineate urban and rural status. Decedents were classified as rural or urban based on residence.
RESULTS: During 1999–2008, 992 ANAI and 1,971 AKW resident UI deaths occurred. Overall, the ANAI age-adjusted UI rate was 104.1/100,000 compared with 45.9/100,000 for AKW (Rate Ratio (RR)=2.4, 95% CI: 2.17–2.56). Among ANAI, poisoning was the leading cause of UI death (20.9/100,000) followed by traffic-related motor vehicle events (17.3/100,000), drowning/submersion (12.3/100,000), UI caused by the natural environment (10.7/100,000) and other land transport UI (8.6/100,000). The five most common UI categories accounted for 71% (704) of ANAI injuries. Among AKW traffic-related motor vehicle events were the leading cause of AKW UI death (12.7/100,000) followed by poisoning (9.8/100,000). Rural UI mortality was significantly higher among ANAI and AKW compared with urban counterparts (AN RR=1.2, 95% CI: 1.06–1.46; AKW RR=1.5, 95% CI: 1.38–1.68). Among ANAI, rural rates associated with drowning/submersion (RR=3.2, 95% CI: 1.72–5.91) and other land transport such as snowmobiles (RR=4.6, 95% CI: 2.19–9.65) were significantly elevated compared with urban ANAI rates.
CONCLUSIONS: Rural residents of Alaska experience higher mortality rates than urban residents and ANAI are disproportionately affected. Rural residents experience different exposures than urban residents that might be reflected in the differences in rates. Injuries occurring in rural areas might be more likely to be fatal due to access, communications, availability of emergency services, and longer transport times to definitive care. Better injury surveillance systems capturing increased detail could inform targeted prevention efforts by improving information about both fatal and non-fatal injury circumstances in rural and urban environments.