BACKGROUND: American Indian/Alaska Natives (AI/ANs) in the United States and the Bemidji Indian Health Service (IHS) Area (Michigan, Minnesota, Wisconsin, and Chicago) face numerous health and socioeconomic disparities. Nationally, AI/ANs experience higher age-adjusted unintentional injury (UI) mortality rates than the general population. Little work has been conducted on UI among Bemidji Area (BA) AI/AN; previous reports aggregate BA with nearby IHS Areas or limit analyses to IHS service areas.
METHODS: Age-adjusted UI mortality rates per 100,000 and 95% confidence intervals were retrieved from CDC WONDER for the years 2006-2010 and 2011-2015 for Michigan, Minnesota, Wisconsin, BA (excluding Chicago) in aggregate, and the United States for AI/AN, whites, and the all races population. Differences in rates by geography, race, year, sex, and urbanicity were examined.
RESULTS: In 2011-2016 the BA A/AN UI age-adjusted rate was 73.9 per 100,000 (95% CI: 68.3,79.4), statistically significantly higher than the whites rate of 41.8 (95% CI: 41.4,42.3). AI/ANs had higher UI mortality rates than whites in Michigan, Minnesota, and Wisconsin. However, AI/AN rates varied significantly by state: Michigan’s rate was half that of Minnesota’s (51.7 and 100.1 per 100,000). BA AI/AN had statistically significant higher mortality rates for drowning, motor vehicle traffic, and poisoning as compared to whites (2.11, 1.84, and 2.64 times higher respectively). Statistically significant state differences were also seen with cause of death: Michigan and Wisconsin’s AI/AN poisoning mortality rate was 1.89 and 1.79 times higher than for whites respectively, while in Minnesota the AI/AN rate was 5.60 times higher than for whites. Since 2006-2010, the BA UI mortality rate for AI/AN has significantly increased 20% while the poisoning mortality rate increased 71%. Nationally, AI/AN mortality rates from UI decreased 1% (non-significant) while poisoning significantly increased by 27%. Motor vehicle traffic mortality rates were 2.63 times higher for rural (26.3 per 100,000 95% CI: 21.6,31.0) than for urban AI/AN residents (10.0 per 100,000 95% CI: 7.6,12.8). Additionally, there was a significant increase in poisoning deaths for urban AI/AN residents between 2006-2010 and 2011-2016. BA AI/AN males had a statistically significant higher UI mortality rate than AI/AN females.
CONCLUSIONS: BA AI/AN UI mortality rates are increasing; UI, poisoning and motor vehicle traffic deaths were statistically significantly higher in 2011-2016 than in 2006-2010. However, it is unknown whether this reflects actual changes in mortality rates or may be attributable to factors such as changes in race identification or coding of cause of death.