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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
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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