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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 CancerAll regions combinedNorthern Plains
AI/ANNHWRatio AI/AN to NHWAI/ANNHWRatio AI/AN to NHW
RankRateaRankRateaRate Ratio95% CIRankRateaRankRateaRate Ratio95% CI
All Sites / TypesNone368.4None476.00.77b0.76–0.78None538.1None464.81.16b1.12–1.20
Prostate1105.61154.40.68b0.66–0.711174.61162.21.080.97–1.19
Female Breast285.32134.40.63b0.61–0.662115.92130.30.89b0.81–0.97
Lung and Bronchus357.4370.30.82b0.79–0.853104.3365.51.59b1.47–1.72
Colon and Rectum446.3450.80.91b0.87–0.95472.5452.31.39b1.26–1.52
Kidney / Renal Pelvis518.21012.61.45b1.36–1.54524.11012.91.88b1.61–2.17
Corpus / Uterus, not otherwise specified618.1623.60.77b0.71–0.83619.5526.60.74b0.58–0.92
Non-Hodgkin Lymphoma714.1819.40.73b0.67–0.78718.5719.40.950.79–1.14
Ovary811.5914.40.80b0.72–0.881411.0914.00.790.57–1.04
Stomach910.9185.81.88b1.72–2.051113.2185.62.35b1.86–2.91
Pancreas109.91310.80.91b0.83–1.001311.11310.21.100.86–1.38
Urinary Bladder119.6523.90.40b0.37–0.44814.8622.90.65b0.51–0.80
Cervix Uteri129.4157.41.28b1.15–1.421212.5157.41.69b1.29–2.18
Leukemia139.41112.60.75b0.69–0.811013.51112.71.060.85–1.30
Liver / Intrahepatic Bile Ducts149.0214.32.11b1.92–2.321510.9223.72.97b2.29–3.78
Oral Cavity / Pharynx158.51211.00.77b0.70–0.84913.91210.51.32b1.06–1.62
Myeloma166.2204.91.27b1.14–1.42187.2205.11.41b1.04–1.85
Thyroid175.6148.30.67b0.61–0.74177.3147.90.920.71–1.18
Melanoma–Skin184.8721.70.22b0.20–0.25214.6815.90.29b0.20–0.41
Esophagus194.4195.10.87b0.76–0.99168.2195.31.55b1.14–2.05
Testis204.1176.70.61b0.53–0.70195.1176.60.770.53–1.11
Brain213.6166.90.53b0.46–0.59223.7166.60.55b0.38–0.78
Gallbladder223.3320.93.59b3.04–4.22252.6311.12.48b1.49–3.86
Larynx233.1223.80.81b0.69–0.94205.0213.81.330.92–1.84
Other Biliary242.2291.51.48b1.21–1.80331.0271.50.670.22–1.47
Soft Tissues including Heart252.1233.00.70b0.59–0.84242.8242.71.020.61–1.58
Alaska and Southern Plains Regions
Type of CancerAlaskaSouthern Plains
AI/ANNHWRatio AI/AN to NHWAI/ANNHWRatio AI/AN to NHW
RankRateaRankRateaRate Ratio95% CIRankRateaRankRateaRate Ratio95% CI
All Sites / TypesNone511.0None486.81.051.00–1.11None492.6None461.21.07b1.04–1.10
Prostate478.31180.70.43b0.35–0.531156.71146.51.070.99–1.15
Female Breast1134.92136.50.990.87–1.122115.72129.70.89b0.83–0.96
Lung and Bronchus393.2371.61.30b1.14–1.48387.1382.21.061.00–1.13
Colon and Rectum2102.6450.62.03b1.78–2.31460.2451.81.16b1.08–1.25
Kidney / Renal Pelvis619.61013.51.46b1.10–1.91621.51013.01.66b1.46–1.87
Corpus / Uterus, not otherwise specified913.6622.80.60b0.39–0.88522.4619.41.160.98–1.36
Non-Hodgkin Lymphoma1111.7721.60.54b0.39–0.74720.9718.51.130.99–1.28
Ovary167.3913.50.54b0.29–0.92814.7914.01.050.86–1.28
Stomach524.5205.34.61b3.34–6.38159.0185.11.77b1.44–2.15
Pancreas816.01310.21.57b1.13–2.151311.01310.61.040.87–1.24
Urinary Bladder1013.5526.90.50b0.35–0.69914.6519.70.74b0.64–0.86
Cervix Uteri148.5176.21.370.77–2.291014.1149.21.54b1.25–1.87
Leukemia176.91113.10.53b0.35–0.781113.21112.51.060.91–1.23
Liver / Intrahepatic Bile Ducts1211.0195.52.02b1.33–2.99168.1224.31.88b1.51–2.31
Oral Cavity / Pharynx716.31210.61.53b1.12–2.051211.41211.70.980.83–1.15
Myeloma205.2215.21.010.58–1.66177.4194.61.62b1.29–2.00
Thyroid157.4148.50.870.60–1.23195.5165.60.980.78–1.22
Melanoma–Skin301.3814.50.09b0.03–0.20149.6815.80.61b0.50–0.72
Esophagus139.5185.71.66b1.05–2.51214.4214.31.010.76–1.32
Testis186.2157.10.860.50–1.48223.4175.60.62b0.42–0.89
Brain242.9167.00.41b0.22–0.73186.1156.90.880.70–1.08
Gallbladder195.6350.86.65b2.94–55.85262.1340.82.48b1.54–3.78
Larynx223.5233.31.070.56–1.92205.0204.51.130.87–1.44
Other Biliary214.9291.43.47b1.63–7.23252.1281.41.551.00–2.30
Soft Tissues including Heart271.8243.10.570.23–1.23233.0252.41.240.89–1.69
Pacific Coast and East Regions
Type of CancerPacific CoastEast
AI/ANNHWRatio AI/AN to NHWAI/ANNHWRatio AI/AN to NHW
RankRateaRankRateaRate Ratio95% CIRankRateaRankRateaRate Ratio95% CI
All Sites / TypesNone312.7None488.00.64b0.62–0.66None286.1None492.90.58b0.54–0.62
Prostate183.21160.80.52b0.47–0.57183.91155.90.54b0.44–0.65
Female Breast274.72142.60.52b0.48–0.57271.42133.60.53b0.45–0.63
Lung and Bronchus351.8370.10.74b0.68–0.80346.8374.20.63b0.53–0.75
Colon and Rectum438.7448.50.80b0.72–0.88436.0455.20.65b0.53–0.79
Kidney / Renal Pelvis712.51112.21.020.86–1.20614.41013.41.070.78–1.43
Corpus / Uterus, not otherwise specified516.7723.60.71b0.58–0.85515.2625.40.60b0.40–0.86
Non-Hodgkin Lymphoma612.6820.10.62b0.53–0.7497.7820.00.38b0.24–0.57
Ovary810.0914.90.67b0.52–0.85145.9914.80.40b0.19–0.72
Stomach137.9185.61.40b1.11–1.75136.1166.90.880.52–1.38
Pancreas99.31311.10.840.68–1.02107.51211.60.65b0.38–1.00
Urinary Bladder118.6624.00.36b0.29–0.44711.9525.80.46b0.32–0.64
Cervix Uteri156.9177.00.980.74–1.27127.1157.30.970.53–1.62
Leukemia128.61012.80.67b0.55–0.8288.11113.00.62b0.40–0.92
Liver / Intrahepatic Bile Ducts109.2214.52.06b1.68–2.49155.7224.41.290.76–2.03
Oral Cavity / Pharynx147.71211.60.66b0.54–0.80107.51311.00.680.44–1.00
Myeloma174.5205.00.900.66–1.19164.4205.10.870.48–1.45
Thyroid184.4147.60.57b0.44–0.73184.2149.30.45b0.26–0.74
Melanoma–Skin164.9526.60.19b0.14–0.24212.8720.50.14b0.07–0.24
Esophagus193.9195.20.760.55–1.02174.4195.20.840.45–1.42
Testis203.8167.20.53b0.38–0.72251.5186.50.23b0.06–0.69
Brain213.2157.30.43b0.32–0.57203.4176.90.50b0.28–0.84
Gallbladder251.5330.91.720.95–2.79241.6311.01.650.42–4.06
Larynx222.5223.40.760.51–1.07193.8214.50.840.43–1.46
Other Biliary241.6291.51.110.63–1.78340.6271.60.370.04–1.33
Soft Tissues including Heart261.5233.10.46b0.29–0.70270.9243.00.29b0.05–0.86
Southwest Region
Type of CancerAI/ANNHWRatio AI/AN to NHW
RankRateaRankRateaRate Ratio95% CI
All Sites / TypesNone232.9None445.10.52b0.51–0.54
Prostate165.71133.80.49b0.44–0.54
Female Breast250.82125.20.41b0.37–0.44
Lung and Bronchus614.9365.60.23b0.20–0.26
Colon and Rectum321.0446.80.45b0.40–0.50
Kidney / Renal Pelvis418.01011.71.53b1.37–1.72
Corpus / Uterus, not otherwise specified516.7719.60.86b0.74–0.99
Non-Hodgkin Lymphoma99.8817.30.57b0.48–0.66
Ovary712.5913.60.920.76–1.10
Stomach811.5184.92.37b2.02–2.76
Pancreas117.9149.80.80b0.66–0.95
Urinary Bladder193.2523.80.13b0.10–0.18
Cervix Uteri127.8157.31.070.85–1.32
Leukemia146.31111.50.55b0.46–0.66
Liver / Intrahepatic Bile Ducts109.0204.22.15b1.80–2.54
Oral Cavity / Pharynx183.31210.40.32b0.24–0.40
Myeloma136.5214.11.60b1.30–1.95
Thyroid155.8139.90.59b0.49–0.70
Melanoma–Skin222.4622.60.11b0.08–0.14
Esophagus232.4194.70.51b0.36–0.70
Testis174.3176.30.68b0.52–0.89
Brain212.5166.60.37b0.28–0.49
Gallbladder165.5320.86.98b5.40–8.89
Larynx261.0223.50.27b0.15–0.44
Other Biliary202.9291.42.15b1.53–2.92
Soft Tissues including Heart241.9232.90.64b0.45–0.88

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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