Injuries, from both unintentional and
intentional causes, are third behind heart disease and cancer as the
leading cause of death among all American Indians and Alaska Natives
(Native Americans).1 Injuries
are the leading cause of death among all children in the United States,
but Native American children are disproportionately affected by injuries,
with rates about 2.5 times 2 the rate for all U.S. children.
In 1993, the Centers for Disease Control and
Prevention (CDC) and the Indian Health Service (IHS) published the Injury
Mortality Atlas of Indian Health Service Areas, 1979–1987, which
summarized the geographic distribution of injury mortality among 3 Native
Americans of all ages by IHS Area. Although similar, the current Atlas
focuses on the problem of injuries among Native American children and
youth (ages 0–19 years) residing in IHS Areas. The purpose of the Atlas is
to provide background information and data to public health practitioners
and policy makers to help identify critical injury problems and set
intervention priorities for intervention among this vulnerable population.
The Atlas contains composite maps of all IHS
Area rates and individual Area maps for eight causes of injury death. It
includes study results of Native American children and youth (0–19 years)
who live in one of the twelve IHS Areas. The Atlas provides information on
several causes of injury deaths: motor vehicle-related,
pedestrian-related, firearm-related, suicide, homicide, drowning, fire,
The IHS has long recognized the high
incidence of misclassification of Indian race on state death certificates,
4, 5 particularly in the California, Oklahoma, and Portland Areas.
Research shows that all IHS Areas have this problem to some degree, but it
ranges from as low as 1% for the Navajo Nation to a 4 high of 30% for
California. The problem of misclassification is addressed in this report.
Death rates presented are those that have been adjusted for
misclassification. In Regional Differences in Indian Health, the IHS also
presents death rates by Area that adjust 6 for misclassification of
American Indian race.
The Atlas is intended for use as a reference
tool for public health professionals and decision makers who are
interested in reducing injuries among Native American children and youth.
Its format allows one to visually recognize injury patterns across IHS
Areas and to compare rates in IHS Areas with national rates. The Atlas is
also intended to raise awareness of specific Areas or groups at elevated
risk of injury death within the IHS and to help focus the issue of
injuries as a public health problem among Native American children and
Native American children and youth in the
IHS Areas are at greater risk of preventable injury-related death than
other children in the United States. The injury maps show how widely this
risk varies by IHS Area. Although it is promising that death rates from
motor vehicle crashes, pedestrian events, drowning, and fire decreased
from 1989 to 1998, the overall injury disparity compared 7 with rates for
white children and youth persists. During this period, rates increased for
firearm-related death and homicide, but the rates remained unchanged for
suicide. Given the variation in the injury problem and Native American
tribal culture, interventions need to be tailored to local settings and
problems. To ensure successful interventions, considerations of local
practices and cultures should be addressed. Such efforts are needed to
help reduce or eliminate the injury disparity gap between Native American
children and other children in America.