Table Of Content

Indian Health Service Division ofProgram Statistics Office of Public Health Support CoverPhoto Taking Blood PhotocourtesyoftheIndianHealthService/ USDepartmentofHealthandHumanServices. rr)rt07j)7/4-(o 4 Indian Health Focus Women 2000-2001 US DEPARTMENT OF HEALTH AND HUMAN SERVICES Indian Health Service Division of Program Statistics Charles W. Grim, DDS, MHSA Edna L. Paisano Director Director Office of Public Health Support Richard M. Church, Pharm. D. Director GMH-RC Library 1101 Wootton Parkway, Suite 650 MD Rockvilie, 206 1-800-444-6472 CONTENTS Introduction 7 Summary of Data 8 Sources and Limitations of Data 10 Population Statistics 10 Vital Event Statistics 10 Patient Care Statistics 13 Sources of Copies and Additional Information 14 CHARTS & TABLES Chart 1 Population by Age and Sex 15 Table 1 Age and Sex Percent Distribution 16 Chart 2 Employment Status by Sex 17 Table 2 Selected Economic Profiles for the United States 17 Chart 3 Low Birthweight(less than 2,500 grams) as a Percent ofTotal Live Births byAge of Mother 18 Table 3 Low Birthweight (less than 2,500 grams) by Age of Mother 19 Chart 4 High Birthweight (4,000 grams or more) as a Percent ofTotal Live Births by Age of Mother 20 Table 4 High Birthweight (4,000 grams or more) by Age of Mother 21 Chart 5.1 Birth Order byAge of Mother, Percent within Birth Order, American Indians and Alaska Natives 22 Chart 5.2 Birth Order byAge of Mother, Percentwithin Birth Order, U.S. All-Races 22 Chart 5.3 Birth Order byAge of Mother, Percentwithin Birth Order, U.S. White 23 Table 5 Number and Percent Distribution of Live Births by Age of Mother within Birth Order 24 Chart 6 Prenatal Care in FirstTrimester 25 Table 6 Prenatal Care in FirstTrimester 25 Chart 7 Mothers Who Smoked During Pregnancy 26 Table 7 Percent of Mothers Who Smoked During Pregnancy for All Births and Low Birthweight by Age of Mother 27 Chart 8 Mothers Who Drank Alcohol During Pregnancy 28 Table 8 Percent of Mothers Who Drank Alcohol During Pregnancy byAge of Mother 28 Chart 9 Birth Rates among Mothers with Diabetes 29 Table 9 Rate of Live Births among Mothers with Diabetes byAge of Mother 29 Chart 10.1 First Cesarean Delivery 30 Chart 10.2 Vaginal Births after Previous Cesarean (VBAC) Delivery 30 Table 10 Rates of First Cesarean Delivery and Vaginal Birth after Previous Cesarean Delivery byAge of Mother 31 Chart 11 Life Expectancy at Birth: Females 31 Chart 12 Deaths by Age and Sex 32 Table 12 Number and Percent Distribution of Deaths by Age and Sex 33 Chart 13 Death Rates, Leading Causes: Females 34 Table 13 Leading Causes of Death for Female 34 Chart 14 Alcohol-Related Death Rates by Age and Sex 35 Table 14 Alcohol-Related Death Rates by Age and Sex 36 Chart 15 Drug-Related Death Rates by Age and Sex 37 Table 15 Drug-Related Death Rates by Age and Sex 38 Chart 16 Unintentional Injury Death Rates by Age and Sex 39 Table 16 Unintentional Injury Death Rates by Age and Sex 40 Chart 17 Suicide Death Rates by Age and Sex 41 Table 17 Suicide Death Rates by Age and Sex 42 Chart 18 Homicide Death Rates by Age and Sex 43 Table 18 Homicide Death Rates by Age and Sex 44 Chart 19 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex 45 Table 19 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex 46 Chart 20 Diabetes Mellitus Death Rates by Age and Sex 47 Table 20 Diabetes Mellitus Death Rates by Age and Sex 48 Chart 21 Heart Disease Death Rates by Age and Sex 49 Table 21 Heart Disease Death Rates by Age and Sex 50 Chart 22 Cerebrovascular Diseases Death Rates by Age and Sex 51 Table 22 Cerebrovascular Diseases Death Rates by Age and Sex 52 Chart 23 Malignant Neoplasm Death Rates by Age and Sex 53 Table 23 Malignant Neoplasm Death Rates by Age and Sex 54 Chart 24 Death Rates, Leading Cancer Sites: Females 55 Table 24 Leading Sites for Cancer Deaths for Female 56 Chart 25 Age-Adjusted Female Breast Cancer Death Rates 57 Table 25 Age-Adjusted Female Breast Cancer Death Rates 57 Chart 26 Age-Adjusted Cervical Cancer Death Rates 58 Table 26 Age-Adjusted Cervical Cancer Death Rates 58 Chart 27 Pneumonia and Influenza Death Rates byAge and Sex 59 Table 27 Pneumonia and Influenza Death Rates by Age and Sex 60 Chart 28 Leading Causes of Hospitalization for Females 61 Table 28 Ten Leading Causes of Hospitalization by Sex 61 Chart 29 Leading Causes ofAmbulatory Medical Visits for Females 62 Table 29 Ten Leading Causes ofAmbulatory Medical Clinical Impressions by Sex 62 Glossary of ICD-9 Codes 65 List of 72 Selected Causes of Death (1979-Present) 65 List of 61 Selected Causes of Infant Death (1979-Present) 66 Additional Causes of Death and Their Corresponding ICD-9 Codes Used in This Publication 68 List of ICD-9-CM Codes used in Patient Care Charts and Tables 68 Methods Used to Rank Leading Sites of Cancer Deaths 69 INTRODUCTION The Indian Health Sendee (IHS) is an agency ofthe Department ofHealth and Human Services (HHS). The IHS goal is to assure that comprehensive, culturally-acceptable personal and public health services are available and accessible to American Indian and Alaska Native (AI/AN) people. The mission ofthe IHS, in partnership with AI/AN people, is to raise their physical, mental, social, and spiritual health to the highest level. The IHS has carried out its responsibilities through developing and operating a health services delivery system designed to provide a broad-spectrum program ofpreventive, curative, rehabilitative, and environ- mental services. This system integrates health services delivered directly through IHS facilities, purchased by IHS through contractual arrangements with providers in the private sector, and delivered through Tribally operated programs and Urban Indian health programs. 3 a. The IHS is concerned with the health ofAI/AN ofall ages. The IHS presents an overview ofthe health status ofAI/AN in its annual publication, Trends in Indian Health. However, IHS recognizes that there are segments and conditions ofthe AI/AN population that require special attention, such as infants, youth, women, the elderly and injuries. This publication examines the health status ofAI/AN women. It is based on data published in the IHS publications 2000-2001 Trends in Indian Health and 2000-2001 RegionalDifferences in Indian Health. The population ofinterest for this publication is AI/AN women residing in the IHS service area. The IHS service area consists ofcounties on and near federal Indian reservations. The AI/AN people residing in the service area comprise about 60 percent of all AI/AN people residing in the U.S. It is estimated to be approxi- mately 1.6 million in 2003 compared to 2.6 million in the entire US. SUMMARY OF DATA AI/ANwomen comprise 51 per- races population is considerably alcohol duringpregnancymore centoftheIHS servicepopu- higher at 7.5. Highbirthweight than three times the rate forwomen lation, as is true forU.S. all-races (4,000grams ormore) are arelatively in the U.S. all-races population, andwhitewomeninthe population greaterproblem forAI/ANwomen i.e., 3.6 percentofAI/AN mothers groups. However,AI/ANwomen thanlowbirthweight. ForAI/AN compared to 1.1 percentforU.S. are considerablyyoungerthan their women, 12.6 percent ofallbabies in all-races mothers. Partiallyas a result counterparts in thesepopulations. the IHS service areawere high ofbehaviors (e.g., dietary) prior to Accordingto the 1990 census, birthweight, compared to 10.1 per- pregnancy,AI/ANwomen giving 49.6 percentofAI/ANwomen are centforU.S. all-races women and birth are 1.8 times as likelyto be youngerthan25 years ofage and 6.5 11.2 percentforU.S.whitewomen. personswith diabetes than U.S. percentare olderthan 64years.The all-raceswomen givingbirth. comparablepercentages forU.S. all- AI/ANwomen generallybegin pre- raceswomen are 34.8 and 14.6, and natal care later thanwomen in the AI/ANwomen tend to give birth forU.S.whitewomen are 33.4 and U.S. all-races population. Prenatal usingdifferent methods ofdelivery 15.7.AI/ANwomengenerallyhave care began in the firsttrimesterfor thanwomen in the U.S. all-races alower social andeconomic status 68.5 percent ofAI/AN live births, population.Theyhave a 17percent thanwomenin theU.S.general whereas this percentage forthe U.S. lowerrate ofprimarycesarean deliv- population.The 1990 census also generalpopulation is 82.5. None eries (i.e., numberoffirst cesarean showed that 13.4percent ofAI/AN ofthe IHS Areas reach the U.S. deliveries per 100 live births to women aged 16 and olderare unem- all-races rate; although Nashville is womenwho have nothad aprior ployed in contrastto 6.2 and 5.0 closest at 77.1.The Navajo rate of cesarian delivery) than U.S. all-races percentfortheU.S. all-races and 56.4, the lowestArea rate, is only women.Also,AI/AN womenwho white populations,respectively. 68 percent ofthe U.S. all-races rate. have had a cesarean delivery are 14 percent more likelyto have a subse- AI/ANwomen on average give birth AI/AN women are more likelyto quentvaginal deliverythanwomen to children atyoungerages than exhibitriskybehaviors duringpreg- in the U.S. all-races population. women in the U.S. general popula- nancythan their counterparts in tion. ForAI/ANwomen, 45.7per- the U.S. all-races population. For The life expectancy (adjusted to cent are under age20when they example,20.2 percent ofAI/AN compensate formisreporting of have theirfirst child.This compares women report thattheysmoke AI/AN race on state death certifi- to 24.4percent forU.S. all-races duringpregnancy.Women in the cates) forAI/AN females is 6.8 mothers and21.9 percentforU.S. U.S. all-races population, in contrast, years greater than itis forAI/AN white mothers. Despite the large smoke at a lowerrate duringpreg- males,i.e., 74.2 compared to 67.4. number ofyoungmothers,low nancy, i.e., 13.2 percent.There is Therefore, itfollows thatAI/AN birthweight (less than2,500 grams) an established relationship between females die atrelativelyolder ages occurs atlower rates amongAI/AN smoking and lowbirthweightbirths. thanAI/AN males.The percentage women than itdoes forwomen in OfallAI/AN lowbirthweight, ofdeaths pertaining to ages under theU.S. all-races andwhite popula- 28.3 percentwere towomenwho 45 is 22.7 percentforAI/AN tions. ForAI/AN women, 6.3 per- reported smoking duringpregnancy. females and 32.5 percentfor males. cent ofreportedlive births are of Alcohol consumption is another However, for ages over 64, the lowbirthweight,justbelowthe level riskybehavior more prevalent among female percentage is 53.2 compared fortheU.S.white population (6.5 AI/AN pregnantwomen. AI/AN to the male percentage of40.6. percent).The percentage forU.S. all- women report thattheyconsume AI/AN females die mainlyfrom