P.L. 83-568, the Transfer Act, on August 5, 1954. This Act provides "that all

functions, responsibilities, authorities, and duties ... relating to the maintenance

and operation of hospital and health facilities for Indians, and the conservation

of Indian health ... shall be administered by the Surgeon General of the United

States Public Health Service."

The IHS goal is to raise the health status of American Indians and Alaska Natives

to the highest possible level. The mission is to provide a comprehensive health

services delivery system for American Indians and Alaska Natives with opportunity

for maximum tribal involvement in developing and managing programs to meet

their health needs. The IHS also acts as the principal Federal health advocate for

Indian people by assuring they have knowledge of and access to all Federal, State,

and local health programs they are entitled to as American citizens. It is also the

responsibility of the IHS to work with these programs so they will be cognizant of

entitlements of Indian people.

The IHS has carried out its responsibilities through developing and operating a

health services delivery system designed to provide a broad-spectrum program of

preventive, curative, rehabilitative and environmental services. This system integrates health services delivered directly through IHS facilities and staff on the one

hand, with those purchased by IHS through contractual arrangements on the other,

taking into account other health resources to which the Indians have access. Tribes

are also actively involved in program implementation.

The 1975 Indian Self-Determination Act, P.L. 93-638 as amended, builds upon IHS

policy by giving Tribes the option of manning and managing IHS programs in their

communities, and provides for funding for improvement of Tribal capability to

contract under the Act. The 1976 Indian Health Care Improvement Act, P. L.

94-437 as amended, was intended to elevate the health status of American Indians

and Alaska Natives to a level equal to that of the general population through a

program of authorized higher resource levels in the IHS budget. Appropriated

resources were used to expand health services, build and renovate medical

facilities, and step up the construction of safe drinking water and sanitary disposal

facilities. It also established programs designed to increase the number of Indian

health professionals for Indian needs and to improve health care access for Indian

people living in urban areas.

The operation of the IHS health services delivery system is managed through local

administrative units called service units. A service unit is the basic health

organization for a geographic area served by the IHS program, just as a county or

city health department is the basic health organization in a State health department.

1
2
Current regional differences are depicted, and comparisons to the general

population are made, when appropriate. Historical trend information can be found

in the IHS companion publication called Trends in Indian Health.

The tables and charts are grouped into five major categories: 1) IHS Structure, 2)

Population Statistics, 3) Natality and Infant/Maternal Mortality Statistics, 4) General

Mortality Statistics, and 5) Patient Care Statistics. The tables provide detailed data, while

the charts show significant relationships. A table and its corresponding chart appear

next to each other. However, some charts that are self-explanatory do not have a

corresponding table. Also, a table may have more than one chart associated with it.

3
 Bemidji Phoenix

 Billings Portland

 California Tucson

As of October 1, 1993, the Area Offices consisted of 143 basic administ

called service units. Of the 143 service units, 70 were operated by T

number of service units ranged from 2 in Tucson to 23 in California.

The IHS operated 41 hospitals, 66 health centers, 4 school health cent

health stations; while Tribes operated 8 hospitals, 110 health centers, 4 sc

centers, 62 health stations, and 171 Alaska village clinics. Both Cal

Portland had no hospitals while Aberdeen and Phoenix had 8 hosp

Tucson had the fewest health centers with 3, and California the most w

Population Statistics

In fiscal year 1992 the IHS user population (count of those American I

Alaska Natives who used IHS services at least once during the last 3-y

was approximately 1,150,000. Tucson (18,799) and Nashville (34,167

smallest user populations while Oklahoma (246,750) and Navajo (226,7

largest user populations.

The Indian population is younger, less educated and poorer than the U.

population. For the IHS user population in 1992, 13.3 percent of the pe

under age 5 compared to 7.5 percent for the U.S. All Races population

considerable variation by Area with Nashville at 10.9 percent and Ala

percent. According to the 1990 Census, 65.3 percent of Indians (age 25 

residing in the current Reservation States are high school graduates 

compared to 75.2 percent for the U.S. All Races population. For 3 

(Tucson, Navajo, and Phoenix), the percentage was less than 60.0 

State-level Indian data). The 1990 Census also indicated that the median 

income in 1989 for Indians residing in the current Reservation States w

while for the U.S. All Races it was $30,056. Aberdeen had the low

household income at $12,310, and California the highest at $28,029 

State-level Indian data).

Natality and Infant/Maternal Mortality Statistics

The birth rate for American Indians and Alaska Natives residing in the 

area was 28.1 (rate per 1,000 population) in 1989-1991. It is 1.7 times the 

rate of 16.7 for the U.S. All Races population. For the period 1989-1991, 

4
y 

In 1989-1991, the age-adjusted mortality rate (all causes) for American Indians and

Alaska Natives residing in the IHS service area was 585.2 (rate per 100,000

population) compared to 520.2 for the U.S. All Races population in 1990. When

the 3 IHS Areas with apparent problems in underreporting of Indian race on death

certificates are excluded, the rate is 713.9. This is 37 percent greater than the U.S.

rate. The Aberdeen Area rate of 1,067.2 is more than double the U.S. rate.

The 2 leading causes of death for the IHS service area population in 1989-1991

were "diseases of the heart" and "accidents and adverse effects." However, this was

the order for only 3 of the IHS Areas (Billings, Phoenix, and Tucson). Three (3)

IHS Areas (Alaska, Albuquerque, and Navajo) had the order reversed. The

remaining 6 IHS Areas (Aberdeen, Bemidji, California, Nashville, Oklahoma, and

Portland) had the same 2 leading causes of death as the U.S. All Races population

(1990), i.e., "diseases of the heart" and "malignant neoplasms." The leading causes

of death were determined without any adjustment for age which is the customary

method. However, it should be noted that the age composition of a population does

influence its mortality pattern.

For most of the specific causes of death identified in this publication, the 1989-1991

Indian age-adjusted mortality rate (calculated by excluding the 3 IHS Areas with

apparent death certificate problems) was greater than the 1990 U.S. All Races rate.

There was also considerable variation in the rates among the IHS Areas. However,

some of the Area rates need to be interpreted with caution because of the small

number of deaths involved. Following is a comparison of the Indian (9 Area) rate

to the U.S. rate where there are significant differences.

 1) alcoholism—630 percent greater

 2) tuberculosis—580 percent greater

 3) diabetes mellitus—232 percent greater

 4) accidents—216 percent greater

 5) suicide—85 percent greater

 6) homicide—80 percent greater

 7) malignant neoplasms—18 percent less

Patient Care Statistics

In FY 1992 there were over 93,000 admissions to IHS and Tribal direct and contract

general hospitals. The number of admissions ranged from 876 in Tucson to 20,147

in Navajo. The leading cause of hospitalization in IHS and Tribal direct and contract

general hospitals was "obstetric deliveries and complications of puerperium and

pregnancy." There were 5 IHS Areas with a different leading cause; Bemidji and

5
services, Oklahoma (489,697) and Navajo (409,747).

The rate of new tuberculosis cases for the IHS in CY 1991 was 2.2 times 

the U.S., 23.1 new cases per 100,000 population compared to 10.4. Only 

(California and Bemidji) had a rate less than the U.S. rate.

6
registration records within an Area. Those cases that are not clear are sent to the

IHS Area Offices as possible duplicates for resolution.

The IHS user population estimates, which are shown in this publication, need to

be contrasted with the IHS service population (eligible population) estimates, which

are shown in the Trends in Indian Health publication. The service population

estimates are based on official U.S. Census Bureau county data. These are

self-identified Indians who may or may not use IHS services. IHS service populations

between Census years (e.g., 1980 and 1990) are estimated by a smoothing technique

in order to show a gradual transition between Census years. This normally results

in upward revisions to service population figures projected prior to a Census, since

each Census tends to do a better job in enumerating American Indians and Alaska

Natives. IHS service populations beyond the latest Census year (1990) are projected

through linear regression techniques, using the most current 10 years of Indian

birth and death data provided by the National Center for Health Statistics.

IHS user population figures are used for calculating IHS patient care rates. However,

since State birth and death certificates do not provide information on use of IHS

services, IHS service population figures are used in calculating Indian vital event

rates for the IHS service area.

The social and economic data contained in this publication are from the 1990 Census.

At the time of this publication, IHS had not yet obtained county-level social and economic

data. Therefore, State-level data were used to develop estimates for each IHS Area. That

is, Indian data for each of the States where an IHS Area currently provides services were

combined to form an estimate for the IHS Area. IHS has made arrangements with the

Census Bureau to obtain county-level social and economic data for Indians which will

allow IHS to make more precise calculations at the IHS Area level.

Vital Event Statistics

American Indian and Alaska Native vital event statistics are derived from data

furnished annually to the IHS by the National Center for Health Statistics (NCHS).

Vital event statistics for the U.S. population were derived from data in various NCHS

publications, as well as from some unpublished data from NCHS. NCHS obtains

birth and death records for all U.S. residents from the State departments of health,

based on information reported on official State birth and death certificates. The

records NCHS provides IHS contain the same basic demographic items as the vital

event records maintained by NCHS for all U.S. residents, but with names, addresses,

and record identification numbers deleted. It should be noted that Tribal identity

is not recorded on these records.

7
Natality statistics are based on the total file of birth records occurring in th

year. Mortality statistics are based on the total file of registered deaths occu

U.S. each year. Tabulations of vital events for IHS Areas are by place of re

The Indian vital event statistics in this publication pertain only to Ameri

and Alaska Natives residing in the counties that make up the IHS servic

contrasts with earlier editions of the Trends in Indian Health publica

showed vital event statistics for all American Indians and Alaska Natives 

the Reservation States. Calculations done on a Reservation State basis 

counties within the State, even those outside the IHS service area. Reserv

vital event rates tend to be lower in value (i.e., lower birth rates, lowe

rates) than IHS service area rates. Since prior to 1972, only total Reserv

data are available, Reservation State data need to be used to show trends 

to 1955, the inception of the IHS. However, now that there are sufficien

data available for the IHS service area to show meaningful trends, the 

Indian Health publication, beginning with the 1992 edition, shows 

statistics for the IHS service population. The reason for this is that IHS s

data are more indicative of the health status of the Indians that IHS se

The Indian population is considerably younger than the U.S. All Races 

Therefore, the mortality rates presented in this publication have been ag

where applicable, so that appropriate comparisons can be made bet

population groups. One exception is the information presented for lea

of death. In order to determine the leading causes of death for a popula

it is necessary to rank causes of death without any adjustment for age. 

should be kept in mind that the ranking of causes of death for a popula

is affected by its age composition.

The age-adjusted mortality rates presented in this publication were co

the direct method, that is, by applying the age-specific death rate for a 

of death to the standard population distributed by age. The total po

enumerated in 1940 was selected as the standard to be consistent with N

rates for the total population and for each race-sex group were adjusted 

by using the same standard population. The age-adjusted rates were based 

age groups. An age-adjusted rate that was calculated based upon a small 

deaths should be interpreted with caution since the observed rate m

different from the true underlying rate. This occasionally occurred wh

rate was calculated for a specific cause of death, e.g., tuberculosis. 

The vital event statistics in this publication are for the 3-year (calendar ye

1989-1991, as compared to 1987-1989 for the previous edition in 

8
p

through the use of three ICD-9 cause of death code groups; 291-alcoholic psychoses;

303-alcohol dependence syndrome and; 571.0-571.3-alcoholic liver disease. Various

IHS Area statisticians and epidemiologists believed this definition to be incomplete

and suggested that it be expanded to include five additional ICD-9 code categories.

These "new" categories were used for the first time in the 1993 edition. They include;

305.0-alcohol overdose; 425.5-alcoholic cardiomyopathy; 535.3-alcoholic gastritis;

790.3-elevated blood-alcohol level; and E860.0, E860.1-accidental poisoning by

alcohol, not elsewhere classified. This expanded definition results in about a 25

percent increase in the number of alcoholism deaths identified in comparison to

the previous 3-group definition. This expanded definition of alcoholism deaths is

now used in all IHS publications, including Trends in Indian Health.

There is also a change in this edition regarding the treatment of deaths related to

injuries and poisonings. In prior editions, mortality data were shown separately for

three of the causes (i.e., accidents, suicide, and homicide) that comprise the injuries

and poisonings group. Commencing with this edition, mortality data are now also

shown for the composite group, "deaths due to injury and poisoning" (ICD-9 codes

E800-E999) and the other causes that comprise this composite group. The same

treatment will be used in the companion document, Trends in Indian Health. The

following titles and codes are used for this purpose.

(new) Deaths due to injury and poisoning (E800-E999)

Accidental deaths (E800-E949)

Motor vehicle accidents (E810-E825)

Other accidents (E800-E807, E826-E949)

Suicide (E950-E959)

Homicide (E960-E978)

(new) Injury undetermined whether accidently or purposely inflicted

(E980-E989)

(new) Injury resulting from operations of war (E990-E999)

Patient Care Statistics

Patient care statistics are derived from IHS reporting systems. There are four main

patient care reporting systems. The Monthly Inpatient Services Report is a patient

census report which is prepared by each IHS hospital. It indicates the number of

discharges and days by type of service (e.g., adult, pediatric, obstetric, newborn),

and is used for the direct inpatient workload statistics. The Inpatient Care System

is the source of IHS hospital inpatient data pertaining to various patient

characteristics (age, sex, principal diagnoses, other diagnoses, community of

9
The Dental Data System is the source for dental services data. Th

monitored by IHS Headquarters Dental personnel. The tuberculosis dat

on cases reported to the Centers for Disease Control.

10
year by 365.

Birth Weight — Weight of fetus or infant at time of delivery (recorded in pounds

and ounces, or grams).

Cause of Death — For the purpose of national mortality statistics, every death is

attributed to one underlying condition, based on information reported on the death

certificate and utilizing the international rules for selecting the underlying cause of

death from the reported conditions.

Contract Care — Services not available directly from IHS or Tribes that are

purchased under contract from community hospitals and practitioners.

Health Center — A facility, physically separated from a hospital, with a full range

of ambulatory services including at least primary care physicians, nursing, pharmacy,

laboratory, and x-ray, which are available at least 40 hours a week for outpatient

care.

Health Station — A facility, physically separated from a hospital or health center

where primary care physician services are available on a regularly scheduled basis

but for less than 40 hours a week.

Infant Mortality — Death of live-born children who have not reached their first

birthday expressed as a rate (i.e., the number of infant deaths during a year per

1,000 live births reported in the year).

Life Expectancy — The average number of years remaining to a person at a

particular age and is based on a given set of age-specific death rates, generally the

mortality conditions existing in the period mentioned.

Live Birth — A live birth is the complete expulsion or extraction from its mother

of a product of conception irrespective of the duration of pregnancy, which after

such separation, breathes or shows any other evidence of life, such as beating of the

heart, pulsation of the umbilical cord, or definite movement of voluntary muscles.

Low Birth Weight -—Birth weight of less than five pounds, eight ounces or 2500 grams.

Neonatal Mortality Rate — The number of deaths under 28 days of age per 1,000

live births.

Occurrence — Place where the event occurred.

Postneonatal Mortality Rate — The number of deaths that occur from 28 days to

365 days after birth per 1,000 live births.

Race — On death certificates, race is usually recorded by the funeral director who

may or not query the family members of the decedent. The race of a newborn does

11
Service Unit — The local administrative unit of IHS.

User Population — American Indians and Alaska Natives who have 

services at least once during the last 3-year period.

Years of Productive Life Lost (YPLL) — A mortality indicator which m

burden of premature deaths. It is calculated by subtracting the age at 

age 65 and summing the result over all deaths.

12
pppyy

 Barbara A. Moore, Statistical Assistant

Patient Care Statistics:

 Stephen F. Kaufman, Chief, Patient Care Statistics Branch

 Marilyn J. Tulsa, Statistician

 Bonnie M. Matheson, Computer Assistant

Copies of this and other Division publications may be obtained from Priscilla

Sandoval or Monique E. Alston, Division Secretaries. 

The Division address and phone number are as follows:

 Indian Health Service

 Office of Planning, Evaluation, and Legislation

 Division of Program Statistics

 Twinbrook Metro Plaza

 12300 Twinbrook Parkway, Suite 450

 Rockville, Maryland 20852

 Phone: (301)443–1180

 Fax: (301)443–1522

13
14
responsibilities extend to all

or parts of 34 States known

as Reservation States.

Chart 1.2

Number of Service Units and

Facilities 

Operated by IHS and Tribes, Oct. 1, 1993

I

ndian Health Service

operated 41 hospitals, 66

health centers, 4 school

health centers, and 44 health

stations as of October 1,

1993. Tribes operated 8

hospitals, 110 health centers,

4 school health centers, 62

health stations, and 171

Alaska village clinics as of

October 1, 1993.

Type of facility IHS Tribal

• Service Units 73 70

• Hospitals 41 8

• Outpatient Facilities 114 347

—Health Centers 66 110

—School Health Centers 4 4

—Health Stations 44 62

—Alaska Village Clinics — 171

.......................................................................................

15
as of October 1, 1993. Tribes

operated 3 health centers, 3

school health centers, and 8

health stations as of October

1, 1993.

Chart 1.4

Number of Service Units and

Facilities 

Operated by Alaska Area and Tribes, Oct. 1, 199

I

n the Alaska Area, Indian

Health Service operated 2

hospitals and 1 health center

as of October 1, 1993. Tribes

operated 5 hospitals, 13

health centers, and 171

village clinics as of October

1, 1993.

p

• Outpatient Facilities 15 

—Health Centers 8 

—School Health Centers 1 

—Health Stations 6 

Type of facility IHS Tr

• Service Units 2 

• Hospitals 2 

• Outpatient Facilities 1 

—Health Centers 1 

—School Health Centers — 

—Health Stations — 

—Village Clinics — 

........................................................................

16
as of October 1, 1993. Tribes

operated 3 health centers as

of October 1, 1993.

Chart 1.6

Number of Service Units and

Facilities

Operated by Bemidji Area and Tribes, Oct. 1, 1993

I

n the Bemidji Area, Indian

Health Service operated 2

hospitals, 2 health centers,

and 5 health stations as of

October 1, 1993. Tribes

operated 13 health centers

and 13 health stations as of

October 1, 1993.

p

• Outpatient Facilities 17 3

—Health Centers 9 3

—School Health Centers 1 —

—Health Stations 7 —

Type of facility IHS Tribal

• Service Units 3 10

• Hospitals 2 —

• Outpatient Facilities 7 26

—Health Centers 2 13

—School Health Centers — —

—Health Stations 5 13

.......................................................................................

17
operated 2 health centers

and 1 health station as of

October 1, 1993.

Chart 1.8

Number of Service Units and

Facilities 

Operated by California Area and Tribes, Oct. 1, 

I

n the California Area,

Indian Health Service did

not operate any facilities as

of October 1, 1993. Tribes

operated 32 health centers

and 17 health stations as of

October 1, 1993.

p

• Outpatient Facilities 11 

—Health Centers 7 

—School Health Centers — 

—Health Stations 4 

Type of facility IHS Tr

• Service Units — 

• Hospitals — 

• Outpatient Facilities — 

—Health Centers — 

—School Health Centers — 

—Health Stations — 

........................................................................

18
hospital, 14 health centers, 1

school health center, and 4

health stations as of October

1, 1993.

Chart 1.10

Number of Service Units and

Facilities 

Operated by Navajo Area and Tribes, Oct. 1, 1993

I

n the Navajo Area, Indian

Health Service operated 6

hospitals, 8 health centers, 1

school health center, and 12

health stations as of October

1, 1993. There were no

Tribally-operated facilities as

of October 1, 1993.

p

• Outpatient Facilities 1 19

—Health Centers — 14

—School Health Centers — 1

—Health Stations 1 4

Type of facility IHS Tribal

• Service Units 8 —

• Hospitals 6 —

• Outpatient Facilities 21 —

—Health Centers 8 —

—School Health Centers 1 —

—Health Stations 12 —

.......................................................................................

19
hospitals and 16 health

centers as of October 1, 1993.

Chart 1.12

Number of Service Units and

Facilities 

Operated by Phoenix Area and Tribes, Oct. 1, 19

I

n the Phoenix Area,

Indian Health Service

operated 8 hospitals, 6 health

centers, 1 school health

center, and 7 health stations

as of October 1, 1993. Tribes

operated 5 health centers

and 4 health stations as of

October 1, 1993.

p

• Outpatient Facilities 12 

—Health Centers 12 

—School Health Centers — 

—Health Stations — 

Type of facility IHS Tr

• Service Units 9 

• Hospitals 8 

• Outpatient Facilities 14 

—Health Centers 6 

—School Health Centers 1 

—Health Stations 7 

........................................................................

20
operated 8 health centers

and 15 health stations as of

October 1, 1993.

Chart 1.14

Number of Service Units and

Facilities 

Operated by Tucson Area and Tribes, Oct. 1, 1993

I

n the Tucson Area, Indian

Health Service operated 1

hospital, 2 health centers,

and 1 health station as of

October 1, 1993. There was 1

Tribally-operated health

center as of October 1, 1993.

p

• Outpatient Facilities 12 23

—Health Centers 11 8

—School Health Centers — —

—Health Stations 1 15

Type of facility IHS Tribal

• Service Units 2 —

• Hospitals 1 —

• Outpatient Facilities 3 1

—Health Centers 2 1

—School Health Centers — —

—Health Stations 1 —

.......................................................................................

21
22
of the user population was

concentrated in 2 IHS Areas,

Oklahoma and Navajo.

Chart 2.2

Percent of Females in User

Population, FY 1992

There was a slightly higher

percentage of females in

1992 in the IHS user

population and the U.S. All

Races population. Oklahoma

had the highest percentage

of females at 53.6.

j

Billings

Portland

Albuquerque

Alaska

Aberdeen

Phoenix

Navajo

Oklahoma

0 100,000 200,000 300,000

58,854

59,324

70,553

74,064

87,225

103,615

111,765

226,754

246,750

User Population

Billings

Bemidji

Nashville

Aberdeen

Portland

Navajo

Alaska

Albuquerque

Phoenix

California

Tucson

Oklahoma

45 46 47 48 49 50 51 52 53 54

U.S. All Races = 51.2%

50.3

51.2

51.5

51.5

52.0

52.2

52.4

53.0

53.0

53.1

53.3

53.6

IHS Total = 52.5%

Percent

.......................................................................................

23
population under age 5 (10.9),

still had a percentage that was

nearly 1.5 times the U.S. All

Races percentage (7.4).

Chart 2.4

Percent of User Population O

Age 64, FY 1992

12.6 percent of the U.S. All

Races population was over

age 64 in 1992, compared to

5.5 for the IHS user

population. Oklahoma and

Nashville had the highest

percentages for this age group.

Billings

Tucson

Aberdeen

Navajo

Phoenix

Alaska

0 2 4 6 8 10 12 14 

12.5

12.6

13

Percent

Phoenix

Billings

Aberdeen

Tucson

Portland

Albuquerque

Navajo

Alaska

California

Bemidji

Nashville

Oklahoma

0 2 4 6 8 10 12 

U.S. All Races 

4.0

4.5

4.6

4.8

4.8

5.1

5.4

5.6

5.8

6.0

6.5

7.1

IHS Total = 5.5%

Percent

........................................................................

24
school graduates or higher

compared to 75.2 percent for

the U.S. All Races

population. Tucson, Navajo,

and Phoenix had percentages

less than 60.0.

Chart 2.6

Percent Bachelor’s Degree or

Higher, Age 25 and Older

1990 Census State-Level Indian Data

The 1990 Census

indicated that 9.0

percent of Indians, age 25

and older, residing in the

current Reservation States

have a bachelor’s degree or

higher. This is well below the

percentage for the U.S All

Races population of 20.3.

The Area percentages ranged

from 4.1 in Alaska to 11.4 in

Oklahoma.

Nashville

Alaska

Aberdeen

Billings

Bemidji

Oklahoma

California

Portland

0 20 40 60 80

61.2

63.1

64.4

67.6

68.1

69.2

71.4

71.5

Percent

Alaska

Tucson

Navajo

Phoenix

Albuquerque

Bemidji

Billings

Aberdeen

Portland

Nashville

California

Oklahoma

0 4 8 12 16 20

4.1

IHS Total = 9.0 U.S. All Races = 20.3

4.6

5.2

6.3

7.0

7.1

7.6

7.8

8.6

10.5

11.1

11.4

Percent

.0 .0 .0 .0 .0 .0

.......................................................................................

25
percent for the U.S All Races

male population. Billings,

Alaska, Aberdeen, and Tucson

had unemployment rates

greater than 25.0 percent.

Chart 2.8

Percent of Females Unemplo

Age 16 and Older

1990 Census State-Level Indian Data

I

n 1990, 13.5 percent of

Indian females, age 16 and

older, residing in the current

Reservation States were

unemployed compared to 6.2

percent for the U.S. All

Races female population.

The Area unemployment

rates ranged from 10.4 in

California to 21.0 in Billings.

edj

Albuquerque

Phoenix

Navajo

Tucson

Aberdeen

Alaska

Billings

0 10 20 

20.0

21.0

23.5

25.2

2

Percent

California

Nashville

Oklahoma

Portland

Bemidji

Albuquerque

Alaska

Phoenix

Navajo

Aberdeen

Tucson

Billings

0 5 10 15 20 

U.S. All Races = 6.

IHS Total = 13.5

10.4

10.6

11.3

13.3

14.8

15.8

16.1

17.4

18.6

19.4

20.2

21

Percent

........................................................................

26
was $19,886. This is

two-thirds of the U.S. All

Races figure for 1989 of

$30,056. Aberdeen, Tucson,

Navajo, and Billings had

median household incomes

that were less than half the

U.S. figure.

Chart 2.10

Percent of Population Below

Poverty Level

1990 Census State-Level Indian data

The 1990 Census indicated

that 31.6 percent of

Indians residing in the current

Reservation States were below

the poverty level. This is 2.4

times the comparable U.S. All

Races figure of 13.1. Aberdeen,

Navajo, Billings, Albuquerque,

and Phoenix had percentages

exceeding 40.0.

Phoenix

Bemidji

Oklahoma

Portland

Nashville

Alaska

California

0 10,000 20,000 30,000

16,392

18,851

19,750

21,123

21,265

24,216

28,029

Dollars

Alaska

California

Tucson

Nashville

Oklahoma

Portland

Bemidji

Phoenix

Albuquerque

Billings

Navajo

Aberdeen

0 10 20 30 40 50

U.S. All Races = 13.1 IHS Total = 31.6

24.0

24.0

24.0

24.7

27.0

29.2

33.7

41.8

44.6

46.8

49.6

42.1

Percent

.......................................................................................

27
28
T

service area population

in 1989-1991 was 1.7 times

the rate for the U.S. All

Races population in 1990,

i.e., 28.1 compared to 16.7.

Even the IHS Area with the

lowest birth rate (Nashville,

21.9) had a rate considerably

greater than the U.S. rate (31

percent greater).

Table 3.1

Number and Rate of Live Births

Calendar Years 1989–1991

Number Rate 1

U.S. All Races (1990) 4,158,212 16.7

All IHS Areas 101,780 28.1

Aberdeen 8,222 35.8

Alaska 9,176 35.4

Albuquerque 5,659 28.1

Bemidji 5,433 29.6

Billings 4,716 33.4

California 7,231 23.1

Nashville 3,313 21.9

Navajo 17,788 32.6

Oklahoma 17,956 22.9

Phoenix 10,241 28.4

Portland 10,278 26.9

Tucson 1,767 24.0

1

 Rate per 1,000 population.

Oklahoma

California

Tucson

Portland

Albuquerque

Phoenix

Bemidji

Navajo

Billings

Alaska

Aberdeen

0 10 20 30 40

Rate per 1,000 Population

22.9

23.1

24.0

26.9

28.1

28.4

29.6

32.6

33.4

35.4

35.8

.......................................................................................

29
aces popuato, .e., 7.0

percent in 1990. All IHS

Areas had relatively fewer low

weight births than occurred

in the general population.

Table 3.2

Births of Low Weight as a Per

of Total Live Births

Calendar Years 1989–1991

Total live births 1

Number low

weight 2

U.S. All Races (1990) 4,158,212 289,418 

All IHS Areas 101,780 5,897 

Aberdeen 8,222 467 

Alaska 9,176 487 

Albuquerque 5,659 347 

Bemidji 5,433 282 

Billings 4,716 261 

California 7,231 464 

Nashville 3,313 198 

Navajo 17,788 1,116 

Oklahoma 17,956 1,002 

Phoenix 10,241 579 

Portland 10,278 583 

Tucson 1,767 111 

1

 Includes 5,304 U.S. All Races live births and 202 American Indian/Alaska Native live birt

not stated.

2

 Births of less than 2,500 grams.

3

 Percent low weight based on live births with a birth weight reported.

Phoenix

Portland

Nashville

Albuquerque

Navajo

Tucson

California

0246

Percent of Total Births

5.7

5.7

6.0

6.1

6.3

6.3

6.4

........................................................................

30
compared to 75.8 percent for

the U.S. All Races population

in 1990. The percentages

varied widely among IHS

Areas, ranging from 47.2 for

Navajo to 73.1 for Alaska.

Table 3.3

Live Births With Prenatal Care

Beginning in First Trimester

Calendar Years 1989–1991

Total live

births 1

Live births with

trimester prenatal

care began reported

Live births with prenatal care

beginning in the first trimester 2

Number Percent

U.S. All Races (1990) 4,158,212 4,068,409 3,084,950 75.8

All IHS Areas 101,780 99,226 58,166 58.6

Aberdeen 8,222 8,122 4,992 61.5

Alaska 9,176 9,008 6,581 73.1

Albuquerque 5,659 5,257 2,692 51.2

Bemidji 5,433 5,285 3,249 61.5

Billings 4,716 4,685 2,898 61.9

California 7,231 7,179 4,537 63.2

Nashville 3,313 3,251 2,299 70.7

Navajo 17,788 17,494 8,257 47.2

Oklahoma 17,956 17,407 10,407 59.8

Phoenix 10,241 9,926 5,118 51.6

Portland 10,278 9,859 6,126 62.1

Tucson 1,767 1,753 1,010 57.6

1

 Includes 89,803 U.S. All Races live births and 2,554 American Indian/Alaska Native live births for which

trimester of pregnancy that prenatal care began was not reported on the State birth certificate.

2

 Percent based on live births with this information reported.

Aberdeen

Bemidji

Billings

Portland

California

Nashville

Alaska

0 20 40 60 80

Percent of Total Live Births

61.5

61.5

61.9

62.1

63.2

70.7

73.1

With Trimester Prenatal Care Began Reported

.......................................................................................

31
taateadeat.

1

1

1

2

5

Bemidji

Oklahoma

Phoenix

Aberdeen

Navajo

024

Number of Deaths

32
excluded, the rate is 12.0.

This is 30 percent higher

than the U.S. All Races rate

of 9.2 for 1990. The

Aberdeen and Billings Areas

had the highest rates, 17.5

and 16.1, respectively.

Table 3.5

Infant Mortality Rates 

(Under 1 Year)

Calendar Years 1989–1991

Live births Infant deaths Rate 1

U.S. All Races (1990) 4,158,212 38,351 9.2

All IHS Areas 101,780 1,038 10.2

9* Areas 2 66,315 797 12.0

Aberdeen* 8,222 144 17.5

Alaska* 9,176 130 14.2

Albuquerque* 5,659 45 8.0

Bemidji* 5,433 51 9.4

Billings* 4,716 76 16.1

California 7,231 35 4.8

Nashville* 3,313 43 13.0

Navajo* 17,788 168 9.4

Oklahoma 17,956 92 5.1

Phoenix* 10,241 114 11.1

Portland 10,278 114 11.1

Tucson* 1,767 26 14.7

1

 Rate per 1,000 live births.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

Portland

* Nashville

* Alaska

* Tucson

* Billings

* Aberdeen

0 5 10 15 20

Rate per 1,000 Live Births

13.0

11.1

14.2

16.1

17.5

14.7

.......................................................................................

33
odaace odeat

certificates are excluded, the

rate is 5.6. This is still less

than the U.S. All Races rate

of 5.8 for 1990. The

Aberdeen Area had the

highest rate at 8.0.

Table 3.6

Neonatal Mortality Rates 

(Under 28 Days)

Calendar Years 1989–1991

Live births Infant deaths 

U.S. All Races (1990) 4,158,212 24,309 

All IHS Areas 101,780 475 

9* Areas 2 66,315 369 

Aberdeen* 8,222 66 

Alaska* 9,176 49 

Albuquerque* 5,659 21 

Bemidji* 5,433 17 

Billings* 4,716 36 

California 7,231 16 

Nashville* 3,313 26 

Navajo* 17,788 83 

Oklahoma 17,956 42 

Phoenix* 10,241 59 

Portland 10,278 48 

Tucson* 1,767 12 

1

 Rate per 1,000 live births.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

 Navajo

* Alaska

* Phoenix

* Tucson

* Billings

* Nashville

* Aberdeen

0246

Rate per 1,000 Live Births

4.7

5.3

5.8

7.

........................................................................

34
pg 

race on death certificates are

excluded, the rate is 6.5. This

is 1.9 times the U.S. All Races

rate of 3.4 for 1990. The

Aberdeen and Alaska Areas

had the highest rates, 9.5 and

8.8, respectively.

Table 3.7

Postneonatal Mortality Rates 

(28 Days to Under 1 Year)

Calendar Years 1989–1991

Live births Infant deaths Rate 1

U.S. All Races (1990) 4,158,212 14,042 3.4

All IHS Areas 101,780 563 5.5

9* Areas 2 66,315 428 6.5

Aberdeen* 8,222 78 9.5

Alaska* 9,176 81 8.8

Albuquerque* 5,659 24 4.2

Bemidji* 5,433 34 6.3

Billings* 4,716 40 8.5

California 7,231 19 2.6

Nashville* 3,313 17 5.1

Navajo* 17,788 85 4.8

Oklahoma 17,956 50 2.8

Phoenix* 10,241 55 5.4

Portland 10,278 66 6.4

Tucson* 1,767 14 7.9

1

 Rate per 1,000 live births.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

* Bemidji

Portland

* Tucson

* Billings

* Alaska

* Aberdeen

0 2 4 6 8 10

Rate per 1,000 Live Births

6.3

6.4

7.9

8.5

8.8

9.5

.......................................................................................

35
.8 pecet.

Chart 3.9

Leading Causes of Infant Dea

U.S. All Races, 1990

I

n 1990, 21.5 percent of all

infant deaths in the U.S.

were caused by congenital

anomalies. This was followed

by sudden infant death

syndrome at 14.1 percent.

4.2

4

Respiratory Distress

Syndrome

Disorders Related to

Short Gest. & Low

Birthweight

0 10 20 

Percent of Total Infant Deaths

4.0

21.5

14.1

10.5

7.4

4.3

Congenital Anomalies

Sudden Infant

Death Syndrome

Disorders Related to

Short Gest. & Low

Birthweight

Respiratory Distress

Syndrome

Newborn Affected by

Maternal Complications

0 10 20 

Percent of Total Infant Deaths

of Pregnancy

........................................................................

36
p

Chart 3.11

Leading Causes of Infant Deaths

Alaska Area, Calendar Years 1989–1991

I

n 1989-1991, 25.4 percent

of all infant deaths in the

Alaska Area were caused by

sudden infant death

syndrome. This was followed

by congenital anomalies at

14.6 percent.

4.9

4.9

g

Pneumonia & Influenza

Homicide

0 10 20 30

Percent of Total Infant Deaths

25.4

14.6

7.7

4.6

3.8

Sudden Infant

Death Syndrome

Congenital Anomalies

Accidents & Adverse

Effects

Pneumonia & Influenza

Meningitis

0 10 20 30

Percent of Total Infant Deaths

.......................................................................................

37
aoaes at .pecet.

Chart 3.13

Leading Causes of Infant Dea

Bemidji Area, Calendar Years 1989–1991

I

n 1989-1991, 31.4 percent

of all infant deaths in the

Bemidji Area were caused by

congenital anomalies. This

was followed by sudden

infant death syndrome at

27.5 percent.

31.4

27.5

7.8

3.9

3.9

Congenital Anomalies

Sudden Infant

Death Syndrome

Accidents & Adverse

Effects

Respiratory Distress

Syndrome

Meningitis

0 10 20 30 

Percent of Total Infant Deaths

4.4

4.4

Infections Specific to

Perinatal Period

Respiratory Distress

Syndrome

0 10 20 

Percent of Total Infant Deaths

........................................................................

38
p

Chart 3.15

Leading Causes of Infant Deaths

California Area, Calendar Years 1989–1991

I

n 1989-1991, 37.1 percent

of all infant deaths in the

California Area were caused

by sudden infant death

syndrome. This was followed

by congenital anomalies at

17.1 percent.

37.1

17.1

8.6

2.9

2.9

Sudden Infant

Death Syndrome

Congenital Anomalies

Disorders Related to

Short Gest. & Low

Birthweight

Pneumonia & Influenza

Infections Specific to

Perinatal Period

0 10 20 30 40

Percent of Total Infant Deaths

5.3

5.3

Infections Specific to

Perinatal Period

Newborn Affected by

Complications of

Placenta, etc

0 10 20 30

Percent of Total Infant Deaths

.......................................................................................

39
.6 pecet.

Chart 3.17

Leading Causes of Infant Dea

Navajo Area, Calendar Years 1989–1991

I

n 1989-1991, 30.4 percent

of all infant deaths in the

Navajo Area were caused by

congenital anomalies. This

was followed by sudden

infant death syndrome at

12.5 percent.

Newborn Affected by

Complications of

Placenta, etc

Newborn Affected by

Maternal Complications

 

0 10 20 30 

Percent of Total Infant Deaths

7.0

7.0

of Pregnancy

30.4

12.5

8.9

7.7

5.4

Congenital Anomalies

Sudden Infant

Death Syndrome

Accidents &

Adverse Effects

Respiratoy Distress

Syndrome

Disorders Related

to Short Gest. &

Low Birthweight

0 10 20 30 

Percent of Total Infant Deaths

........................................................................

40
p

Chart 3.19 

Leading Causes of Infant Deaths

Phoenix Area, Calendar Years 1989–1991

I

n 1989-1991, 23.7 percent

of all infant deaths in the

Phoenix Area were caused by

congenital anomalies. This

was followed by sudden

infant death syndrome at

18.4 percent.

5.4

2.2

Accidents &

Adverse Effects

Pneumonia & Influenza

0 10 20 30 40

Percent of Total Infant Deaths

23.7

18.4

7.9

4.4

3.5

Congenital Anomalies

Sudden Infant

Death Syndrome

Accidents &

Adverse Effects

Disorders Related

to Short Gest. &

Low Birthweight

Pneumonia & Influenza

0 10 20 30

Percent of Total Infant Deaths

.......................................................................................

41
7.5 pecet.

Chart 3.21

Leading Causes of Infant Dea

Tucson Area, Calendar Years 1989–1991

I

n 1989-1991, 26.9 percent

of all infant deaths in the

Tucson Area were caused by

sudden infant death

syndrome. This was followed

by congenital anomalies at

23.1 percent.

4.4

3.5

Newborn Affected by

Complications of

Placenta, etc

Pneumonia & Influenza

0 10 20 30 

Percent of Total Infant Deaths

23.

7.7

7.7

3.8

Sudden Infant

Death Syndrome

Congenital Anomalies

Accidents &

Adverse Effects

Disorders Related

to Short Gest. &

Low Birthweight

Pneumonia & Influenza

0 10 20 

Percent of Total Infant Deaths

........................................................................

42
, p

When the 3 IHS Areas with

apparent problems in

underreporting of Indian race

on death certificates are

excluded, the IHS rate in this

instance is only slightly higher

(260.9) because of the problem

with SlDS in the Portland Area.

In the Portland Area, 39.5

percent of infant deaths were

because of SlDS.

Table 3.22

Sudden Infant Death Syndrome Rates

Calendar Years 1989–1991

Infant deaths Live births Rate 1

U.S. All Races (1990) 5,417 4,158,212 130.3

All IHS Areas 259 101,780 254.5

9* Areas 2 173 66,315 260.9

Aberdeen* 43 8,222 523.0

Alaska* 33 9,176 359.6

Albuquerque* 12 5,659 212.1

Bemidji* 14 5,433 257.7

Billings* 17 4,716 360.5

California 13 7,231 179.8

Nashville* 5 3,313 150.9

Navajo* 21 17,788 118.1

Oklahoma 28 17,956 155.9

Phoenix* 21 10,241 205.1

Portland 45 10,278 437.8

Tucson* 7 1,767 396.2

1

 Rate per 100,000 live births.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

 Phoenix

* Albuquerque

* Bemidji

* Alaska

* Billings

* Tucson

Portland

* Aberdeen

0 200 400 600

05

212.1

257.7

359.6

360.5

396.2

437.8

523.0

.......................................................................................

43
44
area population was 585.2.

When the 3 IHS Areas with

apparent problems in

underreporting of Indian race

on death certificates are

excluded, the rate is 713.9.

This is 37 percent higher than

the U.S. All Races rate of

520.2 for 1990. The Aberdeen

rate (1,067.2) was more than

double the U.S. rate.

Table 4.1

Age-Adjusted Mortality Rates

(All Causes)

Calendar Years 1989–1991

Total deaths Rate 1

U.S. All Races (1990) 2,148,463 520.2

All IHS Areas 19,084 585.2

9* Areas 2 12,924 713.9

Aberdeen* 1,891 1,067.2

Alaska* 1,702 771.8

Albuquerque* 979 540.5

Bemidji* 1,198 789.9

Billings* 997 892.8

California 897 310.7

Nashville* 809 553.7

Navajo* 3,009 620.8

Oklahoma 3,400 395.4

Phoenix* 1,849 655.8

Portland 1,863 599.3

Tucson* 490 799.0

1

 Rate per 100,000 population.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

 Albuquerque

* Nashville

Portland

* Navajo

* Phoenix

* Alaska

* Tucson

* Bemidji

* Billings

* Aberdeen

0 500 1,000 1,500

Rate per 100,000 Population

540.5

553.7

599.3

620.8

655.8

771.8

779.0

789.9

892.8

1,067.2

.......................................................................................

45
apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 109.2.

This is nearly double the U.S.

All Races rate of 56.2 for

1990. Each of the remaining

9 IHS Areas had a rate

greater than the U.S. All

Races rate.

Table 4.2

Years of Productive Life Lost

(YPLL) Rates (All Causes)

Calendar Years 1989–1991

Number of 

YPLL 1 

U.S. All Races (1990) 12,237,379 

All IHS Areas 296,436 

9* Areas 3 222,548 

Aberdeen* 32,099 

Alaska* 34,336 

Albuquerque* 16,555 

Bemidji* 15,305 

Billings* 17,875 

California 12,390 

Nashville* 10,608 

Navajo* 54,797 

Oklahoma 31,992 

Phoenix* 33,144 

Portland 29,506 

Tucson* 7,829 

1

 Years of Productive Life Lost (YPLL) is a mortality indicator which measures the bu

deaths. It is calculated by subtracting the age at death from age 65 and summing the res

2

 Rate per 1,000 population under 65 years of age.

3

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

 Albuquerque

* Bemidji

* Phoenix

* Navajo

* Tucson

* Billings

* Alaska

* Aberdeen

0 50 100 

Rate per 1,000 Population Under 65 Years of Age

87.0

96.0

106.0

112.6

13

88.0

........................................................................

46
p

Chart 4.4

Leading Causes of Death

U.S. All Races, Calendar Year 1990

I

n 1990, 33.5 percent of all

deaths in the U.S. were

caused by diseases of the

heart. This was followed by

malignant neoplasms at 23.5

percent.

4.5

4.5

Diabetes Mellitus

Chronic Liver Dis.

& Cirrhosis

0 10 20 30

Percent of Total Deaths

Diseases of the Heart

Malignant Neoplasms

Cerebrovascular

Diseases

Accidents &

Adverse Effects

Chronic Obstructive

Pulmonary Diseases

0 10 20 30 40

Percent of Total Deaths

4.0

4.3

6.7

23.5

33.5

.......................................................................................

47
Chart 4.6

Leading Causes of Death

Alaska Area, Calendar Years 1989–1991

I

n 1989-1991, 21.2 percent

of all deaths in the Alaska

Area were caused by

accidents and adverse effects.

This was followed by diseases

of the heart at 17.3 percent.

5.9

4.8

Chronic Liver Dis.

& Cirrhosis

Diabetes Mellitus

0 10 20 

Percent of Total Deaths

Accidents &

Adverse Effects

Diseases of the Heart

Malignant Neoplasms

Suicide

Pneumonia & Influenza

0 10 20 

Percent of Total Deaths

3.8

5.1

16.0

17.3

21.2

........................................................................

48
p

Chart 4.8

Leading Causes of Death

Bemidji Area, Calendar Years 1989–1991

I

n 1989-1991, 26.2 percent

of all deaths in the Bemidji

Area were caused by diseases

of the heart. This was

followed by malignant

neoplasms at 18.6 percent.

6.2

5.6

Chronic Liver Dis.

& Cirrhosis

Diabetes Mellitus

0 10 20

Percent of Total Deaths

26.2

18.6

11.9

5.8

4.8

Diseases of the Heart

Malignant Neoplasms

Accidents &

Adverse Effects

Diabetes Mellitus

Cerebrovascular

Diseases

0 10 20 30

Percent of Total Deaths

.......................................................................................

49
pecet.

Chart 4.10

Leading Causes of Death

California Area, Calendar Years 1989–1991

I

n 1989-1991, 24.4 percent

of all deaths in the

California Area were caused

by diseases of the heart. This

was followed by malignant

neoplasms at 14.6 percent.

Chronic Liver Dis.

& Cirrhosis

Diabetes Mellitus

0 10 

Percent of Total Deaths

5.3

5.9

Diseases of the Heart

Malignant Neoplasms

Accidents &

Adverse Effects

Cerebrovascular

Diseases

Chronic Liver Dis.

& Cirrhosis

0 10 20 

Percent of Total Deaths

5.0

6.0

14.3

14.6

24.4

........................................................................

50
Chart 4.12

Leading Causes of Death

Navajo Area, Calendar Years 1989–1991

I

n 1989–1991, 24.0 percent

of all deaths in the Navajo

Area were caused by

accidents and adverse effects.

This was followed by diseases

of the heart at 15.2 percent.

5.4

4.3

Cerebrovascular

Diseases

Diabetes Mellitus

0 10 20 30

Percent of Total Deaths

24

15.2

11.3

5.6

4.1

Accidents &

Adverse Effects

Diseases of the Heart

Malignant Neoplasms

Pneumonia & Influenza

Chronic Liver Dis.

& Cirrhosis

0 10 20 30

Percent of Total Deaths

24.0

.......................................................................................

51
Chart 4.14

Leading Causes of Death

Phoenix Area, Calendar Years 1989–1991

I

n 1989-1991, 17.5 percent

of all deaths in the

Phoenix Area were caused by

diseases of the heart. This

was followed by accidents

and adverse effects at 16.8

percent.

Cerebrovascular

Diseases

Diabetes Mellitus

0 10 20 30 

Percent of Total Deaths

5.0

5.5

17

16.8

10.2

7.7

6.5

Diseases of the Heart

Accidents &

Adverse Effects

Malignant Neoplasms

Diabetes Mellitus

Chronic Liver Dis.

& Cirrhosis

0 10 

Percent of Total Deaths

........................................................................

52
Chart 4.16

Leading Causes of Death

Tucson Area, Calendar Years 1989–1991

I

n 1989-1991, 14.7 percent

of all deaths in the Tucson

Area were caused by diseases

of the heart. This was

followed by accidents and

adverse effects at 14.1

percent.

5.7

5.3

Chronic Liver Dis.

& Cirrhosis

Cerebrovascular

Diseases

0 10 20 30

Percent of Total Deaths

14.7

14.1

10

7.8

7.1

Diseases of the Heart

Accidents &

Adverse Effects

Malignant Neoplasms

Chronic Liver Dis.

& Cirrhosis

Diabetes Mellitus

0 10 20

Percent of Total Deaths

10.0

.......................................................................................

53
wtappaet pobes 

underreporting of Indian race

on death certificates are

excluded, the rate is 159.3. This

is nearly 3 times the U.S. All

Races rate of 55.1 for 1990.

Three Areas (Alaska, Navajo,

and Aberdeen) had rates

exceeding 180.0.

Table 4.17

Age-Adjusted Injury and

Poisoning1

 Mortality Rates

Calendar Years 1989-1991

Deaths 2 

U.S. All Races (1990) 150,211 

All IHS Areas 4,109 

9* Areas 4 3,150 

Aberdeen* 363 

Alaska* 499 

Albuquerque* 249 

Bemidji* 197 

Billings* 227 

California 188 

Nashville* 127 

Navajo* 923 

Oklahoma 398 

Phoenix* 457 

Portland 377 

Tucson* 108 

1

 Includes the following ICD-9 cause of death groups combined: Motor vehicle accidents

accidents-E800-E807, E826-E949. Suicide-E950-E959. Homicide-E960-E978. Injury und

accidentally or purposely inflicted-E980-E989. Injury resulting from operations of war-E9

2

 Incudes deaths with age not reported. For IHS, includes Albuquerque-1 death, Oklah

Phoenix-1 death.

3

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

4

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

* Albuquerque

* Phoenix

* Tucson

* Billings

* Aberdeen

* Navajo

* Alaska

0 50 100 150 200 

Rate per 100,000 Population

125.1

133.5

164.3

174.8

183.2

191.0

203.6

........................................................................

54
death certificates are excluded, the

rate is 116.9. This is 216 percent

higher than the U.S. All Races rate

of 37.0 for 1990. The Navajo Area

had the highest rate (149.6) which

was mainly attributable to motor

vehicle accidents. For the IHS

service area, 23.1 percent of the

motor vehicle accidents were

pedestrian-related compared to 15.4

percent for the U.S. All Races

population.

 Phoenix

* Tucson

* Billings

* Aberdeen

* Alaska

* Navajo

0 50 100 150

Rate per 100,000 Population

92.5

107.4

126.8

133.1

147.5

149.6

.......................................................................................

Table 4.18

Age-Adjusted Accident Mortality Rates

Calendar Years 1989–1991

Motor vehicle accidents

Pedestrian-related 1

All accidents Totals

Percent of motor

vehicle accident Other accidents

Deaths Rate 2 Deaths Rate 2 Deaths deaths Deaths Rate 2

U.S. All Races (1990) 91,983 37.0 46,814 18.8 7,205 15.4% 45,169 18.2

All IHS Areas 2,925 86.0 1,642 48.3 380 23.1% 1,283 37.6

9* Areas 2 2,292 116.9 1,277 64.9 316 24.7% 1,015 52.0

Aberdeen* 258 133.1 153 77.8 25 16.3% 105 55.3

Alaska* 360 147.5 68 28.8 20 29.4% 292 118.7

Albuquerque* 165 84.2 110 55.6 39 35.5% 55 28.6

Bemidji* 142 84.8 78 48.5 12 15.4% 64 36.3

Billings* 164 126.8 108 83.2 15 13.9% 56 43.6

California 128 42.0 76 24.5 14 18.4% 52 17.5

Nashville* 102 68.8 60 40.6 15 25.0% 42 28.2

Navajo* 722 149.6 454 93.2 134 29.5% 268 56.4

Oklahoma 258 33.4 150 20.0 24 16.0% 108 13.5

Phoenix* 310 92.5 203 59.0 43 21.2% 107 33.5

Portland 247 66.8 139 37.7 26 18.7% 108 29.2

Tucson* 69 107.4 43 64.5 13 30.2% 26 42.9

1

 Includes motor vehicle accidents having ICD-9 codes E810-E825 with a fourth digit code .7. The fourth digit code .7 indicates that a pedestrian was the subject

decedent as a result of the motor vehicle accident.

2

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths should be interpreted with caution.

3

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a problem with underreporting of Indian race on death certificates.

Therefore a separate IHS rate was calculated excluding these 3 Areas.

55
with apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 21.3.

This is 85 percent higher

than the U.S. All Races rate

of 11.5 for 1990. Three Areas

(Alaska, Billings, and

Aberdeen) had rates more

than double the U.S. rate.

Table 4.19

Age-Adjusted Suicide Mortalit

Rates

Calendar Years 1989–1991

Deaths 

U.S. All Races (1990) 30,906 

All IHS Areas 571 

9* Areas 2 432 

Aberdeen* 55 

Alaska* 87 

Albuquerque* 47 

Bemidji* 22 

Billings* 35 

California 28 

Nashville* 11 

Navajo* 91 

Oklahoma 54 

Phoenix* 69 

Portland 57 

Tucson* 15 

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

Portland

* Navajo

* Phoenix

* Tucson

* Albuquerque

* Aberdeen

* Billings

* Alaska

0 10 20 30 

Rate per 100,000 Population

15.1

18.8

18.9

21.1

22.7

26.9

27.8

34.

........................................................................

56
with apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 18.4.

This is 80 percent higher

than the U.S. All Races rate

of 10.2 for 1990. The Tucson

Area rate of 35.7 was 3.5

times the U.S. rate.

Table 4.20

Age-Adjusted Homicide Mortality

Rates

Calendar Years 1989–1991

Deaths Rate 1

U.S. All Races (1990) 24,932 10.2

All IHS Areas 529 15.3

9* Areas 2 369 18.4

Aberdeen* 44 20.3

Alaska* 43 17.5

Albuquerque* 33 16.5

Bemidji* 25 15.7

Billings* 24 17.7

California 28 8.7

Nashville* 11 7.8

Navajo* 96 19.6

Oklahoma 78 10.6

Phoenix* 69 19.6

Portland 54 14.6

Tucson* 24 35.7

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths should be interpreted

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

* Bemidji

* Albuquerque

* Alaska

* Billings

* Navajo

* Phoenix

* Aberdeen

* Tucson

0 10 20 30 40

Rate per 100,000 Population

15.7

16.5

17.5

17.7

19.6

19.6

20.3

35.7

.......................................................................................

57
injury and poisoning deaths due

to other causes was 4.8. When the

3 IHS Areas with apparent

problems in underreporting of

Indian race on death certificates

are excluded, the rate is 5.4. This

is 6 times the U.S. All Races rate

of 0.9 for 1990. The Area rates

should be interpreted with

caution because of the small

number of deaths involved.

* Albuquerque

* Nashville

* Billings

* Phoenix

* Aberdeen

* Navajo

* Alaska

* Bemidji

Portland

0 2 4 6 8 10 

Rate per 100,000 Population

3.2

3.8

4.7

4.9

5.6

5.8

8.0

8.6

1

........................................................................

Table 4.21

Age-Adjusted Mortality Rates 

Injury and Poisoning Deaths 

Other Causes 1

Calendar Years 1989–1991

Deaths 

U.S. All Races (1990) 2,390 

All IHS Areas 85 

9* Areas 3 56 

Aberdeen* 6 

Alaska* 9 

Albuquerque* 4 

Bemidji* 8 

Billings* 4 

California 4 

Nashville* 3 

Navajo* 14 

Oklahoma 6 

Phoenix* 8 

Portland 19 

Tucson* — 

1

 Includes the following ICD-9 cause of death groups combined: Injury undetermined w

or purposely inflicted-E980-E989. Injury resulting from operations of war-E990-E999. (The

due to this cause for the U.S. All Races during 1990 and 0 deaths for the American Indian 

population in the IHS service area, 1989-1991.)

2

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

3

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

58
with apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 51.8.

This is 630 percent higher

than the U.S. All Races rate

of 7.1 for 1990. The

Aberdeen Area rate of 95.6

was 13.5 times the U.S. rate.

Table 4.22

Age-Adjusted Alcoholism Mortality

Rates

Calendar Years 1989–1991

All causes

Number of deaths and ICD-9 cause of death group

Rate 1 291 303 305.0 425.5 535.3

571.0–

571.3 790.3

E860.0–

E860.1

U.S. All Races (1990) 19,587 433 5,226 788 860 85 12,000 15 180 7.1

All IHS Areas 1,079 22 290 90 21 6 627 5 18 37.6

9* Areas 2 838 15 233 77 14 3 475 5 16 51.8

Aberdeen* 145 3 38 10 1 — 91 — 2 95.6

Alaska* 89 2 14 24 3 1 39 5 1 43.2

Albuquerque* 82 4 21 6 1 — 50 — — 53.3

Bemidji* 43 1 10 3 1 — 25 — 3 30.6

Billings* 64 1 14 1 1 — 47 — — 61.7

California 51 — 13 2 1 1 34 — — 20.0

Nashville* 29 — 9 1 1 1 16 — 1 22.4

Navajo* 222 3 85 27 5 1 94 — 7 53.7

Oklahoma 64 2 14 2 2 2 41 — 1 9.3

Phoenix* 133 1 33 4 1 — 92 — 2 50.6

Portland 126 5 30 9 4 — 77 — 1 41.0

Tucson* 31 — 9 1 — — 21 — — 52.2

1

 Age-adjusted rate per 100,000 population. The rate computation excludes 3 deaths with age not reported. Rates based on a small number of deaths should be

interpreted with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a problem with underreporting of Indian race on death certificates.

Therefore a separate IHS rate was calculated excluding these 3 Areas.

291—Alcoholic Psychoses; 303—Alcoholic Dependence Syndrome; 305.0—Alcohol Overdose; 425.5—Alcoholic Cardiomyopathy; 535.3—Alcoholic Gastritis;

571.0–571.3—Alcoholic Liver Disease; 790.3—Elevated Blood-Alcohol Level; E860.0, E860.1—Accidental Poisoning by Alcohol, not elsewhere classified.

* Alaska

* Phoenix

* Tucson

* Albuquerque

* Navajo

* Billings

* Aberdeen

0 20 40 60 80 100

Rate per 100,000 Population

43.2

50.6

52.2

53.3

53.7

61.7

95.6

.......................................................................................

59
underreporting of Indian race

on death certificates are

excluded, the rate is 38.8. This

is 232 percent higher than the

U.S. All Races rate of 11.7 for

1990. All of the IHS Areas had

a rate greater than the U.S. rate

with the exception of Alaska

and California (however the

California rate is low because of

Indian race reporting problems).

Table 4.23

Age-Adjusted Diabetes Mellitu

Mortality Rates

Calendar Years 1989–1991

Deaths 

U.S. All Races (1990) 47,664 

All IHS Areas 861 

9* Areas 2 600 

Aberdeen* 90 

Alaska* 19 

Albuquerque* 55 

Bemidji* 69 

Billings* 53 

California 27 

Nashville* 35 

Navajo* 102 

Oklahoma 171 

Phoenix* 142 

Portland 63 

Tucson* 35 

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

j

* Nashville

* Albuquerque

* Bemidji

* Billings

* Aberdeen

* Phoenix

* Tucson

0 20 40 60 

Rate per 100,000 Population

25.7

27.9

37.3

50.0

55.5

57.0

60.3

61.7

........................................................................

60
with apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 3.4. This

is nearly 7 times the U.S. All

Races rate of 0.5 for 1990.

The Area rates should be

interpreted with caution

because of the small number

of deaths involved. The

Navajo and Oklahoma Areas

had the most deaths over the

3-year period, both with 18.

Table 4.24

Age-Adjusted Tuberculosis

Mortality Rates

Calendar Years 1989–1991

Deaths Rate 1

U.S. All Races (1990) 1,810 0.5

All IHS Areas 82 2.7

9* Areas 2 57 3.4

Aberdeen* 12 7.8

Alaska* 6 2.9

Albuquerque* 3 2.1

Bemidji* 1 0.8

Billings* 5 4.0

California 1 0.3

Nashville* 1 0.9

Navajo* 18 3.8

Oklahoma 18 2.3

Phoenix* 8 3.5

Portland 6 2.2

Tucson* 3 4.4 1

 Rate per 100,000 population. Rates based on a small number of deaths should be interpreted with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

Oklahoma

* Alaska

* Phoenix

* Navajo

* Billings

* Tucson

* Aberdeen

02468

Rate per 100,000 Population

2.3

2.9

3.5

3.8

4.0

4.4

7.8

.......................................................................................

61
problems in underreporting of

Indian race on death certificates

are excluded, the rate is 1.3. This

is the same as the U.S. All Races

rate for 1990. The Area rates

should be interpreted with

caution because of the small

number of deaths involved. The

Navajo and Oklahoma Areas had

the most deaths over the 3-year

period, both with 8.

Table 4.25

Age-Adjusted Gastrointestinal

Diseases Mortality Rates

Calendar Years 1989–1991

Deaths 

U.S. All Races (1990) 6,007 

All IHS Areas 44 

9* Areas 2 29 

Aberdeen* 1 

Alaska* 2 

Albuquerque* 3 

Bemidji* 2 

Billings* 3 

California 1 

Nashville* 3 

Navajo* 8 

Oklahoma 8 

Phoenix* 6 

Portland 6 

Tucson* 1 

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

 Bemidji

* Nashville

* Navajo

* Phoenix

*Tucson

Portland

* Billings

012

Rate per 100,000 Population

1.7

1.7

1.9

2.1

2.3

2

........................................................................

62
Areas with apparent problems

in underreporting of Indian

race on death certificates are

excluded, the rate is 142.8.

This is 6 percent less than the

U.S. All Races rate of 152.0 for

1990. The Albuquerque and

Navajo Area rates are well

below the U.S. rate.

Table 4.26

Age-Adjusted Diseases of the

Heart Mortality Rates

Calendar Years 1989–1991

Deaths Rate 1

U.S. All Races (1990) 720,058 152.0

All IHS Areas 4,171 132.1

9* Areas 2 2,414 142.8

Aberdeen* 406 249.0

Alaska* 295 148.0

Albuquerque* 150 88.0

Bemidji* 314 216.7

Billings* 183 183.2

California 219 78.7

Nashville* 216 142.2

Navajo* 456 97.4

Oklahoma 1,105 123.3

Phoenix* 322 126.9

Portland 433 151.5

Tucson* 72 117.5

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths should be interpreted

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

* Phoenix

* Nashville

* Alaska

Portland

* Billings

* Bemidji

* Aberdeen

0 50 100 150 200 250

Rate per 100,000 Population

126.9

142.2

148.0

151.5

183.2

249.0

216.7

.......................................................................................

63
Areas with apparent problems

in underreporting of Indian

race on death certificates are

excluded, the rate is 28.5. This

is slightly higher than the U.S.

All Races rate of 27.7 for 1990.

The Aberdeen Area rate of

45.2 was 2.4 times the Navajo

Area rate of 19.2.

Table 4.27

Age-Adjusted Cerebrovascular

Diseases Mortality Rates

Calendar Years 1989–1991

Deaths 

U.S. All Races (1990) 144,088 

All IHS Areas 839 

9* Areas 2 499 

Aberdeen* 78 

Alaska* 63 

Albuquerque* 40 

Bemidji* 58 

Billings* 40 

California 54 

Nashville* 44 

Navajo* 90 

Oklahoma 188 

Phoenix* 67 

Portland 98 

Tucson* 19 

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths sh

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

* Nashville

* Alaska

Portland

* Tucson

* Bemidji

* Billings

* Aberdeen

0 10 20 30 40 

Rate per 100,000 Female Population

29.8

31.6

33.9

33.9

36.9

38.5

4

........................................................................

64
the 3 IHS Areas with

apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 111.2.

This is 18 percent less than

the U.S. All Races rate of

135.0 for 1990. However, the

Aberdeen, Bemidji, Billings,

and Alaska Areas had rates

greater than the U.S. rate.

Table 4.28

Age-Adjusted Malignant Neoplasm

Mortality Rates

Calendar Years 1989–1991

Deaths Rate 1

U.S. All Races (1990) 505,322 135.0

All IHS Areas 2,793 94.5

9* Areas 2 1,770 111.2

Aberdeen* 262 164.3

Alaska* 273 144.5

Albuquerque* 136 86.9

Bemidji* 223 162.8

Billings* 150 153.1

California 131 49.4

Nashville* 150 111.5

Navajo* 339 79.3

Oklahoma 644 78.5

Phoenix* 188 77.9

Portland 248 90.1

Tucson* 49 83.2

1

 Age-adjusted rate per 100,000 population. Rates based on a small number of deaths should be interpreted

with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

* Albuquerque

Portland

* Nashville

* Alaska

* Billings

* Bemidji

* Aberdeen

0 50 100 150 200

Rate per 100,000 Population

86.9

90.1

111.5

144.5

153.1

162.8

164.3

.......................................................................................

65
the 3 IHS Areas with

apparent problems in

underreporting of Indian

race on death certificates are

excluded, the rate is 12.9.

This is 44 percent less than

the U.S. All Races rate of

23.1 for 1990. The Billings

Area rate of 21.9 approached

the U.S. rate.

Table 4.29

Age-Adjusted Breast Cancer

Mortality Rates For Females

Calendar Years 1989–1991

Total deaths 

U.S. All Races (1990) 43,391 

All IHS Areas 180 

9* Areas 2 108 

Aberdeen* 18 

Alaska* 16 

Albuquerque* 6 

Bemidji* 10 

Billings* 11 

California 12 

Nashville* 15 

Navajo* 15 

Oklahoma 40 

Phoenix* 15 

Portland 20 

Tucson* 2 

1

 Age-adjusted rate per 100,000 female population. Rates based on a small number o

interpreted with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) 

problem with underreporting of Indian race on death certificates. Therefore a separate IHS 

excluding these 3 Areas.

* Phoenix

Portland

* Bemidji

* Alaska

* Aberdeen

* Nashville

* Billings

0 10 20 

Rate per 100,000 Female 

Population

11.0

12.8

13.2

17.7

19.9

20.5

21.9

........................................................................

66
in underreporting of Indian race

on death certificates are excluded,

the rate is 6.7. This is 2.4 times the

U.S. All Races rate of 2.8 for 1990.

The Area rates should be

interpreted with caution because of

the small number of deaths

involved. Navajo (23) was the only

Area with more than 20 deaths over

the 3-year period.

Table 4.30

Age-Adjusted Cervical Cancer

Mortality Rates For Females

Calendar Years 1989–1991

Total deaths Rate 1

U.S. All Races (1990) 4,627 2.8

All IHS Areas 92 6.0

9* Areas 2 58 6.7

Aberdeen* 9 10.8

Alaska* 5 4.3

Albuquerque* 5 5.8

Bemidji* 4 5.7

Billings* 4 7.8

California 3 2.0

Nashville* 2 3.0

Navajo* 23 10.4

Oklahoma 18 5.1

Phoenix* 4 2.8

Portland 13 8.4

Tucson* 2 5.7

1

 Age-adjusted rate per 100,000 female population. Rates based on a small number of deaths should be

interpreted with caution.

2

 The 3 IHS Areas that do not have an asterisk (California, Oklahoma, and Portland) appear to have a

problem with underreporting of Indian race on death certificates. Therefore a separate IHS rate was calculated

excluding these 3 Areas.

* Bemidji

* Tucson

* Albuquerque

* Billings

Portland

* Navajo

* Aberdeen

0 3 6 9 12

Rate per 100,000 Female 

Population

5.7

5.7

5.8

7.8

8.4

10.4

10.8

.......................................................................................

67
apparent problems in

underreporting of Indian race

on death certificates are

excluded, the life expectancy is

70.2 years. This is 5.2 years less

than the 1990 figure of 75.4 for

the U.S. All Races population.

Most Areas had figures less

than the U.S. figure.

Chart 4.32

Life Expectancy at Birth, Mal

Calendar Years 1989–1991

I

n 1989-1991, the life

expectancy at birth for

males in the IHS service area

population was 69.1 years.

When the 3 IHS Areas with

apparent problems in

underreporting of Indian

race on death certificates are

excluded, the life expectancy

is 66.0 years. This is 5.8 years

less than the 1990 figure of

71.8 years for the U.S. All

Races male population. Most

Areas had figures less than

the U.S. figure.

* Aberdeen

* Billings

* Alaska

* Bemidji

* Tucson

* Navajo

* Phoenix

* Albuquerque

Portland

* Nashville

Oklahoma

California

0 20 40 60 

Years

IHS Total - All Areas = 69.1

IHS Total - 9 * Areas = 66.0

59.2

63.

63.

65.

66.9

67.

68.

70.

70.

70.

7

U.S. All Races (1990) = 71.8

* Bemidji

* Phoenix

* Navajo

Portland

* Nashville

* Albuquerque

Oklahoma

California

0 20 40 60 80 

Years

69.3

71.5

72.1

72.9

73.7

74.3

79.5

82.2

........................................................................

68
pg 

race on death certificates are

excluded, the life expectancy

is 74.7 years. This is 4.1 years

less than the 1990 figure of

78.8 years for the U.S. All

Races female population.

Most Areas had figures less

than the U.S. figure.

* Phoenix

Portland

* Nashville

* Navajo

* Albuquerque

Oklahoma

California

0 20 40 60 80 100

Years

75.5

75.9

76.6

77.7

78.5

83.4

85.0

69
70
Over 38 percent of these

admissions were in 2 IHS

Areas, Navajo (20,147) and

Oklahoma (15,581).

Chart 5.2

Hospital Admission Rates, 

FY 1992

The IHS admission rate of

811.1 admissions per

10,000 population in FY 1992

was 34 percent lower than

the U.S. rate of 1,221.0 in CY

1992. The IHS Area rates

ranged from 163.1 in

California, where the IHS

provides little inpatient care,

to 1,476.3 in Alaska.

2,888

5,959

6,146

11,287

11,636

12,877

15,581

20,147

Bemidji

Billings

Albuquerque

Aberdeen

Phoenix

Alaska

Oklahoma

Navajo

0 5,000 10,000 15,000 20,000

IHS and Tribal Direct and Contract General Hospitals

California

Portland

Tucson

Bemidji

Oklahoma

Albuquerque

Nashville

Navajo

Billings

Phoenix

Aberdeen

Alaska

0 500 1,000 1,500

IHS and Tribal Direct and Contract General Hospitals

Hospital Admissions per 10,000 User Population

163.1

291.4

466.0

490.7

IHS Total = 811.1

U.S. = 1,221.0

631.4

829.8

840.6

888.5

1,004.5

1,089.3

1,041.1

1,476.3

......................................................................................

71
Aberdeen 1,089.3 11,287 7,875 3,151 — 

Alaska 1,476.3 12,877 5,381 321 5,90

Albuquerque 829.8 6,146 4,862 1,284 — 

Bemidji 490.7 2,888 1,045 426 — 

Billings 1,004.5 5,959 3,162 2,797 — 

California 163.1 946 — — — 

Nashville 840.6 2,872 965 182 1,08

Navajo 888.5 20,147 18,122 2,025 — 

Oklahoma 631.4 15,581 10,135 3,147 2,03

Phoenix 1,041.1 11,636 9,826 1,750 — 

Portland 291.4 2,056 — 1,565 — 

Tucson 466.0 876 619 257 — 

1

 Number of admissions per 10,000 population.

2

 Number of admissions in thousands.

Sources: IHS Direct: Monthly Report of Inpatient Services

Sources: IHS Contract: Contract Statistical System (Report 3I)

Sources: Tribal Direct: Monthly Report of Inpatient Services

Sources: Tribal Contract: IHS Area submissions

Sources: U.S.: Unpublished Data, NCHS Hospital Discharge Survey Branch

72
in Navajo.

Table 5.3

Number of Hospital Days

Indian Health Service and Tribal Direct and Contract

General Hospitals, FY 1992

Total

days

IHS days Tribal days

Direct Contract Direct Contract

All Areas 422,679 277,447 81,889 40,986 22,357

Aberdeen 48,820 32,434 15,396 — 990

Alaska 70,552 37,928 1,540 26,834 4,250

Albuquerque 27,403 21,846 5,557 — —

Bemidji 10,353 3,312 1,700 — 5,341

Billings 22,894 10,861 12,033 — —

California 4,026 — — — 4,026

Nashville 15,800 6,172 811 4,998 3,819

Navajo 82,721 72,098 10,623 — —

Oklahoma 66,997 38,774 17,474 9,154 1,595

Phoenix 58,805 50,000 8,698 — 107

Portland 8,902 — 6,673 — 2,229

Tucson 5,406 4,022 1,384 — —

Sources: IHS Direct: Monthly Report of Inpatient Services

Sources: IHS Contract: Contract Statistical System (Report 3I)

Sources: Tribal Direct: Monthly Report of Inpatient Services

Sources: Tribal Contract: IHS Area Submissions 

58,805

66,997

70,552

82,721

Phoenix

Oklahoma

Alaska

Navajo

0 20,000 40,000 60,000 80,000 100,000

IHS and Tribal Direct and Contract General Hospitals

......................................................................................

73
ad te puepeu. s was

followed by respiratory system

diseases at 13.0 percent.

Chart 5.5

Leading Causes of Hospitaliz

Aberdeen Area, FY 1992

For the Aberdeen Area in

FY 1992, 15.4 percent of

all discharges from IHS and

Tribal direct and contract

general hospitals pertained to

obstetric deliveries and

complications of pregnancy

and the puerperium. This was

followed by respiratory system

diseases at 14.9 percent.

10.4

6.1

Injuries & Poisonings

Symptoms, Signs, &

III-Def. Conditions

0 5 10 15 20 

Percent of Total Discharges

IHS and Tribal Direct and Contract General Hospitals

15.4

14.9

12

10.6

6.7

Obstetric Deliveries

& Complications of

Pregnancy

Respiratory System

Diseases

Injuries & Poisonings

Digestive System

Diseases

Symptoms, Signs, &

III-Def. Conditions

0 5 10 15 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

12.0

........................................................................

74
ppgy

and the puerperium. This was

followed by respiratory system

diseases at 13.3 percent.

Chart 5.7 

Leading Causes of Hospitalization

Albuquerque Area, FY 1992

For the Albuquerque Area

in FY 1992, 16.0 percent

of all discharges from IHS

and Tribal direct and

contract general hospitals

pertained to obstetric

deliveries and complications

of pregnancy and the

puerperium. This was

followed by digestive system

diseases at 12.0 percent.

9

4

Digestive System

Diseases

Diseases of the

Musculoskeletal Sys.

& Connective

0 5 10 15 20 25

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

9.0

4.0

Tissue

16

12

11.1

11.1

8

Obstetric Deliveries

& Complications of

Pregnancy

Digestive System

Diseases

Respiratory System

Diseases

Injuries & Poisonings

Mental Disorders

0 5 10 15 20

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

8.0

16.0

12.0

......................................................................................

75
s was oowed by

respiratory system diseases at

13.9 percent.

Chart 5.9 

Leading Causes of Hospitaliz

Billings Area, FY 1992

For the Billings Area in FY

1992, 14.6 percent of all

discharges from IHS and

Tribal direct and contract

general hospitals pertained to

respiratory system diseases.

This was followed by injuries

and poisonings at 13.1 percent.

10.7

10.6

Symptoms, Signs, &

III-Def. Conditions

Digestive System

Diseases

0 5 10 15 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospit

12

11.7

8.2

Respiratory System

Diseases

Injuries & Poisonings

Digestive System

Diseases

Obstetric Deliveries

& Complications of

Pregnancy

Symptoms, Signs, &

III-Def. Conditions

0 5 10 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

........................................................................

76
Chart 5.11 

Leading Causes of Hospitalization

Nashville Area, FY 1992

For the Nashville Area in

FY 1992, 10.8 percent of

all discharges from IHS and

Tribal direct and contract

general hospitals pertained to

circulatory system diseases.

This was followed by mental

disorders at 10.4 percent.

0 5 10 15 20

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

10.8

10.4

10.3

9.9

8.8

Circulatory System

Diseases

Mental Disorders

Symptoms, Sings, &

III-Def. Conditions

Respiratory System

Diseases

Endocrine, Nutritional

& Metabolic Disorders

0 5 10 15

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

......................................................................................

77
copcatos opegacy

and the puerperium. This was

followed by respiratory system

diseases at 14.4 percent.

Chart 5.13 

Leading Causes of Hospitaliz

Oklahoma Area, FY 1992

For the Oklahoma Area in

FY 1992, 30.2 percent of

all discharges from IHS and

Tribal direct and contract

general hospitals pertained to

obstetric deliveries and

complications of pregnancy

and the puerperium. This was

followed by circulatory system

diseases at 11.9 percent.

9.9

5.5

Injuries & Poisonings

Genitourinary System

Diseases

0 5 10 15 20 25 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospita

30

11.9

11

9.5

6.1

Obstetric Deliveries

& Complications of

Pregnancy

Circulatory System

Diseases 

Digestive System

Diseases

Respiratory System

Diseases

Genitourinary System

Diseases

0 5 10 15 20 25 30 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospital

11.0

........................................................................

78
ppgy

and puerperium. This was

followed by respiratory system

diseases at 14.2 percent.

Chart 5.15 

Leading Causes of Hospitalization

Portland Area, FY 1992

For the Portland Area in

FY 1992, 16.7 percent of

all discharges from IHS and

Tribal contract general

hospitals pertained to

digestive system diseases. This

was followed by injuries and

poisonings at 13.3 percent.

9.2

6.7

Injuries & Poisonings

Endocrine, Nutritional

& Metabolic Disorders

0 5 10 15 20

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

16.7

13.3

11.4

11.2

11

Digestive System

Diseases

Injuries & Poisonings

Obstetric Deliveries

& Complications of

Pregnancy

Circulatory System

Diseases

Respiratory System

Diseases

0 5 10 15 20

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospitals

11.0

......................................................................................

79
s was oowed by jues

and poisonings at 11.6 percent.

10.2

9.5

Digestive System

Diseases

Obstetric Deliveries

& Complications of

Pregnancy

0 5 10 

Percent of Area Total Discharges

IHS and Tribal Direct and Contract General Hospita

80
Oklahoma (1,013,286) and

Navajo (859,617).

Table 5.17

Number of Outpatient Visits

Indian Health Service and Tribal Direct and Contract

Facilities, FY 1992

Total 

Indian health service Tribal

Direct Contract Direct Contract

All Areas 5,659,820 3,924,484 167,697 1,407,421 160,218

Aberdeen 597,160 523,209 16,000 55,717 2,234

Alaska 522,063 190,616 905 288,072 42,470

Albuquerque 370,454 340,080 9,115 21,259 —

Bemidji 369,535 127,007 4,085 209,545 28,898

Billings 372,376 342,627 29,749 — —

California 290,504 — — 240,142 50,362

Nashville 239,872 67,978 1,269 160,635 9,990

Navajo 859,617 821,596 38,021 — —

Oklahoma 1,013,286 694,087 20,248 294,407 4,544

Phoenix 569,036 501,041 15,383 49,761 2,851

Portland 383,050 251,052 32,138 81,661 18,199

Tucson 72,867 65,191 784 6,222 670

Sources: IHS Direct: APC Data System (Report 1A)

Sources: IHS Contract: Contract Statistical Data System (Report 3G)

Sources: Tribal Direct and Contract: Area Submissions

Alaska

Phoenix

Aberdeen

Navajo

Oklahoma

0 2 4 6 8 10 12

IHS and Tribal Direct and Contract Facilities

859,617

522,063

569,036

597,160

1,013,286

Scale in One Hundred Thousands

......................................................................................

81
This was followed by diseases

of the respiratory system at

12.1 percent.

Chart 5.19

Leading Causes of Outpatien

Visits

Aberdeen Area, FY 1992

For the Aberdeen Area in

FY 1992, 23.6 percent of

all clinical impressions in IHS

and Tribal direct and contract

facilities pertained to

supplementary classifications.

This was followed by diseases

of the respiratory system at

12.4 percent.

10.7

5.6

5.5

Nervous Sys. & Sense

Organ Diseases

Endocrine, Nutritional

& Metabolic Disorders

Complication of Preg.

& Childbirth

0 5 10 15 

Percent of Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

12.4

8.1

7.8

5.1

Supplementary

Classifications

Diseases of the

Respiratory System

Symptoms, Signs, &

III-Def. Conditions

Nervous Sys. & Sense

Organ Diseases

Diseases of the Skin &

Subcutaneous Tissue

0 5 10 15 20 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

........................................................................

82
to supplementary

classifications. This was

followed by nervous system

and sense organ diseases at

11.2 percent.

Chart 5.21

Leading Causes of Outpatient

Visits

Albuquerque Area, FY 1992

For the Albuquerque Area

in FY 1992, 18.1 percent

of all clinical impressions in

IHS and Tribal direct and

contract facilities pertained

to supplementary

classifications. This was

followed by nervous system

and sense organ diseases at

12.1 percent.

9.7

7.6

7.4

Diseases of the

Respiratory System

Complication of Preg.

& Childbirth

Symptoms, Signs, &

III-Def. Conditions

0 5 10 15 20

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

18.1

12.1

11.3

6.5

5.7

Supplementary

Classifications

Nervous Sys. & Sense

Organ Diseases

Diseases of the

Respiratory System

Complication of Preg.

& Childbirth

Endocrine, Nutritional

& Metabolic Disorders

0 5 10 15 20

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

......................................................................................

83
supplementary classifications.

This was followed by diseases

of the respiratory system at

12.1 percent.

Chart 5.23

Leading Causes of Outpatien

Visits

Billings Area, FY 1992

For the Billings Area in FY

1992, 13.2 percent of all

clinical impressions in IHS

and Tribal direct and contract

facilities pertained to

supplementary classifications.

This was followed by diseases

of the respiratory system at

11.1 percent.

9.8

7

7

Nervous Sys. & Sense

Organ Diseases

Diseases of the

Circulatory System

Endocrine, Nutritional

& Metabolic Disorders

0 5 10 15 20 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

7.0

7.0

11.1

9.9

6.7

5.7

Supplementary

Classifications

Diseases of the

Respiratory System

Nervous Sys. & Sense

Organ Diseases

Injury & Poisoning

Symptoms, Signs, &

III-Def. Conditions

0 5 10 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

........................................................................

84
supplementary classifications.

This was followed by diseases

of the respiratory system at

14.2 percent.

Chart 5.25

Leading Causes of Outpatient

Visits

Nashville Area, FY 1992

For the Nashville Area in FY

1992, 29.6 percent of all

clinical impressions in IHS

and Tribal direct and contract

facilities pertained to

supplementary classifications.

This was followed by diseases

of the respiratory system at

10.2 percent.

8.5

8.5

7.2

Endocrine, Nutritional

& Metabolic Disorders

Nervous Sys. & Sense

Organ Diseases

Mental Disorders

0 5 10 15

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

29.6

10.2

7.2

6.8

4.8

Supplementary

Classifications

Diseases of the

Respiratory System

Nervous Sys. & Sense

Organ Diseases

Endocrine, Nutritional

& Metabolic Disorders

Diseases of the

Circulatory System

0 10 20 30

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

......................................................................................

85
to supplementary

classifications. This was

followed by nervous system

and sense organ diseases at

13.0 percent.

Chart 5.27

Leading Causes of Outpatien

Visits

Oklahoma Area, FY 1992

For the Oklahoma Area in

FY 1992, 13.9 percent of

all clinical impressions in

IHS and Tribal direct and

contract facilities pertained

to supplementary

classifications. This was

followed by diseases of the

respiratory system at 12.6

percent.

12.6

8.5

5.8

Diseases of the

Respiratory System

Complications of Preg.

& Childbirth

Injury & Poisoning

0 5 10 15 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

12.

11

7.7

6.7

Supplementary

Classifications

Diseases of the

Respiratory System

Nervous Sys. & Sense

Organ Diseases

Diseases of the

Circulatory System

Endocrine, Nutritional

& Metabolic Disorders

0 5 10 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

11.0

........................................................................

86
to supplementary

classifications. This was

followed by nervous system

and sense organ diseases at

12.6 percent.

Chart 5.29

Leading Causes of Outpatient

Visits

Portland Area, FY 1992

For the Portland Area in FY

1992, 20.1 percent of all

clinical impressions in IHS

and Tribal direct and contract

facilities pertained to

supplementary classifications.

This was followed by diseases

of the respiratory system at

13.6 percent.

12.2

6.8

6.1

Diseases of the

Respiratory System

Endocrine, Nutritional

& Metabolic Disorders

Injury & Poisoning

0 5 10 15 20

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

20.1

13.6

8.6

5.6

5.4

Supplementary

Classifications

Diseases of the

Respiratory System

Nervous Sys. & Sense

Organ Diseases

Diseases of the

Musculoskeletal Sys.

& Connective 

Diseases of the Skin &

Subcutaneous Tissue

0 5 10 15 20 25

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

Tissue

......................................................................................

87
to supplementary

classifications. This was

followed by nervous system

and sense organ diseases at

10.0 percent.

9.6

8.9

8.4

Endocrine, Nutritional

& Metabolic Disorders

Symptoms, Signs, &

III-Def. Conditions

Diseases of the

Respiratory System

0 5 10 

Percent of Area Total Clinical Impressions

IHS and Tribal Direct and Contract Facilities

88
dental services, Oklahoma

(489,697) and Navajo

(409,747).

Table 5.31

Number of Dental Services

Provided

Indian Health Service and Tribal Direct and Contract

Facilities, FY 1993

Total IHS direct IHS contract Tribal direct Tribal contract

Patients Services Patients Services Patients Services Patients Services Patients Services

All IHS Areas 382,303 2,593,799 250,231 1,730,753 17,924 97,897 108,552 734,411 5,596 30,738

Aberdeen 37,810 234,168 29,796 185,149 1,942 11,361 5,269 33,423 803 4,235

Alaska 39,647 245,285 9,665 70,211 90 2,159 29,892 172,915 — —

Albuquerque 24,667 174,378 22,749 153,854 9 21 1,909 20,503 — —

Bemidji 21,408 148,553 6,687 43,202 1,015 9,018 12,614 89,555 1,092 6,778

Billings 24,776 166,046 24,346 163,953 430 2,093 — — — —

California 21,849 176,049 — — — — 21,596 174,937 253 1,112

Nashville 14,232 94,274 3,285 23,179 25 168 9,896 64,781 1,026 6,146

Navajo 63,215 409,747 57,261 388,182 5,954 21,565 — — — —

Oklahoma 66,695 489,697 47,577 355,493 904 21,974 17,254 105,219 960 7,011

Phoenix 33,298 236,978 28,182 207,961 1,299 3,756 3,801 25,156 16 106

Portland 27,075 181,238 15,672 110,082 3,636 17,884 6,321 47,922 1,446 5,350

Tucson 7,631 37,385 5,011 29,487 2,620 7,898 — — — —

Source: IHS Dental Data Reporting System

Portland

Aberdeen

Phoenix

Alaska

Navajo

Oklahoma

012345

IHS and Tribal Direct and Contract Facilities

181,238

234,168

236,978

245,285

409,747

489,697

Scale in One Hundred Thousands

......................................................................................

89
Area rate (60.0) was almost 6

times the U.S. rate.

Table 5.32

Number and Rate of New

Tuberculosis Cases, CY 1991

Case rate 1 Number of cases

U.S. All Races 10.4 26,283

All IHS Areas 23.1 277

Aberdeen 41.0 33

Alaska 60.0 53

Albuquerque 10.4 7

Bemidji 8.0 5

Billings 22.9 11

California 5.3 5

Nashville 24.2 13

Navajo 28.4 53

Oklahoma 15.7 41

Phoenix 28.2 31

Portland 17.1 21

Tucson 17.8 4

1

 Number of new cases per 100,000 service population. Rates are based on a small

number of new cases and should be interpreted with caution.

Source: Centers for Disease Control (data by State and county)

Billings

Nashville

Phoenix

Navajo

Aberdeen

Alaska

0 20 40 

Number of New Cases per 100,000 Population

22.9

24.2

28.2

28.4

41.0

........................................................................

90