T R EN DS 

IN 

I N DI A N 

H E A LT H 

2014 EDITION
 

U.S. Depar tment of Health and Human Ser vices 

Indian Health Ser vice 

Office of Public Health Suppor t 

Division of Program Statistics 

indian health service

trends in indian health

2014 edition

Department of Health and Human Services

Sylvia Burwell

Secretary

Indian Health Service

Robert G. McSwain

Acting Director

Office of Public Health Support

CAPT Francis Frazier

Acting Director

Division of Program Statistics

Kirk Greenway, M.A., M.P.H.

Director

indian health service, u.s. department of health and human services iii

trends in indian health 2014 edition

preface

Since 1955, the Indian Health Service (IHS) has had the responsibility 

for upholding the Federal Government’s obligations to promote healthy 

American Indian and Alaska Native people, communities, and cultures, 

while honoring and protecting each Tribe’s inherent sovereign rights. 

The IHS mission is to raise the physical, mental, social, and spiritual 

health of American Indians and Alaska Natives to the highest level.

“Trends in Indian Health” provides narrative, tables, and charts that 

describe IHS programs and the health status of American Indians 

and Alaska Natives. The Report presents a structural overview of 

the Agency, along with demographic data on American Indians and 

Alaska Natives and patient care delivery services. Current and trend 

information are detailed and comparisons made to the U.S. population 

at large, where appropriate.

The IHS remains committed to our goal of assuring that comprehensive, 

culturally acceptable personal and public health services are available 

and accessible to American Indian and Alaska Native people. The data 

contained within this Report advances our ongoing efforts to achieve 

this vital health care goal.

/ Robert G. McSwain /

 Robert G. McSwain

 Acting Director
iv

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

acknowledgments

Overall production of Trends in Indian Health was managed by the Division of 

Program Statistics (DPS), Office of Public Health Support (OPHS), Indian Health 

Service (IHS) under the direction of Kirk Greenway, Director.

Production coordination was provided by Priscilla Sandoval.

Production was accomplished by the DPS staff: Kirk Greenway, JoAnn Glakas 

Pappalardo, Alan Friedman, Priscilla Sandoval and Jennifer Joseph.

Data were analyzed by the following Division of Program Statistics and IHS 

Headquarters Divisions staff:

Part I—Indian Health Structure: 

Kirk Greenway, Office of Resource Access and Partnerships (ORAP), 

National Laboratory Consultant and Office of Finance and Accounting.

Part II—Population Statistics: 

JoAnn Glakas Pappalardo; contractors Linda Querec and Debra Heller; 

Urban Indian Health Program.

Part III—Natality and Infant/Maternal Mortality Statistics: 

JoAnn Glakas Pappalardo

Part IV—General Mortality Statistics: 

JoAnn Glakas Pappalardo, Alan Friedman and contractor Debra A. Heller.

Part V—Patient Care Statistics: 

Kirk Greenway, Office of Direct Service Contracting Tribe, Office of Tribal 

Self Governance, Office of Management Support Division of Acquisitions, 

Division of Grants Management, Urban Indian Health Program, and Office 

of Clinical and Preventive Services (OCPS) Division of Oral Health.

Part VI—Community Health Statistics: 

JoAnn Glakas Pappalardo, Kirk Greenway, and OCPS, ORAP, Office of 

Engineering and Environmental Health Division of Sanitation and 

Facilities Construction.

Technical and editorial review was provided by Kirk Greenway, JoAnn Glakas 

Pappalardo, Alan Friedman and Priscilla Sandoval.

Graphics (charts and tables) were created and compiled by Priscilla Sandoval.

This report was designed and prepared for publication by National Institutes of 

Health, Medical Arts Branch.

We would also like to recognize the contributions of the staff of each of the IHS 

areas and express our appreciation to them for providing data and reviewing 

information contained in this publication. The report would not have been 

possible without the efforts of many dedicated individuals across all the IHS areas.
indian health service, u.s. department of health and human services v

trends in indian health 2014 edition

contents

Overview 1

Trends in Indian Health 3

Introduction 3

Scope and Organization of this Report 3

Summary of Data Shown 4

Indian Health Service Organizational Structure 4

Population Statistics 4

Natality and Infant/Maternal Mortality Statistics 5

General Mortality Statistics 5

Patient Care Statistics 6

Community Health Statistics 6

Sources and Limitations of Data 8

Population Statistics 8

IHS Service Population 8

Definition 8

Description of Service Population Calculation 8

Changes in Methodology 10

ICD-9 Conversion to ICD-10 10

2000 U.S. Census Populations with Bridged Race Categories (2000 Census Bridged File) 10

Age-Adjustment Based on the 2000 Standard Population 10

Vital Event Statistics 11

Patient Care Statistics 13

Community Health Statistics 13

Glossary 16

Sources of Copies and Additional Information 18

Part 1: Indian Health Service Structure

Chart 1.1 Indian Health Service 19

Chart 1.2 Indian Health Service Area Offices 19

Chart 1.3 American Indian and Alaska Native Tribal Governments 20

Chart 1.4 Indian Health Care Improvement Act, Title V Urban Health Services 20

Chart 1.5 Number of Facilities Operated by Indian Health Service and Tribes 

as of October 1, 2013 21

Chart 1.6 Trend in Indian Health Service Budget 21

Table 1.6 Trend in Indian Health Service Budget 22
vi

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Chart 1.7 Accreditation Status of Selected Health Facilities, July 2014 23

Table 1.7 Accreditation Status of Hospitals, Health Centers, and 

Youth Regional Treatment Centers, July 2014 23

Chart 1.8 Accreditation Status of IHS Laboratories, July 2014 24

Table 1.8 Indian Health Service Laboratory Accreditation Status, July 2014 24

Part 2: Population Statistics

Chart 2.1 American Indians and Alaska Native IHS Service Population 25

Chart 2.2 Indian Health Service—Service Population by Area, Calendar Year 2014 25

Table 2.1 IHS Service Population by Area, 2000-2020 26

Chart 2.3 Population by Age and Sex, 2000 Census with Bridged Race Categories 27

Table 2.3 Age and Sex Percent Distribution 28

Chart 2.4 Population by Age, 2000 Census with Bridged Race Categories 29

Table 2.4 Percent Age Distribution 29

Chart 2.5 Educational Attainment 30

Chart 2.6 Employment Status by Sex 30

Chart 2.7 Income Status in 1999 31

Table 2.5 Selected Economic Profiles for the United States, 2000 Census 31

Chart 2.8 Urban Indian Health Programs Service Area Population by Category 32

Table 2.8 Urban Indian Health Programs Service Area Population by Category 32

Part 3: Natality and Infant/Maternal Mortality Statistics

Chart 3.1 Birth Rates 33

Table 3.1 Number and Rate of Live Births 34

Chart 3.2 Low Birthweight (less than 2,500 grams) as a Percent of Total Live Births 

by Age of Mother 35

Table 3.2 Low Birthweight (less than 2,500 grams) by Age of Mother 36

Chart 3.3 High Birthweight (4,000 grams or more) as a Percent of Total Live Births 

by Age of Mother 37

Table 3.3 High Birthweight (4,000 grams or more) by Age of Mother 38

Chart 3.4 Birth Order by Age of Mother, Percent within Birth Order, American Indians 

and Alaska Natives 39

Chart 3.5 Birth Order by Age of Mother, Percent within Birth Order, U.S. All Races 39

Chart 3.6 Birth Order by Age of Mother, Percent within Birth Order, U.S. White 39

Table 3.4 Number and Percent Distribution of Live Births by Age of Mother 

within Birth Order 40

Chart 3.7 Maternal Death Rates 41

Table 3.7 Maternal Death Rates 42
indian health service, u.s. department of health and human services vii

trends in indian health 2014 edition

Chart 3.8 Infant Mortality Rates 43

Table 3.8 Infant Mortality Rates 44

Chart 3.9 Infant Mortality Rates by Age 45

Table 3.9 Infant Mortality Rates by Age 46

Chart 3.10 Leading Causes of Infant Deaths (Birth to Under 1 Year) 47

Chart 3.11 Leading Causes of Neonatal Deaths (Under 28 Days) 47

Chart 3.12 Leading Causes of Postneonatal Deaths (28 Days to Under 1 Year) 48

Table 3.10 Leading Causes of Infant Deaths by Age 49

Part 4: General Mortality Statistics

Chart 4.1 Death Rates, Leading Causes: Ages 1 to 4 Years 50

Table 4.1 Ten Leading Causes of Death for Decedents for 1 to 4 Years of Age 50

Chart 4.2 Death Rates, Leading Causes: Ages 5 to 14 Years 51

Table 4.2 Ten Leading Causes of Death for Decedents for 5 to 14 Years of Age 51

Chart 4.3 Death Rates, Leading Causes: Ages 15 to 24 Years 52

Table 4.3 Ten Leading Causes of Death for Decedents for 15 to 24 Years of Age 52

Chart 4.4 Death Rates, Leading Causes: Ages 25 to 44 Years 53

Table 4.4 Ten Leading Causes of Death for Decedents for 25 to 44 Years of Age 53

Chart 4.5 Death Rates, Leading Causes: Ages 45 to 54 Years 54

Table 4.5 Ten Leading Causes of Death for Decedents for 45 to 54 Years of Age 54

Chart 4.6 Death Rates, Leading Causes: Ages 55 to 64 Years 55

Table 4.6 Ten Leading Causes of Death for Decedents for 55 to 64 Years of Age 55

Chart 4.7 Death Rates, Leading Causes: 65 Years of Age and Older 56

Table 4.7 Ten Leading Causes of Death for Decedents for 65 Years of Age and Older 56

Chart 4.8 Death Rates for Leading Causes of All Ages 57

Table 4.8 Ten Leading Causes of Death for Decedents of All Ages 57

Chart 4.9 Death Rates, Leading Causes: Males 58

Chart 4.10 Death Rates, Leading Causes: Females 58

Table 4.9 Leading Causes of Death by Sex 59

Chart 4.11 Selected Age-Adjusted Death Rates, Ratio of AI/AN (2007-2009) 

to U.S. All Races (2008) 60

Table 4.11 Age-Adjusted Death Rates 60

Chart 4.12 Age-Specific Death Rates, Ratio of AI/AN (2007-2009) to U.S. All Races (2008) 61

Chart 4.13 Age-Specific Death Rates, Ratio of AI/AN (2007-2009) to U.S. White (2008) 61

Table 4.12 Age-Specific Death Rates 62

Chart 4.14 Deaths by Age 62

Chart 4.15 Deaths by Age and Race 63

Chart 4.16 Deaths by Age and Sex 63
viii

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Table 4.14 Number and Percent Distribution of Deaths by Age and Sex 64

Chart 4.17 Age-Adjusted Poisoning Death Rates 65

Table 4.17 Poisoning Deaths and Death Rates 66

Chart 4.18 Poisoning Death Rates by Age and Sex 67

Table 4.18 Poisoning Death Rates by Age and Sex 68

Chart 4.19 Age-Adjusted Unintentional Injury Death Rates 69

Table 4.19 Unintentional Injury Deaths and Death Rates 70

Chart 4.20 Unintentional Injury Death Rates by Age and Sex 71

Table 4.20 Unintentional Injury Death Rates by Age and Sex 72

Chart 4.21 Age-Adjusted Suicide Death Rates 73

Table 4.21 Suicide Deaths and Death Rates 74

Chart 4.22 Suicide Death Rates by Age and Sex 75

Table 4.22 Suicide Death Rates by Age and Sex 76

Chart 4.23 Age-Adjusted Homicide Death Rates 77

Table 4.23 Homicide Deaths and Death Rate 78

Chart 4.24 Homicide Death Rates by Age and Sex 79

Table 4.24 Homicide Death Rates by Age and Sex 80

Chart 4.25 Age-Adjusted Firearm Injury Death Rates 81

Table 4.25 Firearm Injury Deaths and Death Rates 82

Chart 4.26 Firearm Injury Death Rates by Age and Sex 83

Table 4.26 Firearm Injury Death Rates by Age and Sex 84

Chart 4.27 Age-Adjusted Alcohol-Related Death Rates 85

Table 4.27 Alcohol-Related Deaths and Death Rates 86

Chart 4.28 Alcohol-Related Death Rates by Age and Sex 87

Table 4.28 Alcohol-Related Death Rates by Age and Sex 88

Chart 4.29 Age-Adjusted Chronic Liver Disease and Cirrhosis Death Rates 89

Table 4.29 Chronic Liver Disease and Cirrhosis Deaths and Death Rates 90

Chart 4.30 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex 91

Table 4.30 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex 92

Chart 4.31 Age-Adjusted Malignant Neopolasm Death Rates 93

Table 4.31 Malignant Neoplasm Deaths and Death Rates 94

Chart 4.32 Malignant Neoplasm Death Rates by Age and Sex 95

Table 4.32 Malignant Neoplasm Death Rates by Age and Sex 96

Chart 4.33 Age-Adjusted Lung Cancer Death Rates 97

Table 4.33 Lung Cancer Deaths and Death Rates 98

Chart 4.34 Lung Cancer Death Rates by Age and Sex 99

Table 4.34 Lung Cancer Death Rates by Age and Sex 100
indian health service, u.s. department of health and human services ix

trends in indian health 2014 edition

Chart 4.35 Death Rates for Leading Cancer Sites 101

Table 4.35 Leading Sites for Cancer Deaths for Decedents of All Ages 102

Chart 4.36 Death Rates, Leading Cancer Sites: Males 103

Table 4.36 Leading Sites for Cancer Deaths for Males 104

Chart 4.37 Death Rates, Leading Cancer Sites: Females 105

Table 4.37 Leading Sites for Cancer Deaths for Females 106

Chart 4.38 Death Rates, Leading Cancer Sites: 55 Years of Age and Older 107

Table 4.38 Leading Sites for Cancer Deaths for Decedents 55 Years of Age and Older 108

Chart 4.39 Death Rates, Leading Cancer Sites: Males, 55 Years of Age and Older 109

Chart 4.40 Death Rates, Leading Cancer Sites: Females, 55 Years of Age and Older 109

Table 4.39 Leading Sites for Cancer Deaths by Sex, 55 Years of Age and Older 110

Chart 4.41 Age-Adjusted Pneumonia and Influenza Death Rates 111

Table 4.41 Pneumonia and Influenza Deaths and Death Rates 112

Chart 4.42 Pneumonia and Influenza Death Rates by Age and Sex 113

Table 4.42 Pneumonia and Influenza Death Rates by Age and Sex 114

Chart 4.43 Age-Adjusted Tuberculosis Death Rates 115

Table 4.43 Tuberculosis Deaths and Death Rates 116

Chart 4.44 Age-Adjusted Diabetes Mellitus Death Rates 117

Table 4.44 Diabetes Mellitus Deaths and Death Rates 118

Chart 4.45 Diabetes Mellitus Death Rates by Age and Sex 119

Table 4.45 Diabetes Mellitus Death Rates by Age and Sex 120

Chart 4.46 Age-Adjusted Heart Disease Death Rates 121

Table 4.46 Heart Disease Deaths and Death Rates 122

Chart 4.47 Heart Disease Death Rates by Age and Sex 123

Table 4.47 Heart Disease Death Rates by Age and Sex 124

Chart 4.48 Age-Adjusted Cerebrovascular Diseases Death Rate 125

Table 4.48 Cerebrovascular Diseases Deaths and Death Rates 126

Chart 4.49 Cerebrovascular Diseases Death Rates by Age and Sex 127

Table 4.49 Cerebrovascular Diseases Death Rates by Age and Sex 128

Chart 4.50 Age-Adjusted Alzheimer’s Disease Death Rates 129

Table 4.50 Alzheimer’s Disease Deaths and Death Rates 130

Chart 4.51 Alzheimer’s Disease Death Rates by Age and Sex 131

Table 4.51 Alzheimer’s Disease Death Rates by Age and Sex 132

Chart 4.52 Parkinson’s Disease Deaths and Death Rates 133

Table 4.52 Parkinson’s Disease Deaths and Death Rates 133

Chart 4.53 Age-Adjusted Enterocolitis Due to Clostridium Difficile Death Rates 134

Table 4.53 Enterocolitis Due to Clostridium Difficile Deaths and Death Rates 134
x

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Chart 4.54 Human Immunodeficiency Virus (HIV) Disease Death Rates 135

Table 4.54 Human Immunodeficiency Virus (HIV) Disease Deaths and Death Rates 136

Chart 4.55 Human Immunodeficiency Virus (HIV) Disease Death Rates by Age and Sex 137

Table 4.55 Human Immunodeficiency Virus (HIV) Disease Death Rates by Age and Sex 138

Chart 4.56 Age-Adjusted Asthma Death Rates 139

Table 4.56 Asthma Deaths and Death Rates 140

Chart 4.57 Age-Adjusted Mortality for All Causes Death Rates 141

Table 4.57 Mortality for All Causes Deaths and Death Rates 142

Chart 4.58 Life Expectancy at Birth 143

Chart 4.59 Years of Potential Life Lost (YPLL) 144

Chart 4.60 Age-Adjusted Death Rates 144

Table 4.58 Overall Measures of Indian Health 145

Chart 4.61 IHS Program Accomplishments Since 1973 (Adjusted Mortality Data) 146

Chart 4.62 IHS Program Accomplishments Since 1997 (Adjusted Mortality Data) 146

Table 4.61 IHS Program Accomplishments, IHS Service Area 147

Part 5: Patient Care Statistics

Chart 5.1 IHS Tribal and Urban Health Contract, Grant, and Compact Awards 148

Table 5.1 IHS Tribal and Urban Health Contract, Grant, and Compact Awards, 

Fiscal Year 1990-2013 149

Chart 5.2 IHS Tribal and Urban Health Contract and Compact Awards by Type, 

Fiscal Year 2013 150

Chart 5.3 Indian Health Service Tribal and Urban Health Grant and 

Compact Awards by Type, Fiscal Year 2013 150

Table 5.2 IHS Tribal Health Contract and Grant Awards by Type, Fiscal Year 2013 151

Chart 5.4 Urban Indian Health Program Workload and Appropriation 152

Table 5.4 Urban Indian Health Program Workload and Appropriation, FY 1985-2013 153

Chart 5.5 Number of Hospital Admissions 154

Table 5.5 Number of Hospital Admissions 155

Chart 5.6 Average Daily Hospital Patient Load 156

Table 5.6 Average Daily Hospital Patient Load 157

Chart 5.7 Leading Causes of Hospitalization: Ages Under 1 Year 158

Table 5.7 Ten Leading Causes of Hospitalization for GM&S Patients Under 1 Year of Age 158

Chart 5.8 Leading Causes of Hospitalization: Ages 1 to 4 Years 159

Table 5.8 Ten Leading Causes of Hospitalization for GM&S Patients 1 to 4 Years of Age 159

Chart 5.9 Leading Causes of Hospitalization: Ages 5 to 14 Years 160

Table 5.9 Ten Leading Causes of Hospitalization for GM&S Patients 5 to 14 Years of Age 160

Chart 5.10 Leading Causes of Hospitalization: Ages 15 to 24 Years 161

Table 5.10 Ten Leading Causes of Hospitalization for GM&S Patients 15 to 24 Years of Age 161
indian health service, u.s. department of health and human services xi

trends in indian health 2014 edition

Chart 5.11 Leading Causes of Hospitalization: Ages 25 to 44 Years 162

Table 5.11 Ten Leading Causes of Hospitalization for GM&S Patients 25 to 44 Years of Age 162

Chart 5.12 Leading Causes of Hospitalization: Ages 45 to 54 Years 163

Table 5.12 Ten Leading Causes of Hospitalization for GM&S Patients 45 to 54 Years of Age 163

Chart 5.13 Leading Causes of Hospitalization: Ages 55 to 64 Years 164

Table 5.13 Ten Leading Causes of Hospitalization for GM&S Patients 55 to 64 Years of Age 164

Chart 5.14 Leading Causes of Hospitalization: 65 Years of Age and Older 165

Table 5.14 Ten Leading Causes of Hospitalization for GM&S Patients 

65 Years of Age and Older 165

Chart 5.15 Leading Causes of Hospitalization for GM&S Patients by Sex 166

Table 5.15 Ten Leading Causes of Hospitalization for GM&S Patients by Sex 166

Chart 5.16 Leading Causes of Hospitalization for Males 167

Chart 5.17 Leading Causes of Hospitalization for Females 167

Table 5.16 Ten Leading Causes of Hospitalization by Sex 168

Chart 5.18 Hospital Discharge Rates by Age 169

Table 5.18 Comparison of Indian Health Service and U.S. Hospital Discharge Rates by Age 169

Chart 5.19 Beds per Hospital, IHS (FY 2013) Versus U.S. Short-Stay (CY 2012) 170

Table 5.19 Comparison of Indian Health Service and U.S. Hospitals by Bed Size 170

Chart 5.20 Number of Ambulatory Medical Visits 171

Table 5.20 Number of Ambulatory Medical Visits 172

Chart 5.21 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages Under 1 Year 173

Table 5.21 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients Under 1 Year of Age 173

Chart 5.22 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 1 to 4 Years 174

Table 5.22 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 1 to 4 Years of Age 174

Chart 5.23 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 5 to 14 Years 175

Table 5.23 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 5 to 14 Years of Age 175

Chart 5.24 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 15 to 24 Years 176

Table 5.24 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 15 to 24 Years of Age 176

Chart 5.25 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 25 to 44 Years 177

Table 5.25 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 25 to 44 Years of Age 177
xii

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Chart 5.26 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 45 to 54 Years 178

Table 5.26 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 45 to 54 Years of Age 178

Chart 5.27 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 55 to 64 Years 179

Table 5.27 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 55 to 64 Years of Age 179

Chart 5.28 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

65 Years of Age and Older 180

Table 5.28 Ten Leading Causes of Ambulatory Medical Clinical Impressions 

for Patients 65 Years of Age and Older 180

Chart 5.29 Leading Causes of Ambulatory Medical Clinical Impressions Visits 181

Table 5.29 Ten Leading Causes of Ambulatory Medical Visits for All Sexes 181

Chart 5.30 Leading Causes of Ambulatory Medical Clinical Impressions Visits for Males 182

Chart 5.31 Leading Causes of Ambulatory Medical Clinical Impressions Visits for Females 182

Table 5.30 Ten Leading Causes of Ambulatory Medical Clinical Impressions Visits by Sex 183

Chart 5.32 Percent Distributions for Population and Patient Care Workloads, 

Ages Under 25, Fiscal Year 2013 184

Chart 5.33 Percent Distributions for Population and Patient Care Workloads, Ages 25 

and Over, Fiscal Year 2013 185

Table 5.32 Percent Distributions for Estimated Population, Ambulatory Medical Clinical 

Impressions, and Inpatient Discharges and Days, Fiscal Year 2013 185

Chart 5.34 Percent Distribution of Ambulatory Medical Visits by Type of Provider 186

Table 5.34 Number of Ambulatory Medical Visits by Type of Provider 186

Chart 5.35 Trend in Average Daily Patient Load 187

Chart 5.36 Trend in Number of Ambulatory Medical Visits 187

Chart 5.37 Trend in Preventive Ambulatory Medical Clinical Impressions Visits 188

Chart 5.38 Dental Services Provided 188

Chart 5.39 Dental Services Provided by Tribal/Urban Programs 189

Table 5.38 Number of Dental Services Provided 190

Part 6: Community Health Statistics

Chart 6.1 Age-Adjusted Drug-Related Death Rates 191

Table 6.1 Drug-Related Deaths and Death Rates 192

Chart 6.2 Drug-Related Death Rates by Age and Sex 193

Table 6.2 Drug-Related Death Rates by Age and Sex 194

Chart 6.3 Alcohol-Related Discharge Rates (First-Listed Diagnosis) 195

Table 6.3 Number and Rate for Discharges with a First-Listed Alcohol-Related 

Diagnosis of Persons 15 Years Old and Older 195
indian health service, u.s. department of health and human services xiii

trends in indian health 2014 edition

Chart 6.4 Hospitalizations for Injuries and Poisonings 196

Chart 6.5 Age-Adjusted Motor Vehicle Death Rates for Males 196

Table 6.5 Motor Vehicle Deaths and Death Rates for Males 197

Chart 6.6 Age-Adjusted Motor Vehicle Death Rates for Females 198

Table 6.6 Motor Vehicle Deaths and Death Rates for Females 199

Chart 6.7 IHS Public Health Nursing—Percent of Visits by Program Area, Fiscal Year 2013 200

Table 6.7 IHS Public Health Nursing Visits by Program Area, Fiscal Year 2013 200

Chart 6.8 IHS Public Health Nursing—Percent of PHN Visits by Type of Activity, 

Fiscal Year 2013 201

Table 6.8 IHS Public Health Nursing Visits Worked by Type of Activity, Fiscal Year 2013 201

Chart 6.9 IHS Public Health Nursing—Percent Visits by Age and Sex, Fiscal Year 2013 202

Table 6.9 IHS Public Health Nursing Visits by Age and Sex of Patients, Fiscal Year 2013 202

Chart 6.10 IHS Public Health Nursing Visits by Age, Fiscal Year 2013 versus 2000 Census 203

Table 6.10 IHS Public Health Nursing Visits by Age of Patients 203

Chart 6.11 Distribution of CHR Client Contacts by Setting, 

October 1, 2007 to September 30, 2013 204

Table 6.11 Community Health Representative Client Contacts by Setting, 

October 1, 2007 to September 30, 2013 204

Chart 6.12 CHR Client Contacts by Leading Detailed Activities, 

October 1, 2007 to September 30, 2013 205

Table 6.12 Community Health Representative Client Contacts 

by Leading Detailed Activities, October 1, 2007 to September 30, 2013 205

Chart 6.13 Leading Health Problems for CHR Client Contacts, 

October 1, 2007 to September 30, 2013 206

Table 6.13 Community Health Representative Client Contacts by Leading Health Problems, 

October 1, 2007 to September 30, 2013 206

Chart 6.14 Leading Health Problems for CHR Client Contacts by Age, 

October 1, 2007 to September 30, 2013 207

Table 6.14 Community Health Representative Client Contacts by Leading Health Problems 

by Age, October 1, 2007 to September 30, 2013 207

Chart 6.15 Leading Types of CHR Incoming Client Referrals, Fiscal Years 2007-2013 208

Chart 6.16 Leading Types of CHR Ongoing Client Referrals, Fiscal Years 2007-2013 208

Chart 6.17 Types of Indian Homes Provided with Sanitation Facilities by IHS Through 2013 209

Table 6.17 Indian Home Provided with Sanitation Facilities by IHS, FYs 1960-2013 210

Chart 6.18 Contributions to Indian Health Service Sanitation Facilities Projects, 

Fiscal Year 2013 211

Table 6.18 P.L. 86-121 Program—Summary of Cash Contributions Received in 

Fiscal Year 2013 by Contributor 211

Chart 6.19 Sanitation Facilities Deficiencies, Fiscal Year 2013—Costs 212

Chart 6.20 Sanitation Facilities Deficiencies, Fiscal Year 2013—Units 212

Table 6.19 Sanitation Facilities Deficiency Summary, Fiscal Year 2013 213
xiv

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Chart 6.21 IHS Clinicians Documenting Patient Education, Fiscal Year 2013 214

Table 6.21 IHS Clinicians Documenting Patient Education, Fiscal Year 2013 214

Chart 6.22 IHS Clients Served by IHS Areas, Fiscal Year 2013 215

Chart 6.23 IHS Patient Education, Percent of Clients Served by Location, Fiscal Year 2013 215

Tables 6.22 IHS Clients Served by Location, Fiscal Year 2013 216

Chart 6.24 Top 25 IHS Patient and Family Education Code Documented 

by All IHS Areas, Fiscal Year 2013 217

Table 6.24 Top 25 IHS Patient and Family Education Code Documented 

by All IHS Areas, FY 2013 217

Glossary of ICD-10 Codes 219

List of 113 Causes of Death (1999-present) 219

List of 130 Causes of Infant Death (1999-present) 223

Additional causes of death and their corresponding ICD-10 Codes (1999-present) 228

List of ICD-9-CM Codes used in Patient Care Charts and Tables 229

Methods Used to Rank Leading Sites of Cancer Deaths 230

Index to Charts and Tables 232
indian health service, u.s. department of health and human services 1

trends in indian health 2014 edition

overview

The Indian Health Service (IHS), an agency within the Department of Health and Human 

Services (HHS), is responsible for providing federal health services to American Indian 

and Alaska Native (AI/AN) people. The provision of health services to federally 

recognized Indians grew out of a special relationship between the federal government 

and Indian Tribes. This government-to-government relationship is based on Article I, 

Section 8, of the United States Constitution, and has been given form and substance 

by numerous treaties, laws, Supreme Court decisions, and Executive Orders. 

The Indian Health program became a primary responsibility of the HHS under 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 is the federal health care provider and health advocate for AI/AN people and 

its goal is to assure that comprehensive, culturally-acceptable personal and public 

health services are available and accessible to AI/AN people. The mission of the 

IHS, in partnership with AI/AN people, is to raise their physical, mental, social, and 

spiritual health to the highest level. It is also the responsibility of the IHS to work 

with the people involved in the health delivery programs so they may be cognizant 

of entitlements of AI/AN people, as American citizens, to all federal, state, and 

local health programs, in addition to IHS and Tribal services. The IHS also acts as 

the principal federal health advocate for AI/AN people in the building of health 

coalitions, networks, and partnerships with Tribal nations and other government 

agencies as well as with non-federal organizations, e.g., academic medical centers 

and private foundations.

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, purchased by IHS 

through contractual arrangements with providers in the private sector, and delivered 

through Tribally operated programs and Urban Indian Health Programs.

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

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

communities, and provided 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 AI/AN people 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.

US Code Title 25 Chapter 18, the Indian Health Care Improvement Act (IHCIA) became 

the cornerstone legal authority for the provision of health care to American Indians 

and Alaska Natives when it was made permanent on March 23, 2010, as part of the 

Patient Protection and Affordable Care Act. The authorization of appropriations for 

the IHCIA had expired in 2000, and while various versions of the bill were considered 

by Congress since then, the act now has no expiration date. The new law permanently 

reauthorizes the IHS and it contains numerous provisions to modernize and update 
2

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

the IHS. These included an enhancement of the authority of the IHS Director, including 

the responsibility to facilitate advocacy and promote consultation on matters 

relating to Indian health within the Department of Health and Human Services. In 

addition, IHCIA provides authorization for hospice, assisted living, long-term, and 

home- and community-based care, extends the ability to recover costs from third 

parties to Tribally operated facilities, and updates current law regarding collection 

of reimbursements from Medicare, Medicaid, and CHIP (Children’s Health Insurance 

Program) by Indian health facilities. It also allows tribes and tribal organizations to 

purchase health benefits coverage for IHS beneficiaries. Other changes also occurred. 

IHS was authorized to enter into arrangements with the Departments of Veterans 

Affairs and Defense to share medical facilities and services. The Act allowed a Tribe or 

Tribal organization carrying out a program under the Indian Self-Determination and 

Education Assistance Act and an urban Indian organization carrying out a program 

under Title V of IHCIA to purchase coverage for its employees from the Federal 

Employees Health Benefits Program. The Community Health Representative program 

was authorized for urban Indian organizations to train and employ Indians to provide 

health care services. IHS was directed to establish comprehensive behavioral health, 

prevention, and treatment programs for Indians.

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

administrative units called service units. A service unit is the primary level of health 

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

health department in a state health department.

A few service units cover a number of small reservations; some large reservations are 

divided into a number of service units. The service units are grouped into larger culturaldemographic-geographic management jurisdictions administered by Area Offices.
indian health service, u.s. department of health and human services 3

trends in indian health 2014 edition

trends in indian health

Introduction

“Trends in Indian Health” provides basic statistical information to the IHS and its 

programs, Tribes, other federal and state government agencies, as well as other 

customers interested in the IHS. This publication uses narrative, charts, and tables 

to describe the IHS program and the health status of AI/AN people residing in the IHS 

service area. The IHS service area consists of counties “on” or “near” federal Indian 

reservations, i.e. contract health service delivery areas (CHSDAs). As of CY 2014 the 

Indians residing in the service area comprise about 58 percent of all AI/AN people 

(alone) residing in the U.S. Information pertaining to the IHS organizational structure, 

AI/AN demography, and patient care is included. Historical trends are depicted, and 

comparisons to other population groups are made, when appropriate. 

Scope and Organization of this Report

Narrative, charts, and tables are grouped into six major categories: 

• IHS Structure, 

• Population Statistics, 

• Natality and Infant/Maternal Mortality Statistics, 

• General Mortality,

• Patient Care Statistics, and

• Community Health Statistics

The tables provide detailed data, while the charts further depict significant 

relationships. Throughout this report each table and its corresponding chart appear 

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

table. In other instances, a table may have more than one chart associated with it.
4

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

summary of data shown

Indian Health Service Organizational Structure

The IHS is comprised of 12 regional administrative units called Area Offices. As of 

October 1, 2013, the Area Offices consisted of 168 basic administrative units called 

service units. Of the 168 service units, 107 were operated by Tribes. 

The IHS operated 28 hospitals, 61 health centers, three school health centers, 

and 34 health stations. Tribes have two different vehicles for exercising their selfdetermination—they can choose to take over the operation of an IHS facility through 

a P.L. 93-638 self determination contract (Title I) or a P.L. 93-638 self-governance 

compact, as amended (Title V). A distinction is made in this publication regarding 

these two Tribal modes of operation, i.e., Title I and Title V. A non-638 contract 

mechanism is used by Alaska to provide funding to several tribally operated village 

clinics. Tribes operated 17 hospitals (Title I, two hospital and Title V, 15 hospitals), 

249 health centers (Title I, 95 and Title V, 154), 6 school health centers (Title I, three 

and Title V, three), 70 health stations (Title I, 39; Title V, 30; and Other, one), and 164 

Alaska village clinics (Title I, eight and Title V, 150, and Other, six).

Urban Indian Health Programs operated 33 Urban Indian Organizations of which 

there were 21 full ambulatory care programs, 6 limited ambulatory care programs, 

and 6 outreach and referral programs as of July 1, 2014. 

As of July 2014, all IHS hospitals and eligible IHS-operated health centers were 

accredited by the Joint Commission, Centers for Medicare and Medicaid Services 

(CMS), and the Accreditation Association for Ambulatory Healthcare (AAAHC). Ninety 

(90) percent of Youth Regional Treatment Centers (YRTCs) were accredited by Joint 

Commission and the Commission on the Accreditation of Rehabilitation Facilities 

(CARF) as of October 10, 2014.

Population Statistics

In Calendar Year (CY) 2014, the IHS service population (a count of those AI/AN people 

who are eligible for IHS services) will be approximately 2.1 million. Since 2000, the 

IHS service population has been increasing at a rate of about 1.8 percent per year.

The AI/AN population residing in the IHS service area is younger than the U.S. all 

races population, based on the 2000 Census with bridged-race categories. For AI/AN, 

31 percent of the population was younger than 15 years, and six percent was older 

than 64 years. For the U.S. all races population, the corresponding values were 

21 and 12 percent respectively. The AI/AN median age was 25.0 years compared to 

34.9 years for U.S. all races. The estimated CY 2015 population was 2,161,310 AI/AN 

residing in the Urban Indian Health Programs service area. 

According to the 2000 Census with bridged-race categories, AI/ANs have lower 

incomes than the general population. In 1999, AI/AN people residing in U.S. had a 

median household income of $30,599 compared to $41,994 for U.S. all races. The 

AI/AN median household income was only marginally higher than the median 

household income ($29,423) for Blacks. During this time period, 25.7 percent of 

AI/AN people in the U.S. lived below the poverty level in contract to 12.4 percent for 

the U.S. all races population.
indian health service, u.s. department of health and human services 5

trends in indian health 2014 edition

Natality and Infant/Maternal Mortality Statistics

The birth rate for AI/AN people residing in the IHS service area was 25.4 (rate per 

1,000 population) in 2007-2009. It is 1.8 times the 2008 birth rate of 14.0 for the U.S. 

all races population.

The maternal mortality rate for AI/AN people residing in the IHS service area dropped 

from 28.5 (rate per 100,000 live births) in 1972 1974 to 23.2 in 2007-2009, a decrease 

of 19 percent. These AI/AN rates have been adjusted to compensate for misreporting 

of AI/AN race on state death certificates.

The infant mortality rate for AI/AN people residing in the IHS service area dropped 

from 25.0 (rate per 1,000 live births) in 1972 1974 to 8.3 in 2007-2009, a decrease of 

67 percent. These rates have been adjusted to compensate for misreporting of AI/AN 

race on state death certificates. The 2007-2009 rate (8.3) is 26 percent higher than 

the U.S. all races rate (6.6) for 2008.

General Mortality Statistics

The leading cause of death for AI/AN people residing in the IHS service area 

(2007-2009) was from diseases of the heart followed by malignant neoplasms. 

(This is the same as for the total U.S. all races population in 2008). However, the 

cause-of-death ranking differs by sex. For AI/AN males, the top two leading causes 

of death were diseases of the heart and malignant neoplasms. For AI/AN females, 

the top two leading causes of death were reversed compared to males malignant 

neoplasms and diseases of the heart.

In 2007-2009, the AI/AN (IHS service area) age adjusted death rates for the following 

causes were considerably higher than those for the U.S. all races population in 2008. 

These AI/AN rates have been adjusted to compensate for misreporting of AI/AN race 

on state death certificates. The following list is a comparison of AI/AN age adjusted 

rate (using data that are also adjusted for misreporting of AI/AN race on the state 

death certificates) to the U.S. rate where there are substantial differences.

Comparison of 2007-2009 AI/AN death rates to 2008 U.S. all races death rates.

• Alcohol related—520 percent greater;

• Tuberculosis—450 percent greater;

• Chronic liver disease and cirrhosis—368 percent greater

• Motor Vehicle Crashes—207 percent greater;

• Diabetes mellitus—177 percent greater; 

• Unintentional injuries—141 percent greater;

• Poisoning— 118 percent greater;

• Homicide—86 percent greater;

• Suicide—60 percent greater;

• Pneumonia and influenza—37 percent greater; and

• Firearm injury—16 percent greater;
6

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Patient Care Statistics

In FY 2013, there were 70,673 admissions to IHS and Tribal direct and contract general 

hospitals. The leading cause of hospitalization was supplementary classification, 

followed by obstetric deliveries and complications of pregnancy and puerperium.

The total number of ambulatory medical visits (IHS and Tribal direct and contract 

facilities) was almost fourteen million in FY 2013, an increase of more than 660 

percent since FY 1970. The leading cause of ambulatory medical visits in IHS and 

Tribal direct and contract facilities was supplementary classification conditions. The 

supplementary classification category includes such clinical impressions as other 

preventive health services, well child care, physical examination, tests only (lab, 

x-ray, screening), and hospital, medical, or surgical follow up.

The number of direct and contract dental services provided by Indian Health Service, 

Tribal, and Urban Programs, as reported to the IHS central database, has increased almost 

2,000 percent (from under 0.2 million in FY 1955 to about 3.7 million in FY 2013).

Community Health Statistics

The community health representatives (CHR) program reported approximately 5.7 

million client services during FY 2007. This number reflects about a third of the 

264 tribal CHR Programs submitting data. Most of these services took place in the 

home (37 percent) and community (27 percent). During FY 2007-2013, the leading 

service category was Case Management (23 percent), followed by Health Education 

(15 percent), Patient Care (15 percent), and Case Finding/Screening (13 percent). It 

is important to note that while transportation is typically the first service that most 

people think CHRs provide, in fact it ranks seventh in leading services (detailed 

activities) representing only 8 percent of services provided nationwide. During 

FY 2007-2013, the top six Health problems/issues were: Diabetes Mellitus 

(15 percent); Hypertension (10 percent); Other Health Promotion/Disease Prevention 

(10 percent); Heart (5 percent); Nutrition (4 percent); and Dialysis (4 percent). 

A majority of services delivered in those top six Health Problems were to patients 

age 60 and over (see graphs). 

For people accepted for treatment into the IHS substance abuse treatment program, 

most initial contacts are for alcohol addiction only. However, the number of initial 

contacts involving other drugs has been increasing. Also, the age adjusted drug 

related death rate for AI/AN residing in the IHS service area increased from 4.1 

deaths per 100,000 population in 1979 1981 to 22.7 in 2007-2009. These AI/AN 

rates have been adjusted to compensate for misreporting of AI/AN race on state 

death certificates. The 2007-2009 AI/AN rate (22.7) is 1.8 times greater than the U.S. 

all races rate (12.6) for 2008.

The IHS Injury Prevention (IP) Program promotes a comprehensive public health 

approach to prevent injuries. Evidence-based projects are used to reduce motor 

vehicle injuries and fatalities by increasing occupant restraint use through Tribal 

motor vehicle occupant restraint policy development; supporting tribal law 

enforcement in deterring drunk drives (DUI policy development); and highway 

environmental modifications (street lights, guard rails, highway stripping, etc). 

Injuries are the leading cause of death for American Indians and Alaska Natives 

from ages 1-44 years, and the third leading cause of death overall. Unintentional 

injury mortality rates for Indian people are approximately 2.4 times higher than the 

combined all-U.S. races rate (CY 2007-2009). 
indian health service, u.s. department of health and human services 7

trends in indian health 2014 edition

Effective community-based injury prevention initiatives use multiple strategies to 

reduce and prevent injuries and fatalities. The IHS Injury Prevention Program promotes 

building the capacity of Tribes and communities by increasing understanding 

about the injury problem, sharing effective solutions, and assisting communities 

in implementing programs. As a result of these efforts, unintentional injury deaths 

to American Indian and Alaska Native people, while still high, decreased by 58% 

between 1973 and 2003. Some of the successful initiatives that IHS employs include: 

Tribal Injury Prevention Cooperative Agreement Program (TIPCAP), Ride Safe (targets 

motor vehicle related injuries to children ages 3-5 years), and Sleep Safe (targets fire 

and burn injuries to children ages 3-5 years).

The final PHN performance result for FY 2013 was 388,590 encounters, but several 

large service units did move away from the IHS Resource Patient Management 

System (RPMS) to the use of commercial off the shelf packages which changed the 

way PHN visits were coded, exported and compiled in FY 2013 (some PHN data was 

not included in the FY 2013 results due to this situation). The FY 2015 target is set 

at 425,679 encounters as identified data concerns in FY 2013 are resolved in 2014. 

The PHN program will continue to work to report the most accurate information to 

describe the important services provided by the national PHN Program.

With completion of all projects approved through FY 2013, over 302,000 AI/AN 

homes have been provided first service sanitation facilities since 1960. As of the end 

of FY 2013, there were over 176,000 AI/AN homes in need of sanitation facilities, 

including over 30,000 AI/AN homes without potable water. 

The FY 2013 economically feasible sanitation deficiencies to serve existing AI/AN 

homes and communities totals $1,717 million. This amount is to provide first service 

sanitation facilities, to upgrade existing facilities, to provide solid waste facilities, as 

well as to provide assistance to operation and maintenance organizations.

In FY 2013, 4,800,312 patient education codes were documented for 3,695,117 

patients. Areas documenting the highest levels of patient education are: Oklahoma 

City (28 percent), Navajo (17 percent), and Phoenix (16 percent). Areas with the 

greatest improvement in documentation as compared to FY 2007 are: California 

(increase of 69.9 percent), Bemidji (increase of 65.4 percent), Great Plains (increase 

of 57.9 percent), and Navajo (increase of 54.6 percent). Nashville (decrease of 10.2 

percent) and Alaska (decrease of 12.4 percent) were the only areas that documented 

less patient education in FY 2014 than FY 2007. All healthcare disciplines are 

encouraged to provide and document patient education.

In FY 2013, pharmacists documented 25 percent of the patient education provided 

to patients, followed by clinical nurses (23 percent), physicians (12 percent), LPNs 

(nine percent), nursing assistants (seven percent), public health nurses and nurse 

practitioners (five percent). Other disciplines provided less than five percent and 

are grouped together in the other category, which altogether provided 14 percent 

of patient education. Most patient education is provided in the hospital (51 percent) 

or health center (42 percent) location. Health locations, health stations, and village 

clinics, account for approximately seven percent of health education provided and 

the remaining one percent of health education is provided in other health care 

related settings.

The top two patient education codes in FY 2013 comprised 81 percent of all patient 

education codes provided (4,596,740 codes out of a total 5,643,613). The top 25 education 

codes are grouped in six categories. The most education was provided on medications 

(60 percent), immunizations (22 percent), tobacco (eight percent), health promotion/

disease prevention (six percent), diabetes (three percent), and flu (one percent).
8

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

sources and limitations of data

Population Statistics

Registered AI/AN patients with at least one direct or contract inpatient stay, outpatient 

visit, or dental visit during the last three years are defined as users. IHS user 

population estimates are drawn from data in the IHS National Data Warehouse. First 

implemented in 1984 as the Patient Registration System, it functioned adequately for 

many years; but system changes resulted in registration record errors. New systemwide improvements were implemented. From December 2003 through January 2006, 

local facilities re-sent complete and up-to-date information for all patients who 

had ever received direct or contract health services from IHS or Tribally-operated 

programs to a central data repository. Data matching software was then applied to the 

information, allowing for the identification and removal of duplicate records. Thanks 

to the dedicated efforts of Area Statistical Officers and National Data Warehouse staff, 

this publication contains very accurate user population estimates.

The service population estimates are based on official U.S. Census Bureau county data, 

representing self-identified AI/AN people who may or may not use IHS services. IHS 

service populations between census years (e.g., 1990 and 2000) are estimated using 

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 AI/AN 

people. IHS service populations beyond the latest census year with available data 

are projected through linear regression techniques, using the most current ten years 

of AI/AN birth and death data provided by the National Center for Health Statistics 

(NCHS), Centers for Disease Control and Prevention (CDC).

IHS user population figures are used for calculating IHS patient related rates. Since 

State birth and death certificates, however, do not provide information on use of 

IHS services, IHS service population figures are used in calculating AI/AN vital event 

rates for the IHS service areas.

The social and economic data contained in this publication are from the 2000 census 

and reflect the characteristics of persons self-identifying as AI/AN (alone).

IHS Service Population

Definition

The IHS service population is based on the 2000 census bridged-race file (developed by the Census Bureau and NCHS, CDC). It consists of AI/AN and serves as 

a measure of those eligible for IHS services. Those AI/AN eligible are estimated 

by counting AI/AN who reside in geographic areas in which IHS has responsibilities (“on or near” reservations) and is comprised of approximately 58 percent 

of all AI/AN residing in the U.S. These people may or may not use IHS health 

services. (Migration is not a factor when developing the IHS service population). 

Description of Service Population Calculation

Since state birth and death certificates do not provide information on use of IHS 

services, the IHS service population counts are used as the denominator when 

calculating AI/AN vital event rates for the IHS service areas.

IHS service populations between census years (e.g., 1990 and 2000) are estimated 

using a smoothing technique in order to illustrate a gradual transition between 

census years. This normally results in upward revisions to service population 
indian health service, u.s. department of health and human services 9

trends in indian health 2014 edition

figures projected prior to a census, since each census tends to conduct a better job 

in enumerating AI/AN people. IHS service populations beyond the 2000 census are 

projected through linear regression techniques, using the most current ten years of 

AI/AN birth and death data provided by NCHS.

DPS produces service populations for IHS Areas, service units, and counties. 

IHS service population figures are based on the 2000 census with bridged-race 

file county data. The Census Bureau enumerates those individuals who identify 

themselves as AI/AN. The IHS service population consists of those enumerated 

AI/ANs who reside in the geographic areas in which IHS has responsibilities (“on or 

near” reservations, i.e., contract health service delivery areas (CHSDAs)).

The 2000 Census allowed respondents to report more than one race category to 

describe themselves and household members. This was a result of the revised 

Office of Management and Budget (OMB) guidelines issued on October 30, 1997. All 

other censuses prior to 2000 had offered the respondent with the option for selfidentification of a single race with which the respondent most closely identified. As 

a result of the aforementioned OMB revised standards a methodology was developed 

to “bridge” the 2000 Census with previous decennial censuses. This impacted the 

manner in which the total AI/AN population was counted.

The Census Bureau and NCHS are credited for developing the bridging methodology to 

address the inconsistencies for identifying race between the 2000 Census and the 

previous censuses. The 2000 Census with bridged-race categories re-categorizes more 

than one race responses to a single race response. The bridged 2000 Census single race 

corresponds with the single race categories used on the birth and death certificates.

Addressing the inconsistencies in the denominators produced based on the latest 

2010 bridged population, the IHS determined that since this publication uses vital 

event years prior to the 2010 Census, specifically prior to 2007-2009, the more 

reliable bridged-race file based on the 2000 census should continue to be used. The 

IHS is continuing to conduct a detailed evaluation of the methodologies used when 

developing the 2010 bridged-race file. This is as a result of the AI/AN population being 

highly affected by the enormous increase in population counts when answering “selfidentification” as an AI/AN and a combination of at least one other race (combination).

Additional information may be attained by viewing: http://www.cdc.gov/nchs/nvss/

bridged_race.htm

Source: National Center for Health Statistics. Estimates of the July 1, 2000-July 1, 2009, 

United States resident population from the Vintage 2004 postcensal series by year, 

county, age, sex, race, and Hispanic origin, prepared under a collaborative arrangement 

with the U.S. Census Bureau. Available on the Internet at: http://www.cdc.gov/nchs/

nvss/bridged_race/data_documentation.htm#JULY2009. Accessed January 13, 2015

Using the 2000 Census with bridged-race categories increased the AI/AN population 

denominators resulting in slightly decreased IHS mortality rates. The 2000 Census 

with bridged-race categories population for all AI/AN in the U.S. is 3.3 million. This 

falls between the population of all AI/AN in the U.S. of 2.5 million who identified 

themselves as an AI/AN race (alone) and the population of all AI/AN in the U.S. of 

4.2 million who identified themselves as an AI/AN and a combination of at least one 

other race (combination).

IHS service populations beyond the 2000 census are projected through linear 

regression techniques using the latest ten years of AI/AN birth and death data 

provided by NCHS. The estimated natural change for a county (number of births 

minus number of deaths) is applied accumulatively to the latest census enumeration 
10

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

for the county for each year beyond the census. DPS produces a new set of IHS 

service population projections each year.

The IHS service populations are produced for the IHS area, service unit, and county 

levels. If a county is split between and/or among service units and/or IHS service 

areas, DPS allocates the county population to the affected service units and/or 

service areas. These population allocations are based on percentage splits developed 

and agreed by the affected IHS areas. A letter of agreement describing the formal 

arrangement (including a valid authorization by all authorities for the population 

allocation) is sent to DPS and kept on file. These percentage splits are calculated 

using sub-county census data and census maps.

DPS also generates AI/AN population estimates and projections, utilizing an identical 

methodology, for non-service IHS counties. Therefore, DPS produces census-based 

AI/AN population figures for every U.S. county and all 50 states.

Changes in Methodology 

DPS continues to use updated methodologies to produce age-adjusted mortality 

rates. These applied methodologies coincide with methodologies used by NCHS, 

CDC and the U.S. Census Bureau. Using these updated methodologies enabled 

AI/AN mortality rates to be compared to U.S. all races mortality rates produced by 

the aforementioned agencies. 

The three major updated methodologies applied by DPS include:

ICD-9 Conversion to ICD-10

Beginning with the 1999 mortality data, a new classification system was 

implemented to categorize causes of death. The International Classification of 

Diseases, Version 10 (ICD-10) was used by the states and NCHS to code all causes 

of death for years 1999 and onward. The ICD-10 classification system consists 

of a new nomenclature scheme with new and revised categories for some causes 

of death. Comparability ratios are applied when appropriate, i.e., to adjust data 

analyzed using the past classification system (ICD-9). Such revisions are noted 

on the data when applicable. 

2000 U.S. Census Populations with Bridged Race Categories (2000 Census Bridged File)

The 2000 U.S. Census Population with Bridged-Race Categories (2000 Census 

Bridged File) for AI/ANs was used by IHS to calculate mortality and natality ageadjusted rates. The 2000 Census allowed respondents to report more than one 

race category to describe their race. The birth and death certificates (vital events) 

used by the states for years 2007-2009 allow only a single race category to 

be reported. Vital event totals are used in the numerator and the 2000 Census 

bridged population is used as the denominator to produce the birth or death 

rates that occur in the population of interest. The denominator data are based 

on the 2000 Census bridge file, which re-categorizes responses to a single race 

where more than one race was reported. This corresponds to the single race 

categories used on birth and death certificates.

Age-Adjustment Based on the 2000 Standard Population

The DHHS recommended that all HHS agencies use the 2000 Census standard 

population to age-adjust mortality rates. IHS calculates age-adjusted rates based 

on the 2000 standard population to comply with this HHS recommendation.
indian health service, u.s. department of health and human services 11

trends in indian health 2014 edition

Vital Event Statistics

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

NCHS publications1,2,3,4,5

 as well as from some unpublished data from IHS.1 NCHS 

obtains birth and death records for all U.S. residents from state health departments, 

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

records NCHS provides to 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.

The natality and mortality data are only as accurate as the reporting by the states to 

NCHS. NCHS does perform numerous edit checks, applies verification methods, and 

imputes values for non-responses.4,5

Misreporting of AI/AN race on state death certificates occurs, especially in areas 

distant from traditional AI/AN reservations. In order to determine the degree and 

scope of the misreporting, IHS conducted a study utilizing the National Death Index 

(NDI) maintained by NCHS. The study involved matching IHS patient records of those 

patients who could have died during 1986 through 1988 with all death records of 

U.S. residents for 1986 through 1988 as contained on the NDI. The results were 

published in a document entitled, Adjusting for Miscoding of Indian Race on State 

Death Certificates, November 1996. The study revealed that on 10.9 percent of 

the matched IHS-NDI records, the race reported for the decedent was other than 

AI/AN. The percentage of records with inconsistent classification of race ranged from 

1.2 percent in the Navajo Area to 28.0 and 30.4 percent in the Oklahoma and 

California Areas, respectively.1

The results of the NDI study provide sufficient numbers to calculate adjustments for 

each IHS Area, IHS overall, and selected age groups. In addition to these adjustments 

based on the study findings, IHS assumed the following: (a) the results from 1986-88 

apply to other years; (b) IHS age-group adjustments applied also to each Area; and (c) 

the Area adjustments applied to the causes of death used in this publication, i.e. if 

an Area’s total deaths needed to be increased by ten percent, than the deaths for each 

cause of death would also increase by this same rate. These assumptions cannot be 

statistically supported by the results of the study. However, it was necessary to adjust 

all the death rates in this publication to provide a meaningful and comprehensive 

look at health status. 

These NDI adjustments were used for the first time in the 1997 edition of this publication. 

Both unadjusted and adjusted information is shown, as applicable. The adjustments 

were applied to the results obtained from using an unadjusted death file. 

IHS has more specific adjustment factors for the age group less than one year. These 

are derived from the linked birth/infant death data sets produced by NCHS.3 In 

this edition, unadjusted and adjusted infant mortality rates will be shown. These 

1 Indian Health Service, Department of Health and Human Services. Adjusting for Miscoding on Indian Race on 

the State Death Certificate. November 1996.

2 Fay MP, Feuer EJ. Confidence intervals for directly adjusted rates: a method based on the gamma distribution. 

Stat Med 16:791-801, 1997.

3 Mathews TJ, MacDorman MF. Infant mortality statistics from the 2008 period linked birth/infant death dataset. 

National vital statistics reports; vol 60 no 5. Hyattsville, MD: National Center for Health Statistics. 2012.

4 Minino AM, Murphy SL, Xu Jq, Kochanek KD. Deaths: Final data for 2008. National vital statistics reports; vol 59 

no 10. Hyattsville, MD: National Center for Health Statistics, 2011.

5 Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; vol 59 no 1. 

Hyattsville, MD: National Center for Health Statistics. 2010.
12

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

adjustments based on the linked data sets take precedent over the NDI adjustments 

for the under one-year age group, described above.

Preliminary results based on the latest NDI match for years 1999, 2000, and 2001 

indicate that the adjustment factors illustrate ratios that not significantly different 

for those adjustment factors established during the late 1980’s.

Natality statistics are based on the total file of birth records occurring in the U.S. each 

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

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

The AI/AN vital event statistics in this publication pertain only to AI/AN people 

residing in the counties that make up the IHS service area, in contrast to earlier 

editions of the Trends in Indian Health publication which showed vital event statistics 

for all AI/AN people residing in the Reservation States. Calculations done on a 

Reservation State basis include all counties within the State, even those outside the 

IHS service area. Reservation State vital event rates tend to be lower in value (i.e., 

lower birth rates, lower death rates) than IHS service area rates. Since prior to 1972, 

only Reservation State data were available; these data were used to show trends 

going back to 1955, the inception of the IHS. However, now that sufficient vital event 

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

Indian Health, beginning with the 1992 edition, shows vital event statistics for the IHS 

service population. IHS service area data are more indicative of the health status of 

the AI/AN people that IHS serves.

The AI/AN population is considerably younger than the U.S. all races population. 

Death rates presented in this publication have been age-adjusted to the 2000 

standard population, where applicable, so that appropriate comparisons can be 

made between these population groups. One exception is the information presented 

for leading causes of death.6

 In order to determine the leading causes of death for 

a population group, it is necessary to rank causes of death without any adjustment 

for age. However, it should be kept in mind that the ranking of causes of death for a 

population group is affected by its age composition. 

All age-adjusted death rates calculated using a small number of deaths should be 

interpreted with caution as the observed rate may be quite different from the true 

underlying rate. This occasionally occurred when an Area rate was calculated for 

a specific cause of death. Any rate based upon fewer than 20 deaths may not be 

reliable as the sample will be too small.

The NCHS definition of alcohol-related deaths includes all of these ICD-10 codes 

groups and that are used in all IHS publications. (NOTE: The category “alcohol-induced 

causes” includes not only deaths from dependent and nondependent use of alcohol, 

but also accidental poisoning by alcohol. It excludes unintentional injuries, homicides, 

and other causes indirectly related to alcohol use as well as deaths due to fetal 

alcohol syndrome.)4

Age-Adjustment

The age adjusted death rates presented in this publication were computed by the 

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

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

enumerated in 2000 was selected as the standard since this is the standard used by 

NCHS.7

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

6 http://www.cdc.gov/nchs/products/pubs/pubd/hestats/leadingdeaths03/leadingdeaths03.htm

7 Anderson RN, Rosenberg, HM. Age Standardization of Death Rates: Implementation of the Year 2000 Standard; 

National Vital Statistics Reports, vol 47 no 3. Hyattsville, Maryland: National Center for Health Statistics. 1998.
indian health service, u.s. department of health and human services 13

trends in indian health 2014 edition

separately, by using the same standard population. The age adjusted rates were 

based on ten year age groups. It is important not to compare age-adjusted death 

rates with crude rates.

A new table, “Poisoning Deaths and Death Rates,” was added beginning with the 

2002-2003 edition because of its significance in the AI/AN community. The 

“poisoning” table and chart include deaths for the following ICD-10 codes: U01.6-U01.7 

(poisoning via terrorism); X40-X49 (accidental poisoning by exposure to noxious 

substances); X60-X69 (suicide by poisoning); X85-X90 (homicide by poisoning); 

Y10-Y19 (undetermined poisoning); and Y35.2 (poisoning by legal intervention/war).

Patient Care Statistics

Patient care statistics are derived from several IHS reporting systems. Almost all 

patient care data used in this report for IHS and Tribal facilities originated from the 

National Data Warehouse (NDW), the central data repository which is managed by the 

National Patient Information Reporting System (NPIRS) team in collaboration with the 

IHS Division of Program Statistics. This effort began in December 2003 with files that 

contained initial loads of historical data as early as 2001 from the sites. Initial loads 

were completed in November 2005. In January 2006, incremental files started to 

be exported from all reporting sites. As of this writing, almost all reporting sites 

(99 percent) transmit exports to the NDW in incremental files monthly in one of two 

standard formats, Health Level 7 (HL7) or simplified format. Reporting sites do not need 

to run the Resource Patient Management System (RPMS) software locally in order to send 

files successfully to the NDW. Data received by the NDW is subject to errors in entering, 

transmitting, and formatting. Data quality issues with registration and encounter 

data might occur. The NPIRS team works with the Division of Program Statistics, Area 

Statistical staff, and Facility statistical staff to resolve such issues and continuously 

analyze, maintain, and improve the timeliness and accuracy of the data.

The NDW contains only IHS federal and Tribal direct and contract facility inpatient 

and outpatient data pertaining to various patient characteristics (age, sex, principal 

diagnoses, other diagnoses, community of residence, etc.). The data are collected by the 

local medical records system at each facility (RPMS or other), one record per inpatient 

discharge or outpatient visit, and then transmitted electronically to the NDW. 

Starting with the 1996 edition, leading causes of hospitalization and ambulatory 

medical visits are shown for specific age groups. In prior editions, they were only 

shown for all ages and by sex.

In some cases, other information systems than the NDW were used by individual 

programs to provide data, presented in this report, pertaining to patient care. Facility 

accreditation, Tribal health contract and grant awards, urban projects, and provision 

of sanitary services reports were taken from data sources and reports run by the 

individual IHS programs.

Community Health Statistics

Data on the IHS Community Health Representatives (CHR) Program is obtained only 

from the CHR Patient Care Component (PCC) application in the IHS Resource Patient 

Management System (RPMS). While the primary focus of CHR PCC is documentation of 

patient services, it can also record all services and activities to provide a complete 

accounting picture of CHR functions and services for program management and 

administration. Roughly a third of CHR Programs report annually, reflecting the 

transfer of resources to Tribes as part of Self Determination choices and geographic 
14

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

and security-related challenges just to access and use the CHR data application. The 

data is derived from CHR Programs which enter and export data through CHR PCC and 

fluctuates annually, ranging between 133 to 148 of approximately 300 CHR programs 

reporting nationwide. Data presented herein are primarily aggregate patient data over 

six fiscal years (FY 2007-2013). Data from CHR Programs utilizing “regular” RPMS PCC, 

also known as the electronic health record (EHR), is not accessible through the reporting 

mechanism used at present. Future data based on improvements to the CHR PCC should 

reflect enhanced capacity and more specificity to better classify health problems and 

services delivery; and discussions to allow CHRs access to EHR are ongoing. 

Case Management in CHR PCC can include services such as making medical 

appointments or scheduling check-ups or other activities on behalf of patients to 

ensure they receive health or socio-economic services and care needed. Health 

Education includes planning, preparing or providing education to patients on health 

and wellness. Patient care services provided by CHRs includes hands-on care such 

as checking vital signs, providing emotional support, delivering medications/

supplies/equipment, etc., and applies only to those patients who have a known 

illness as diagnosed by medical professionals. Case Finding and Screening is 

performed to find, discover or detect health problems for clients not known to be 

diagnosed with a health problem. Monitoring patients includes following up on 

health and well-being of clients pursuant to clinician referrals or as part of regularly 

scheduled work activities or care plans, ensuring that patients have enough food, 

medications, and a safe living environment. Transport Patients includes conveying 

patients to medical appointments when patients in mostly remote or rural areas 

do not have resources to get to health care or in the absence of public or tribally 

sponsored transportation systems. 

IHS continues to encourage Tribal governments to utilize the CHR PCC data application 

for its 1) user-friendliness, 2) functionality and capacity to yield reports to supply 

needed patient information and track individual Tribal CHR program effectiveness 

along with 3) identification of health trends and 4) baseline information for grant 

justifications. Historically and anecdotally patients, providers, tribal leaders and 

community members have viewed “transportation” as the primary service provided 

by CHRs. It is important to note that while transportation is typically the first (and 

sometimes only) service that most people believe CHRs provide, in fact, it ranks 

fifth in leading services (detailed activities) representing only 8 percent of services 

provided nationwide. CHRs verbally report that they often take advantage of an hour 

of transport time to provide health education or emotional support to patients but 

then often do not report other services provided during transport or while waiting 

for a patient in CHR PCC. 

Ongoing plans for the CHR Program include increased integration of CHRs into 

the patient-centered medical home health care team through collaboration with 

improvement initiatives within the Indian Health System, enhanced education and 

skills based competencies through online educational modules, and increased 

functionality and accessibility of RPMS CHR PCC to ensure program accountability 

and effectiveness. 

The IHS Public Health Nursing (PHN) Program is a community health nursing program 

that focuses on the goals of promoting health and quality of life, and preventing 

disease and disability. The PHN Program provides quality, culturally sensitive health 

promotion and disease prevention nursing care services through primary, secondary 

and tertiary prevention services to individuals, families, and community groups. 

PHN home visiting nursing services include services for: Maternal and pediatric 

populations, including childhood obesity prevention through breastfeeding 
indian health service, u.s. department of health and human services 15

trends in indian health 2014 edition

promotion, screening for early identification of developmental problems, and 

parenting education; Elder care services, including safety and health maintenance 

care; Chronic disease care management; and Communicable disease investigation, 

treatment, and public health.

Public Health Nurses are licensed, professional nursing staff who are available 

to support a smooth transition as the patient transfers from the clinic/hospital 

setting into the community. The PHN Program aligns with the Agency’s priorities 

and works to integrate sustained progress towards all GPRA measures. For example, 

breastfeeding is an important practice for American Indian/Alaska Native families 

in at-risk communities for childhood obesity and diabetes as this is an effective 

prevention strategy. The IHS PHN Program participates in this Agency’s initiative to 

decrease childhood obesity and prevent diabetes by supporting the Baby Friendly 

Hospital Initiative activity in the community.

Public Law 86-121 authorizes IHS to provide essential sanitation facilities to Indian 

homes and communities (P.L. 86-121; 42 U.S.C. § 2004a). The HIS Sanitation Facilities 

Construction (SFC) Program, an integral component of the IHS disease prevention 

activity, has carried out those authorities since 1959 using both contributed funds 

and funds appropriated for SFC to provide potable water and waste disposal facilities 

for American Indian/Alaska Native (AI/AN) people. The provision of safe water and 

wastewater disposal not only plays a significant day to day role in improving the 

quality of life for AI/AN people.

Data on patient education is collected through the Resource and Patient Management 

System (RPMS) and the National Data Warehouse (NDW).
16

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

glossary

Age-Adjustment (direct method)—The 

application of age-specific rates in a 

population of interest to a standardized 

age distribution in order to eliminate 

differences in observed rates that result 

from age differences in population 

composition. This adjustment is usually 

done when comparing two or more 

populations at one point in time or one 

population at two or more points in time.

Area—A defined geographic region for 

Indian Health Service (IHS) administrative 

purposes. Each Area Office administers 

several service units

Average Daily Patient Load—The average 

number of patients occupying beds in a 

hospital on a daily basis. It is calculated 

by dividing total inpatient days for the 

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 using the international rules for selecting 

the underlying cause of death from the 

conditions stated on the death certificate. 

The underlying cause is defined by the World 

Health Organization (WHO) as the disease or 

injury that initiated the train of events leading 

directly to death, or the circumstances of the 

accident or violence, which produced the fatal 

injury. Generally, more medical information is 

reported on death certificates than is directly 

reflected in the underlying cause of death. The 

conditions that are not selected as underlying 

cause of death constitute the non-underlying 

cause of death, also known as multiple cause 

of death. Cause of death is coded according to 

the appropriate revision of the International 

Classification of Diseases (ICD). Effective with 

deaths occurring in 1999, the United States 

began using the Tenth Revision of the ICD (ICD10); during the period 1979-98, causes 

of death were coded and classified according 

to the Ninth Revision (ICD-9). Each of these 

revisions has produced discontinuities in 

cause-of-death trends. These discontinuities 

are measured using comparability ratios.

Census Definitions—Definitions for census 

information including: unemployment, median 

household income, and poverty can be found 

on the census website.

1

Comparability Ratios—Adjustment factors 

designed to measure the effects of a new 

revision of the ICD on the comparability with 

the previous revision of mortality statistics 

cause of death.

2

Contract Care—Services not available directly 

from IHS or Tribes that are purchased under 

contract from community hospitals and 

practitioners. May also be referred to as 

“purchased referred care”.

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 forty hours a 

week for ambulatory 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 

forty hours a week.

High Birthweight—Birthweight of 4,000 grams 

or more.

Infant Mortality—The death of a live-born 

child before his or her first birthday. Deaths 

in the first year of life may be further 

classified according to age as neonatal and 

postneonatal. Neonatal deaths are those that 

occur before the 28th day of life; postneonatal 

deaths are those that occur between 28 and 

365 days of age. 

1 http://www.census.gov

2 Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. 

Comparability of Cause of Death Between ICD-9 

and ICD-10: Preliminary Estimates. National Vital 

Statistics Reports; vol 49 no. 2. Hyattsville, Mary-

land: National Center for Health Statistics. 2001.
indian health service, u.s. department of health and human services 17

trends in indian health 2014 edition

Infant Mortality Rate—A rate based on period 

files calculated by dividing the number of 

infant deaths during a calendar year by the 

number of live births reported in the same 

year. It is expressed as the number of infant 

deaths per 1,000 live births.3

International Classification of Diseases—The 

Ninth Revision (ICD-9) codes are used for years 

prior to 1999. The Tenth Revision (ICD-10) 

codes are used for data years 1999 onward.

Life Expectancy—Life expectancy is the average 

number of years of life 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. Life expectancy may be determined 

by race, sex, or other characteristics using 

age-specific death rates for the population with 

that characteristic.4

Live Birth—In the WHO’s definition, also 

adopted by the United Nations and the 

NCHS, a live birth is the complete expulsion 

or extraction from its mother of a product of 

conception, irrespective of the duration of 

the pregnancy, which, after such separation, 

breathes or shows any other evidence of life 

such as heartbeat, umbilical cord pulsation, 

or definite movement of voluntary muscles, 

whether the umbilical cord has been cut or the 

placenta is attached. Each product of such a 

birth is considered live born.5

Low Birthweight—Birthweight of less than five 

pounds, eight ounces or 2,500 grams.

Maternal Death—The death of a woman while 

pregnant or within 42 days of termination of 

pregnancy, irrespective of the duration and the 

site of the pregnancy. Maternal death is one for 

which the certifying physician has designated 

a maternal condition as the underlying cause 

of death. Maternal conditions are those 

assigned to Complications of Pregnancy, 

Childbirth, and the Puerperium, (ICD-10 codes 

A34, O00-O95.9, O98-O99.9).6

3 http://www.cdc.gov/nchs/deaths.htm

4 http://www.cdc.gov/nchs/deaths.htm

5 http://www.cdc.gov/nchs/births.htm

6 http://www.cdc.gov/nchs/deaths.htm

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—Federal Register Notice (October 30, 

1997), Revision to the Standards for the 

Classification of Federal Data on Race and 

Ethnicity. The revised standards have five 

minimum categories for data on race: American 

Indian or Alaska Native, Asian, 

Black or African American, Native Hawaiian 

or Other Pacific Islander, and White. There 

will be two categories for data on ethnicity: 

“Hispanic or Latino” and “Not Hispanic or 

Latino.” Persons are offered the option to 

select one or more races.7

Reservation State—A State in which IHS has 

responsibilities for providing health care to 

American Indians or Alaska Natives.

Residence—Usual place of residence of person 

to whom an event occurred. For births and 

deaths, residence is defined as the mother’s 

place of residence.

Service Area—The geographic areas in 

which IHS has responsibilities—”on or near” 

reservations, i.e., contract health service 

delivery areas.

Service Population—AI/AN people identified to 

be eligible for IHS services.

Service Unit—The local administrative unit of 

IHS.

User Population—AI/AN people who have used 

IHS services at least once during the last threeyear period according to their community of 

residence.

Years of Potential Life Lost (YPLL)—A mortality 

indicator that measures the burden of 

premature deaths, calculated by subtracting 

the age at death from age 65 and summing the 

result over all deaths.8

7 http://www.whitehouse.gov/omb/

fedreg/1997standards.html

8 http://webapp.cdc.gov/sasweb/ncipc/ypll9.html
18

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

sources of copies and additional information

Additional AI/AN health status information can be obtained from the IHS Division of 

Program Statistics. Specific responsibilities are as follows:

General Information

Kirk Greenway, Principal Statistician and Director, Division of Program Statistics

Priscilla Sandoval, Program Analyst

Jennifer Joseph, Staff Assistant

Demographic Statistics

Jo Ann Glakas Pappalardo, Senior Health Statistician

Alan Friedman, Health Statistician

Patient Care Statistics

Ying Zhang, Senior Health Statistician

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

Program Statistics at:

Indian Health Service

Office of Public Health Support

Division of Program Statistics 

801 Thompson Building Suite 120

Rockville, Maryland 20852

Phone: 301-443-1180

Email: DPS.Publications@ihs.gov
indian health service, u.s. department of health and human services 19

trends in indian health 2014 edition: indian health service structure

The Indian Health Service is 

composed of twelve regional 

administrative units called 

Area Offices. Some of the 

health programs are operated 

by Tribes, and there are a 

limited number of projects 

to serve Indians living in 

urban areas.

Chart 1.1 Indian Health Service – DHHS

 

There were 61 Indian Health 

Service-operated service 

units that administered 28 

hospitals and 98 health 

centers, school health centers, 

and health stations as of 

October 1, 2013.

Chart 1.2 Indian Health Service Area Offices

 
20

trends in indian health 2014 edition: indian health service structure

indian health service, u.s. department of health and human services

There were 107 Tribally 

operated service units that 

administered 17 hospitals 

and 489 health centers, 

school health centers, health 

stations, and Alaska village 

clinics as of October 1, 2013.

Chart 1.3 American Indian and Alaska Native Tribal Governments

 

As of July 1, 2014, there 

are 33 Urban Indian

Organizations. The Urban 

Indian Organizations consisted 

of 21 full ambulatory care, 

6 limited ambulatory care, 

and 6 outreach and 

referral programs. 

Chart 1.4 Indian Health Care Improvement Act, Title V Urban Health Services

 
indian health service, u.s. department of health and human services 21

trends in indian health 2014 edition: indian health service structure

Indian Health Service 

operated 28 hospitals, 

61 health centers, 3 school 

health centers, and 34 health 

stations as of October 1, 2013. 

Tribes can operate a facility 

under a P.L. 93 638 self 

determination contract 

(Title I) or self-governance 

compact (Title V). Tribes 

operated 17 hospitals (Title I, 

2 hospitals and Title V, 

15 hospitals), 249 health 

centers (Title I, 95 and Title V, 

154), 6 school health centers 

(Title I, 3 and Title V, 3), 70 

health stations (Title I, 39; 

Title V, 30; and Other, 1), 

and 164 Alaska village 

clinics (Title I, 8; Title V, 150; 

and Other, 6).

Chart 1.5 Number of Facilities Operated by IHS and Tribes as of October 1, 2013

TRIBAL

Type of Facility Total IHS Total I V Other

Hospitals 45 28 17 2 15 —

Ambulatory Facilities 587 98 489 145 337 7

Health Centers 310 61 249 95 154 —

School Health Centers 9 3 6 3 3 —

Health Stations 104 34 70 39 30 1

Alaska Village Clinics 164 — 164 8 150 6

I—operated under Title I, P.L. 93-638 Self-Determination Contracts

V—operated under Title V, P.L. 106-260 Tribal Self-Governance Amendment of 2000

Other—operated by a local government, not a tribe, for some Alaska Native villages through a standard procurement contract

The Indian Health Service 

budget (appropriations and 

collections) has increased 

56 percent from FY 2006 to 

FY 2015. However, in constant 

2001 dollars, the budget has 

only increased 33 percent.

Chart 1.6 Trend in Indian Health Service Budget

 
22

trends in indian health 2014 edition: indian health service structure

indian health service, u.s. department of health and human services

Table 1.6 Trend in Indian Health Service Budget

(Dollars in Thousands)

Category FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011

Clinical Services 2,176,220 2,288,939 2,433,761 2,625,707 2,953,559 2,962,621

Preventive Health Services 117,110 123,304 127,587 135,227 144,315 144,027

Other Services

 Urban Health 32,744 33,691 34,547 36,189 43,139 43,053

 Indian Health Professions 31,039 31,375 36,291 37,500 40,743 40,661

 Tribal Management 2,394 2,438 2,490 2,586 2,586 2,581

 Direct Operations/Agency Management 62,194 63,631 63,624 65,345 68,720 68,583

 Self Governance 5,668 5,763 5,835 6,004 6,066 6,054

 Contract Support Cost 264,730 269,730 267,398 282,398 398,490 397,693

 Sub-Total Other 398,769 406,628 410,185 430,022 559,744 558,625

 Total Services 2,692,099 2,818,871 2,971,533 3,190,956 3,657,618 3,665,273

Facilities 353,211 361,226 374,646 390,168 394,757 403,947

TOTAL SERVICES & FACILITIES1 3,045,310 3,180,097 3,346,179 3,581,124 4,052,375 4,069,220

Medicare/Medicaid Collections 606,324 676,797 700,538 719,586 809,987 823,688

Private Insurance Collections 75,101 90,151 94,042 72,598 81,006 80,467

VA Reimubursement3 0 0 0 0 0 0

Quarters Collections 6,288 6,288 6,288 6,288 6,288 6,288

Advance Transfer Approp: Diabetes 150,000 150,000 150,000 150,000 150,000 150,000

TOTAL IHS4

 - CURRENT $s 3,726,735 3,947,045 4,140,759 4,373,308 4,943,368 4,973,375

TOTAL IHS4 - CONSTANT $s 5 3,273,833 3,371,346 3,406,030 3,610,160 4,014,888 3,915,660

Category FY 2012 FY 2013 FY 2014 FY 2015

Clinical Services 3,083,867 2,966,268 3,099,127 3,243,045

Preventive Health Services 147,022 142,963 148,081 155,857

Other Services

 Urban Health 42,984 40,729 40,729 41,375

 Indian Health Professions 40,596 38,467 33,466 38,466

 Tribal Management 2,577 2,442 1,442 2,442

 Direct Operations/Agency Management 71,653 67,894 67,894 68,065

 Self Governance 6,044 5,727 4,727 5,727

 Contract Support Cost 471,437 447,788 587,376 617,205

 Sub-Total Other 635,292 603,047 735,634 773,280

 Total Services 3,866,181 3,712,278 3,982,842 4,172,182

Facilities 440,346 418,570 451,673 461,995

TOTAL SERVICES & FACILITIES1 4,306,528 4,130,847 4,434,515 4,634,177

Medicare/Medicaid Collections 868,682 935,439 1,045,658 1,067,6582

Private Insurance Collections 85,370 85,303 90,303 90,3032

VA Reimubursement3 0 341 36,000 39,000

Quarters Collections 7,500 8,000 8,000 8,000

Advance Transfer Approp: Diabetes 150,000 147,000 147,000 150,000

TOTAL IHS4

 - CURRENT $s 5,260,580 5,151,930 5,606,476 5,831,138

TOTAL IHS4

 - CONSTANT $s 5 4,057,810 3,916,632 4,173,631 4,340,877

1

 Total IHS appropriations.

2

 Estimated collections.

3

 The FY 2014 President’s Budget estimated reimbursements from the Department of Veterans Affairs at $52 million. Estimates are revised to $36 million for FY 2014 and $39 million for FY 2015. 

The FY 2013 and FY 2014 actual collections to date may be an indication that the FY 2014 and FY 2015 collections are overestimated and future year estimates will need to be adjusted accordingly.

4

 Total dollars available to spend.

5

 Bureau of Labor Statistics Consumer Price Index Calculator, 2001 Constant US dollars. FY 2015 and FY 2014 calculated based on 2014 information: http://1.usa.gov/1pmwGPt

SOURCE: IHS HQ/OFA/Division of Budget Formulation
indian health service, u.s. department of health and human services 23

trends in indian health 2014 edition: indian health service structure

As of July 2014, all IHS 

hospitals and eligible 

IHS-operated health centers 

were accredited by the Joint 

Commission, Centers for 

Medicare and Medicaid 

Services (CMS), and the 

Accreditation Association 

for Ambulatory Healthcare 

(AAAHC). Nine of ten Youth 

Regional Treatment Centers 

(YRTC) were accredited 

by Joint Commission and 

the Commission on the 

Accreditation of Rehabilitation 

Facility (CARF). The tenth 

center was in the process of 

receiving accreditation as 

of October 2014.

Chart 1.7 Accreditation Status of Selected Health Facilities, July 2014

 

Table 1.7 Accreditation Status of Hospitals, Health Centers, and Youth Regional 

Treatment Centers, July 2014

Type of Facility Total Accredited1

Not 

Accredited

Percent 

Accredited

IHS Hospitals 28 28 0 100

IHS Eligible Health Centers 492 49 0 100

Youth Regional Treatment Centers3 10 94 0 90

1

 Accrediting bodies are Joint Commission, Centers for Medicare and Medicaid Services (CMS), Accreditation Assoication for Ambulatory 

Healthcare (AAAHC).

2

 Excludes health centers not eligible for accreditation survey and those under Tribal management pursuant to P.L. 93-638.

3

 Provide alcohol and substance abuse treatment. Source: YRTC website: http://bit.ly/1oqZR1b 4

 Accreditation of these facilities is a combination of Joint Commission and the Commission on Accreditation of Rehabilitation Facilities (CARF). 

One center is in the process of receiving accreditation.

NOTE: IHS does not track Tribal Hospitals. 

SOURCE: Office of Resource Access and Partnerships 
24

trends in indian health 2014 edition: indian health service structure

indian health service, u.s. department of health and human services

One hundred percent of 

health center laboratories 

and 100 percent of hospital 

laboratories operated by the 

Indian Health Service were 

accredited as of July 2014.

Chart 1.8 Accreditation Status of IHS Laboratories, July 2014

 

Table 1.8 Indian Health Service Laboratory Accreditation Status, July 2014

Area

IHS Hospital Laboratories IHS Health Center Laboratories 

Total Accredited1

Percent 

Accredited Total Accredited1

Percent 

Accredited

All Areas 39 39 100 82 82 100

Alaska 7 7 100 16 16 100

Albuquerque 4 4 100 10 10 100

Bemidji 2 2 100 6 6 100

Billings 1 1 100 8 8 100

California — — — — — —

Great Plains 8 8 100 2 2 100

Nashville 1 1 100 — — —

Navajo 6 6 100 10 10 100

Oklahoma 3 3 100 6 6 100

Phoenix 6 6 100 14 14 100

Portland — — — 10 10 100

Tucson 1 1 100 — — —

1

 Laboratories hold a certificate of accreditation from the College of American Pathologists, the Joint Commission or the Commission on Laboratory 

Accreditation as mandated under the Clinical Laboratory Improvement Amendments (CLIA) of 1988. Excludes laboratories under Tribal 

management pursuant to P.L. 93-638.

NOTE: California and Portland Areas had no inpatient facilities as of July, 2014.

SOURCE: National Laboratory Consultant
25

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

The IHS service population is 

increasing at an average rate 

of about 1.8 percent per year, 

excluding the impact of new 

Tribes. It is estimated to be 

approximately 2.1 million in 

CY 2014. 

Chart 2.1 American Indian and Alaska Native IHS Service Population

 

The largest percentage of the 

CY 2014 service population, 19, 

is located in the Oklahoma City 

Area, followed by the Navajo Area 

with 13. The Tucson Area has the 

smallest percentage, 2.

Chart 2.2 Indian Health Service – Service Population by Area, Calendar Year 2014

 
26

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

Table 2.1 IHS Service Population by Area, 2000-2020

Area

2000 

(Census) 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

All Areas 1,641,828 1,670,097 1,708,398 1,743,523 1,773,292 1,803,526 1,834,767 1,866,886 1,910,088 1,943,672 1,979,297

(% Growth Rate) 1.72 2.29 2.06 1.71 1.70 1.73 1.75 2.31 1.76 1.83

Alaska 107,715 109,779 111,894 114,038 116,203 118,451 120,727 123,007 125,349 127,757 130,168

Albuquerque 95,385 96,813 98,275 99,777 101,320 102,852 104,469 106,125 107,812 109,543 111,310

Bemidji 106,551 108,181 109,881 111,647 113,483 115,405 117,378 119,419 121,542 123,744 126,010

Billings 58,476 59,648 60,843 62,061 63,305 64,573 65,865 67,178 68,517 69,879 71,264

California 166,665 168,401 170,213 172,100 174,067 176,106 178,224 180,420 182,688 185,037 187,454

Great Plains 100,853 103,043 105,305 107,642 110,046 112,528 115,078 117,694 120,382 123,142 125,973

Nashville 93,138 94,906 106,841 109,034 110,924 112,803 114,650 116,492 128,932 130,849 132,748

Navajo 218,455 221,747 225,047 228,404 231,747 235,129 238,538 241,979 245,372 248,862 252,297

Oklahoma 318,344 323,957 329,727 335,654 341,733 347,975 354,378 360,941 367,657 374,529 381,558

Phoenix 175,342 178,438 181,647 184,982 188,424 191,997 195,662 199,486 203,373 207,409 211,559

Portland 168,199 171,995 175,040 183,989 187,324 190,791 194,337 198,126 201,875 205,748 211,189

Tucson 32,705 33,189 33,685 34,195 34,716 34,916 35,461 36,019 36,589 37,173 37,767

Area 2011 2012 2013 2014 2015* 2016* 2017* 2018* 2019* 2020*

All Areas 2,014,280 2,049,961 2,086,381 2,123,470 2,161,310 2,199,830 2,239,089 2,279,064 2,319,746 2,361,144

(% Growth Rate) 1.77 1.77 1.78 1.78 1.78 1.78 1.78 1.79 1.79 1.78

Alaska 132,621 135,143 137,688 140,260 142,897 145,565 148,257 151,009 153,800 156,620

Albuquerque 113,116 114,960 116,842 118,763 120,723 122,718 124,752 126,825 128,934 131,080

Bemidji 128,338 130,742 133,223 135,768 138,376 141,057 143,815 146,641 149,533 152,500

Billings 72,675 74,108 75,564 77,042 78,545 80,072 81,626 83,201 84,798 86,422

California 189,956 192,534 195,185 197,918 200,727 203,606 206,562 209,597 212,703 215,894

Great Plains 128,877 131,857 134,903 138,022 141,210 144,472 147,805 151,210 154,689 158,237

Nashville 134,625 136,492 138,334 140,161 141,969 143,756 145,531 147,277 149,007 150,722

Navajo 255,830 259,334 262,894 266,450 270,045 273,646 277,284 280,931 284,604 288,295

Oklahoma 388,749 396,094 403,600 411,263 419,083 427,060 435,198 443,493 451,944 460,552

Phoenix 215,832 220,217 224,723 229,334 234,076 238,927 243,895 248,984 254,193 259,521

Portland 215,286 219,485 223,796 228,215 232,726 237,348 242,078 246,914 251,851 256,891

Tucson 38,375 38,995 39,629 40,274 40,933 41,603 42,286 42,982 43,690 44,410

*Projected figure.

SOURCE: Estimated American Indian and Alaska Native service population by Area based on 2000-2009 vital events and the 2000 census bridged-race file.
27

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

The AI/AN male and female 

populations (ages 24 and younger) 

are higher than the corresponding 

male and female populations 

for the U.S. all races. Sixteen 

(16) percent of AI/AN males are 

under age 15 and 15 percent of 

AI/AN females are in this age 

group. The percent for U.S. all 

races under 15 is 11 percent for 

males and 10 percent for females.

Chart 2.3 Population by Age and Sex

2000 Census with Bridged Race Categories

 
28

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

Table 2.3 Age and Sex Percent Distribution

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 2000 Census 

with Bridged Race Categories

Age Group

American Indian and 

Alaska Native, IHS 

Service Area1 U.S. All Races U.S. White

Male Female Male Female Male Female

Percent of Both Sexes:

All Ages 49.335 50.665 49.071 50.930 49.321 50.681

Under 1 year 0.998 0.953 0.700 0.667 0.669 0.636

1-4 years 3.947 3.806 2.779 2.654 2.657 2.526

5-14 years 10.969 10.660 7.460 7.103 7.123 6.755

15-24 years 9.060 8.780 7.158 6.801 6.953 6.519

25-34 years 7.008 7.066 7.125 6.995 7.029 6.737

35-44 years 7.084 7.553 7.963 8.049 8.054 7.971

45-54 years 5.060 5.484 6.611 6.854 6.849 6.957

55-64 years 2.846 3.167 4.152 4.500 4.391 4.677

65-74 years 1.539 1.886 2.941 3.568 3.181 3.787

75-84 years 0.653 0.970 1.740 2.662 1.927 2.922

85 years and over 0.171 0.340 0.442 1.077 0.488 1.194

Percent of Within Each Sex: 

All Ages 100.000 100.000 100.000 100.000 100.000 100.000

Under 1 year 2.023 1.881 1.427 1.310 1.356 1.255

1-4 years 8.000 7.512 5.663 5.211 5.387 4.984

5-14 years 22.234 21.040 15.202 13.947 14.442 13.328

15-24 years 18.364 17.330 14.587 13.354 14.097 12.863

25-34 years 14.205 13.947 14.520 13.735 14.252 13.293

35-44 years 14.359 14.908 16.228 15.804 16.330 15.728

45-54 years 10.256 10.824 13.472 13.458 13.887 13.728

55-64 years 5.769 6.251 8.461 8.836 8.903 9.228

65-74 years 3.119 3.722 5.993 7.006 6.450 7.472

75-84 years 1.324 1.915 3.546 5.227 3.907 5.765

85 years and over 0.347 0.671 0.901 2.115 0.989 2.356

1

 Counts may not sum exactly to 2000 Census with Bridged Race Categories totals found in other tables due to rounding of counts by age and sex for counties 

split between service units. This table should be used for population by age and sex only.
29

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

For AI/AN, 31 percent of the 

population was younger than 

15 years and six percent was 

older than 64 years. For the 

U.S. all races population, the 

corresponding percentages 

were 21 and 12, respectively.

Chart 2.4 Population by Age

2000 Census with Bridged Race Categories

 

Table 2.4 Percent Age Distribution

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White 

Populations, 2000 Census with Bridged Race Categories

Age Group

American Indian 

and Alaska Native1 U.S. All Races U.S. White

All Ages 100.000 100.000 100.000

Under 1 year 1.951 1.366 1.305

1-4 years 7.754 5.433 5.182

5-9 years 10.642 7.256 6.887

10-14 years 10.986 7.307 6.991

15-19 years 10.023 7.180 6.924

20-24 years 7.817 6.778 6.548

25-29 years 7.113 6.841 6.620

30-34 years 6.960 7.279 7.146

35-39 years 7.609 8.030 7.995

40-44 years 7.028 7.982 8.030

45-49 years 5.852 7.166 7.292

50-54 years 4.692 6.299 6.514

55-59 years 3.400 4.805 5.036

60-64 years 2.614 3.847 4.033

65-69 years 1.975 3.373 3.578

70-74 years 1.450 3.137 3.390

75-79 years 1.027 2.635 2.891

80-84 years 0.595 1.767 1.958

85 years & over 0.511 1.519 1.682

Median Age 25.0 34.9 36.2

1

Counts may not sum exactly to 2000 Census with Bridged Race Categories totals found in other tables due to rounding of counts by age and sex 

for counties split between service units. This table should be used for population by age and sex only.
30

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

According to the 2000 Census, 

70.9 percent of AI/AN (alone) 

age 25 and older are high school 

graduates or higher, compared with 

80.4 percent for the U.S. all races 

population. For bachelor’s degree 

or higher, these percentages are 

11.5 and 24.4, respectively.

Chart 2.5 Educational Attainment

American Indians and Alaska Natives (alone) and U.S. All Races, 2000 Census

 

According to the 2000 Census, 

13.1 percent of AI/AN (alone) 

males age 16 and older were 

unemployed, compared with 

5.7 percent for the U.S. all races 

male population. For females, 

these percentages were 11.7 

and 5.8, respectively.

Chart 2.6 Employment Status by Sex

American Indians and Alaska Natives (alone) and U.S. All Races, 2000 Census

 
31

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

According to the 2000 Census, the 

median household income in 1999 

for AI/AN (alone) was $30,599, 

compared with $41,994 for the 

U.S. all races population. During 

this period, 25.7 percent of AI/AN 

lived below the poverty level in 

contrast to 12.4 percent for the 

U.S. all races population.

Chart 2.7 Income Status in 1999

American Indians and Alaska Natives (alone) and U.S. All Races, 2000 Census

 

Table 2.5 Selected Economic Profiles for the United States, 2000 Census

American 

Indian and 

Alaska Native 

(alone) All Races

White 

(alone)

Black 

(alone)

Asian 

(alone)

Native 

Hawaiian and 

Other Pacific 

Islander (alone)

Hispanic1

(alone) 

Educational Attainment (Persons 25 years and older):

Percent less than 9th grade 11.1 7.5 5.9 7.9 10.7 7.5 27.8

Percent 9th to 12th grade, no diploma 18.0 12.1 10.5 19.8 8.9 14.2 19.8

Percent high school graduate or higher 70.9 80.4 83.6 72.3 80.4 78.2 52.4

Percent bachelor’s degree or higher 11.5 24.4 26.1 14.3 44.1 13.8 10.4

Civilian Employment Status by Sex (Persons 16 years and older):

Percent unemployed, males 13.1 5.7 4.6 12.0 5.0 10.8 8.2

Percent unemployed, females 11.7 5.8 4.6 10.8 5.3 11.0 10.6

Household Income in 1999:

Median household income $30,599 $41,994 $44,687 $29,423 $51,908 $42,717 $33,676

Percent Below the Poverty Level by Age:

All ages 25.7 12.4 9.1 24.9 12.6 17.7 22.6

Under 5 years 34.5 18.2 12.5 36.7 6.4 11.6 28.8

5 years 33.6 17.6 12.0 35.2 1.5 2.4 28.5

6 to 11 years 31.7 16.9 11.3 33.5 9.5 14.5 28.2

12 to 17 years 29.0 14.8 10.0 29.4 9.9 12.8 26.2

18 to 64 years 22.6 11.1 8.6 20.7 65.1 55.5 19.9

65 to 74 years 21.9 8.5 6.7 21.4 4.4 2.1 18.4

75 years and older 26.3 11.5 10.0 26.6 3.1 1.0 21.8

1

 Data for Hispanic persons are not tabulated separately by race. Data shown for Hispanic persons include all persons of Hispanic origin of any race.

NOTE: Selected Population Groups: American Indian and Alaska Native (alone); White (alone), Black or African American (alone); Asian (alone); and Native Hawaiian and other Pacific Islander (alone); 

and Hispanic (alone).

SOURCE: U.S. Bureau of the Census, Census 2000 Summary File 3
32

trends in indian health 2014 edition: population statistics

indian health service, u.s. department of health and human services

The estimated CY 2015 population 

was 1,082,983 AI/AN people 

residing in the Urban Indian 

Health Programs service area. 

Of these, 59 percent resided 

within comprehensive programs, 

23 percent in urban programs 

offering outreach and referral 

programs, and 18 percent in 

limited programs.

Chart 2.8 Urban Indian Health Programs Service Area Population by Category

 

Table 2.8 Urban Indian Health Programs Service Area Population by Category

Traditional Urban Indian Health Programs

Estimated CY 2015 

Population

Percent of Total American 

Indians in Urban Projects

Total 1,082,983 100.0

Comprehensive Programs 640,009 59.1

Outreach and Referral Programs 245,790 22.7

Limited Programs 197,184 18.2

Demonstration NA NA

NOTE: NA denotes data not available. Demonstration Project population is not collected by the IHS, Office of Urban Indian Health Programs.

SOURCE: IHS Division of Program Statistics, “Projected American Indian/Alaska Native Population for Specified Urban Programs by County, 

2000 to 2020”.
33

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The birth rate for the IHS service 

population in 2007-2009 was 

1.8 times the rate for the U.S. 

all races population in 2008, 

(25.4 and 14.0, respectively). 

The AI/AN birth rate is 90 percent 

greater than the rate for the 

U.S. white population of 13.4.

Chart 3.1 Birth Rates

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

34 indian health service, u.s. department of health and human services

Table 3.1 Number and Rate of Live Births

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races 

and White Populations, 1955-2008 (Rate per 1,000 Population)

American Indian and 

Alaska Native U.S. All Races U.S. White

Calendar Year(s) Number Rate Number Rate Rate1

 (2009) 44,312

2007-2009 (2008) 44,959 25.4 4,247,694 14.0 13.4

2006-2008 (2007) 44,483 23.6 4,316,233 14.3 13.7

2005-2007 (2006) 43,164 23.3 4,265,555 14.2 13.7

2004-2006 (2005) 41,000 22.9 4,138,349 14.0 13.4

2003-2005 (2004) 39,927 22.6 4,112,052 14.0 13.5

2002-2004 (2003) 38,658 22.3 4,089,950 14.1 13.6

2001-2003 (2002) 37,624 21.5 4,021,726 13.9 13.5

2000-2002 (2001) 36,930 22.2 4,025,933 14.1 13.7

1999-2001 (2000) 36,599 22.2 4,058,814 14.4 13.9

1998-2000 (1999) 35,559 22.4 3,959,417 14.2 13.7

1997-1999 (1998) 35,680 22.5 3,941,553 14.3 13.8

1996-1998 (1997) 33,923 22.7 3,880,894 14.2 13.7

1995-1997 (1996) 33,599 23.7 3,891,494 14.4 13.9

1994-1996 (1995) 32,548 23.8 3,899,589 14.6 14.1

1993-1995 (1994) 32,876 23.8 3,952,767 15.0 14.3

1992-1994 (1993) 33,429 25.0 4,000,240 15.4 14.6

1991-1993 (1992) 33,894 26.1 4,065,014 15.8 15.0

1990-1992 (1991) 34,083 27.1 4,110,907 16.2 15.3

1989-1991 (1990) 33,554 28.0 4,158,212 16.7 15.8

1984-1986 (1985) 30,194 28.4 3,760,561 15.8 15.0

1979-1981 (1980) 25,346 29.1 3,612,258 15.9 14.9

1972-1974 (1973) 50,562 29.2 3,136,965 14.8 13.8

1954-1956 (1955) 17,028 37.5 4,097,000 25.0 23.8

1

 Starting in 1991 birth data for the U.S. White population are shown for the race of the mother, rather than the race of the child (as shown for the 

years prior to 1991).

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific 

counties in the IHS service area. Reservation State data and county data are not directly comparable. The AI/AN birth rate column presents data 

for the three-year period specified; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate 

total AI/AN and U.S. population births for a one-year period respectively. 

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
35

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

For 2007-2009, 7.1 percent of all 

AI/AN births in the IHS service area 

were considered low birthweight 

(less than 2,500 grams). This was 

better than the figure for the U.S. 

all races population (8.2 percent 

in 2008). For AI/AN mothers 

under the age of 15 the percent 

of low birthweight is 1.5 times 

less than U.S. all races (8.1 and 

12.4 respectively).

Chart 3.2 Low Birthweight (less than 2,500 grams) as a Percent of Total Live Births 

by Age of Mother

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

36 indian health service, u.s. department of health and human services

Table 3.2 Low Birthweight (less than 2,500 grams) by Age of Mother

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and 

U.S. All Races and White Populations, 2008

Age of Mother

Total 

Live Births

Number Low 

Birthweight

Percent Low 

Birthweight

American Indian and Alaska Native

All Ages 133,7541 9,469 7.1

Under 20 years 23,936 1,661 6.9

Under 15 years 283 23 8.1

15-19 years 23,653 1,638 6.9

20-24 years 45,759 2,973 6.5

25-29 years 34,647 2,354 6.8

30-34 years 18,986 1,450 7.6

35-39 years 8,423 795 9.4

40 years and over 2,003 236 11.8

U.S. All Races

All Ages 4,247,6942 347,209 8.2

Under 20 years 440,522 42,987 9.8

Under 15 years 5,764 712 12.4

15-19 years 434,758 42,275 9.7

20-24 years 1,052,184 86,419 8.2

25-29 years 1,195,774 88,381 7.4

30-34 years 956,716 72,527 7.6

35-39 years 488,875 43,473 8.9

40 years and over 113,623 13,422 11.8

U.S. White

All Ages 3,274,1633 163,561 5.0

Under 20 years 309,714 14,638 4.7

Under 15 years 3,312 117 3.5

15-19 years 306,402 14,521 4.7

20-24 years 791,852 36,713 4.6

25-29 years 942,837 43,801 4.6

30-34 years 757,815 38,086 5.0

35-39 years 383,486 23,080 6.0

40 years and over 88,459 7,243 8.2

1

 Excludes 150 AI/AN live births with birthweight not stated.

2

 Excludes 4,361 U.S. all races live births with birthweight not stated.

3

 Excludes 1,942 U.S. white live births with birthweight not stated.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
37

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The AI/AN population experiences 

more birth of high birthweights 

than the U.S. all races population. 

Gestational diabetes often 

accompanies high birthweight 

pregnancy. In 2007-2009, 9.8 

percent of all babies in the IHS 

service area were high birthweight 

(4,000 grams or more). In contrast, 

the U.S. all races percentage 

was 2.2 percentage points lower 

(7.6 percent) in 2008. For AI/AN 

mothers under the age of 15 the 

percent of high birthweight is 

2.7 times greater than U.S. all 

races (8.1 and 3.0 respectively).

Chart 3.3 High Birthweight (4,000 grams or more) as a Percent of Total Live Births 

by Age of Mother

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

38 indian health service, u.s. department of health and human services

Table 3.3 High Birthweight (4,000 grams or more) by Age of Mother

American Indians and Alaska Natives, IHS Service Area, 2007-2009 and 

U.S. All Races and White Populations, 2008

Age of Mother

Total 

Live Births

Number High 

Birthweight

Percent High 

Birthweight

American Indian and Alaska Native

All Ages 133,7541 13,148 9.8

Under 20 years 23,936 1,792 7.5

Under 15 years 283 23 8.1

15-19 years 23,653 1,769 7.5

20-24 years 45,759 4,016 8.8

25-29 years 34,647 3,697 10.7

30-34 years 18,986 2,344 12.3

35-39 years 8,423 1,078 12.8

40 years and over 2,003 221 11.0

U.S. All Races

All Ages 4,247,6942 323,822 7.6

Under 20 years 440,522 18,505 4.2

Under 15 years 5,764 175 3.0

15-19 years 434,758 18,330 4.2

20-24 years 1,052,184 63,754 6.1

25-29 years 1,195,774 95,853 8.0

30-34 years 956,716 88,093 9.2

35-39 years 488,875 47,294 9.7

40 years and over 113,623 10,323 9.1

U.S. White

All Ages 3,274,1633 278,946 8.5

Under 20 years 309,402 14,957 4.8

Under 15 years 3,312 125 3.8

15-19 years 306,402 14,832 4.8

20-24 years 791,852 53,945 6.8

25-29 years 942,837 83,573 8.9

30-34 years 757,815 76,864 10.1

35-39 years 383,486 40,808 10.6

40 years and over 88,459 8,799 9.9

1

 Excludes 150 AI/AN live births with birthweight not stated.

2

 Excludes 4,361 U.S. all races live births with birthweight not stated.

3

 Excludes 1,942 U.S. white live births with birthweight not stated.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
39

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

During 2007-2009, 39 percent of 

AI/AN mothers were under the age 

of 20 when their first child was 

born and 12 percent were under 

the age of 20 when their second 

child was born.

Chart 3.4 Birth Order by Age of Mother, Percent Within Birth Order,

American Indians and Alaska Natives

 

For the U.S. all races population, 

21 percent of mothers were under 

age 20 when they had their first 

child. The percent of mothers 

under the age of 20 who gave 

birth to their second child 

dropped dramatically to 5 percent.

Chart 3.5 Birth Order by Age of Mother, Percent Within Birth Order, U.S. All Races

 

For the U.S. white population, 

19 percent of mothers were 

under age 20 when they had 

their first child. The percent 

of mothers under the age of 

20 who gave birth to their 

second child dropped to 

5 percent.

Chart 3.6 Birth Order by Age of Mother, Percent Within Birth Order, U.S. White

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

40 indian health service, u.s. department of health and human services

Table 3.4 Number and Percent Distribution of Live Births by Age of Mother within Birth 

Order

American Indians and Alaska Natives, IHS Service Area, 2007-2009 and 

U.S. All Races and White Populations, 2008

Age Group

Total 

Live Births

Live Birth Order

1st Child 2nd Child 3rd Child 4th Child 5th Child 6th+ Child

American Indian and Alaska Native, IHS Service Area

All Ages 133,7541 48,515 36,090 23,636 12,875 6,277 5,678

All Ages 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Under 20 years 17.9 38.5 11.9 3.2 0.6 0.1 0.0

20-24 years 34.2 37.8 43.6 33.2 21.2 11.3 3.6

25-29 years 25.9 15.3 27.3 35.9 38.7 36.9 24.7

30-34 years 14.2 5.8 12.0 18.6 25.4 31.4 36.9

35-39 years 6.3 2.2 4.4 7.6 11.4 16.1 25.7

40-44 years 1.4 0.4 0.8 1.4 2.5 4.0 8.3

45-54 years 0.1 0.0 0.0 0.1 0.1 0.2 0.7

U.S. All Races

All Ages 4,247,6942 1,703,921 1,330,540 705,117 291,351 108,138 82,051

All Ages 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Under 20 years 10.4 20.8 5.3 1.5 0.4 0.1 5.0

20-24 years 24.8 30.1 26.1 19.2 13.3 8.5 3.2

25-29 years 28.2 25.3 29.6 31.8 31.4 29.3 20.0

30-34 years 22.5 15.9 24.7 28.2 30.9 33.1 33.3

35-39 years 11.5 6.5 11.9 16.0 19.1 22.3 29.9

40-44 years 2.5 1.3 2.2 3.1 4.6 6.3 12.4

45-54 years 0.2 0.1 0.1 0.2 0.3 0.5 1.2

U.S. White

All Ages 3,274,1633 1,307,615 1,040,996 551,853 221,546 78,475 56,354

All Ages 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Under 20 years 9.5 19.3 4.7 1.2 0.3 0.1 0.0

20-24 years 24.2 30.1 25.4 17.7 11.3 6.8 2.6

25-29 years 28.8 26.4 30.5 32.0 30.8 27.5 16.8

30-34 years 23.1 16.2 25.1 29.5 32.5 34.3 33.0

35-39 years 11.7 6.6 11.9 16.3 20.1 24.0 32.3

40-44 years 2.5 1.4 2.2 3.1 4.7 6.8 14.0

45-54 years 0.2 0.1 0.1 0.2 0.3 0.5 1.3

0.0 Quantity more than zero but less than 0.05. 

1

 Excludes 683 AI/AN births with birth order not reported.

2

 Excludes 26,576 U.S. all races births with birth order not reported.

3

 Excludes 17,324 U.S. white births with birth order not reported.

NOTE: Percents may not sum to 100.0 due to rounding. 

SOURCE: Rates for U.S. All Races and U.S. White: Martin JA, Hamilton BE, Sutton PD, et al. Births: Final data for 2008. National vital statistics reports; 

vol 59 no 1. Hyattsville, MD: National Center for Health Statistics. 2010.
41

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The maternal mortality rate 

for AI/AN dropped from 28.5 

(rate per 100,000 live births) in 

1972 1974 to 23.2 in 2007-2009, 

a decrease of 19 percent. The 

AI/AN 2007-2009 rate (23.2) 

is 90.2 percent higher than the 

U.S. white rate of 12.2 for 2008. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates. 

Chart 3.7 Maternal Death Rates

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

42 indian health service, u.s. department of health and human services

Table 3.7 Maternal Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and 

White Populations, 1958-2008 (Rate per 100,000 Live Births)

Calendar Year(s)

American Indian 

and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Rate Rate Rate U.S. 

All Races

U.S. 

Unadjusted Adjusted White 1

2007-2009 (2008) 19.4 23.2 15.5 12.2 1.5 1.9

2006-2008 (2007) 15.8 19.6 12.7 10.0 1.5 2.0

2005-2007 (2006) 14.8 20.2 13.3 9.5 1.5 2.1

2004-2006 (2005) 11.3 16.9 15.1 11.1 1.1 1.5

2003-2005 (2004) 10.9 15.9 13.1 9.3 1.2 1.7

2002-2004 (2003) 6.9 10.3 12.1 8.7 0.9 1.2

2001-2003 (2002) 10.0 12.7 8.9 6.0 1.4 2.1

2000-2002 (2001) 9.0 12.6 9.9 7.2 1.3 1.8

1999-2001 (2000) 12.8 16.5 9.8 7.5 1.7 2.2

1998-2000 (1999) 8.7 10.7 9.9 6.8 1.1 1.6

1997-1999 (1998) 5.8 5.8 7.1 5.1 0.8 1.1

1996-1998 (1997) 7.0 8.0 8.4 5.8 1.0 1.4

1995-1997 (1996) 8.2 9.3 7.6 5.1 1.2 1.8

1994-1996 (1995) 6.2 6.2 7.1 4.2 0.9 1.5

1993-1995 (1994) 3.1 3.1 8.3 6.2 0.4 0.5

1992-1994 (1993) 4.1 5.1 7.5 4.8 0.7 1.1

1991-1993 (1992) 7.1 9.1 7.8 5.0 1.2 1.8

1990-1992 (1991) 9.1 11.2 7.9 5.8 1.4 1.9

1989-1991 (1990) 10.1 11.2 8.2 5.4 1.4 2.1

1984-1986 (1985) 4.6 4.6 7.8 5.2 0.6 0.9

1979-1981 (1980) 9.7 9.7 9.2 6.7 1.1 1.4

1972-1974 (1973) 28.5 28.5 15.2 10.7 1.9 2.7

1957-1959 (1958) 82.6 82.6 37.6 26.3 2.2 3.1

1

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data are presented above for the year in which maternal death data were first collected (1958) and as close to the year in which IHS was 

established (1955) as is possible. For this year Reservation State data are shown. Data from 1972 forward are drawn from specific counties in the 

IHS service area. Reservation State data and county data are not directly comparable. The AI/AN maternal death rate columns present data for the 

three-year period specified; the U.S. all races and U.S. white columns present data for a one-year period. 

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
43

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The infant mortality rate for 

AI/AN dropped from 25.0 

(rate per 1,000 live births) in 

1972-1974 to 8.3 in 2007-2009, 

a decrease of 67 percent. The 

2007-2009 rate is 26 percent 

higher than the U.S. all races rate 

of 6.6 for 2008. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 3.8 Infant Mortality Rates

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

44 indian health service, u.s. department of health and human services

Table 3.8 Infant Mortality Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White 

Populations, 1955-2008 (Rate per 1,000 Live Births)

Calendar Year(s)

American Indian 

and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Rate Rate Rate U.S. 

All Races

U.S. 

Unadjusted Adjusted White 1

2007-2009 (2008) 7.3 8.3 6.6 5.6 1.3 1.5

2006-2008 (2007) 7.1 8.3 6.8 5.6 1.2 1.5

2005-2007 (2006) 7.2 8.4 6.7 5.6 1.3 1.5

2004-2006 (2005) 7.0 8.2 6.9 5.7 1.2 1.4

2003-2005 (2004) 6.9 8.3 6.8 5.7 1.2 1.5

2002-2004 (2003) 6.9 8.1 6.9 5.7 1.2 1.5

2001-2003 (2002) 7.2 8.4 7.0 5.8 1.2 1.5

2000-2002 (2001) 7.2 8.5 6.9 5.7 1.2 1.5

1999-2001 (2000) 7.2 8.8 6.9 5.7 1.3 1.5

1998-2000 (1999) 7.3 8.7 7.1 5.8 1.2 1.5

1997-1999 (1998) 7.5 8.8 7.2 6.0 1.2 1.5

1996-1998 (1997) 7.6 8.9 7.2 6.0 1.2 1.5

1995-1997 (1996) 7.1 8.5 7.3 6.1 1.2 1.4

1994-1996 (1995) 7.6 9.3 7.6 6.3 1.2 1.5

1993-1995 (1994) 8.0 9.7 8.0 6.6 1.2 1.5

1992-1994 (1993) 8.7 10.9 8.4 6.8 1.3 1.6

1991-1993 (1992) 8.8 10.9 8.5 6.9 1.3 1.6

1990-1992 (1991) 9.4 11.7 8.9 7.3 1.3 1.6

1989-1991 (1990) 10.2 12.1 9.2 7.7 1.3 1.6

1984-1986 (1985) 11.1 13.4 10.6 9.3 1.3 1.4

1979-1981 (1980) 15.4 18.2 12.6 11.0 1.4 1.7

1972-1974 (1973) 22.2 25.0 17.7 15.8 1.4 1.6

1954-1956 (1955) 62.7 26.4 23.6

1

 Adjusted - specifies a rate or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties 

in the IHS service area. Reservation State data and county data are not directly comparable. AI/AN death rate columns present data for the three-year 

period specified. U.S. all races and U.S. white columns present data for a one-year period. 

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
45

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The neonatal mortality rate 

for AI/AN in 2007-2009 

(4.1 deaths per 1,000 live 

births) was 5 percent lower 

than the U.S. all races rate 

(4.3) and 12 percent higher 

than the U.S. white rate (3.6) 

for 2008. AI/AN fare much 

worse in comparison during 

the postneonatal period. The 

postneonatal rate for AI/AN (4.2) 

was 1.8 and 2.3 times the U.S. all 

races (2.3) and U.S. white (2.0) 

populations rates, respectively. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates.

Chart 3.9 Infant Mortality Rates by Age

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

46 indian health service, u.s. department of health and human services

Table 3.9 Infant Mortality Rates by Age

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and 

White Populations, 1973-2008 (Rate per 1,000 Live Births)

American Indian and Alaska Native

Infant 

Mortality Rates

Neonatal

Under 28 Days

Postneonatal

28 Days-11 Months

Calendar Years Unadjusted Adjusted Unadjusted Adjusted Unadjusted Adjusted

2007-2009 7.3 8.3 3.6 4.1 3.7 4.2

2006-2008 7.1 8.3 3.5 4.2 3.7 4.1

2005-2007 7.2 8.4 3.5 4.2 3.7 4.3

2004-2006 7.0 8.2 3.5 4.2 3.5 4.0

2003-2005 6.9 8.3 3.3 4.1 3.6 4.1

2002-2004 6.9 8.1 3.7 4.5 3.7 4.2

2001-2003 7.2 8.4 3.5 4.3 3.9 4.4

2000-2002 7.2 8.5 3.6 4.4 3.6 4.1

1999-2001 7.2 8.8 3.5 4.3 3.8 4.3

1998-2000 7.3 8.7 3.6 4.2 3.7 4.2

1997-1999 7.5 8.8 3.5 4.3 3.8 4.3

1996-1998 7.6 8.9 3.6 4.4 3.9 4.4

1995-1997 7.1 8.5 3.4 4.0 3.7 4.4

1994-1996 7.6 9.3 3.6 4.5 4.0 4.8

1993-1995 8.0 9.7 3.8 4.6 4.2 5.1

1992-1994 8.7 10.9 4.1 5.2 4.6 5.8

1991-1993 8.8 10.9 4.0 4.9 4.9 6.0

1990-1992 9.4 11.7 4.3 5.3 5.1 6.4

1989-1991 10.2 12.1 4.7 5.4 5.5 6.7

1988-1990 10.6 12.5 4.8 5.6 5.8 7.0

1987-1989 11.0 12.7 5.1 5.5 5.9 7.1

1986-1988 11.1 12.9 5.2 5.9

1985-1987 11.1 13.3 5.3 5.9

1984-1986 11.1 13.4 5.0 6.0

1983-1985 11.1 13.5 5.1 6.0

1982-1984 11.5 13.9 5.1 6.4

1981-1983 12.3 14.7 5.3 7.0

1980-1982 13.2 15.8 5.9 7.3

1979-1981 15.4 18.2 7.2 8.1

1972-1974 22.2 25.0 10.2 12.0

U.S. All Races U.S. White

Calendar Year

Infant 

Mortality 

Rates

Neonatal

Under 

28 Days

Postneonatal 

28 Days11 Months

Infant 

Mortality 

Rates

Neonatal

Under 

28 Days

Postneonatal 

28 Days11 Months

2008 6.6 4.3 2.3 5.6 3.6 2.0

2007 6.8 4.4 2.3 5.6 3.7 1.9

2006 6.7 4.5 2.2 5.6 3.7 1.9

2005 6.9 4.5 2.3 5.7 3.8 1.9

2004 6.8 4.5 2.3 5.7 3.8 1.9

2003 6.9 4.6 2.2 5.7 3.9 1.8

2002 7.0 4.7 2.3 5.8 3.9 1.9

2001 6.9 4.5 2.3 5.7 3.8 1.9

2000 6.9 4.6 2.3 5.7 3.8 1.9

1999 7.1 4.7 2.3 5.8 3.8 1.9

1998 7.2 4.8 2.4 6.0 3.9 2.0

1997 7.2 4.8 2.5 6.0 4.0 2.0

1996 7.3 4.8 2.6 6.1 4.0 2.1

1995 7.6 4.9 2.7 6.3 4.1 2.2

1994 8.0 5.1 2.9 6.6 4.2 2.4

1993 8.4 5.3 3.1 6.8 4.3 2.5

1992 8.5 5.4 3.1 6.9 4.4 2.6

1991 8.9 5.6 3.4 7.3 4.5 2.8

1990 9.2 5.9 3.4 7.7 4.8 2.8

1989 9.8 6.2 3.6 8.2 5.2 2.9

1988 10.0 6.3 3.6 8.5 5.3 3.1

1987 10.1 6.5 3.6 8.6 5.4 3.1

1986 10.4 6.7 3.6 8.9 5.7 3.1

1985 10.6 7.0 3.7 9.3 6.0 3.2

1984 10.8 7.0 3.8 9.4 6.1 3.2

1983 11.2 7.3 3.9 9.7 6.3 3.3

1982 11.5 7.7 3.8 10.1 6.7 3.3

1981 11.9 8.0 3.9 10.5 7.0 3.4

1980 12.6 8.5 4.1 11.0 7.4 3.5

1973 17.7 13.0 4.7 15.8 11.8 4.0

1

 Adjusted – specifies a rate or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 forward, shown above, are drawn from specific counties in the IHS service area for infant mortality by age. Adjusted rates to 

compensate for misreporting of AI/AN race on state death certificates are currently unavailable for AI/AN neonatal and postneonatal mortality for data 

years 1972-1986.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
47

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

infant deaths (2007-2009) were 

congenital malformations, 

deformations, and chromosomal 

abnormalities followed by sudden 

infant death syndrome (SIDS). 

For the U.S. all races population 

(2008), they were congenital 

malformations, deformations, 

and chromosomal abnormalities 

followed by disorders relating 

to short gestation and low 

birthweight, and for the U.S. 

white population (2008), they 

were congenital malformations, 

deformations, and chromosomal 

abnormalities followed by 

disorders relating to short 

gestation and low birthweight. 

Chart 3.10 Leading Causes of Infant Deaths (Births to Under 1 Year)

 

The two leading causes of AI/AN 

neonatal deaths (2007-2009) 

and the U.S. all races and white 

populations in 2008 were 

congenital malformations, 

deformations, and chromosomal 

abnormalities followed by 

disorders relating to short 

gestation and low birthweight. 

For the U.S. all races population 

(2008), they were disorders 

relating to short gestation and 

low birthweight followed by 

congenital malformations, 

deformations, and chromosomal 

abnormalities, and for the U.S. 

white population (2008), they 

were congenital malformations, 

deformations, and chromosomal 

abnormalities followed by 

disorders relating to short 

gestation and low birthweight.

Chart 3.11 Leading Causes of Neonatal Deaths (Under 28 Days)

 
trends in indian health 2014 edition: natality and infant/maternal mortality statistics

48 indian health service, u.s. department of health and human services

The two leading causes of 

AI/AN postneonatal deaths 

(2007-2009) and the U.S. all 

races and white populations in 

2008 were sudden infant death 

syndrome (SIDS) and congenital 

malformations, deformations, 

and chromosomal abnormalities. 

Chart 3.12 Leading Causes of Postneonatal Deaths (28 Days to Under 1 Year)

 
49

trends in indian health 2014 edition: natality and infant/maternal mortality statistics

indian health service, u.s. department of health and human services

Table 3.10 Leading Causes of Infant Deaths by Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008 

(Rate per 100,000 Live Births)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

Total Infant Deaths

All Causes 967 1,112 723.0 831.4 600.6 554.8 1.4 1.5

Congenital malformations, deformations, and 

chromosomal abnormalities 208 244 155.5 182.4 133.7 132.0 1.4 1.4

Sudden infant death syndrome 124 149 92.7 111.4 55.3 47.3 2.0 2.4

Disorders relating to short gestation and low birthweight 93 111 69.5 83.0 111.9 80.7 0.7 1.0

Unintentional injuries 74 82 55.3 61.3 30.9 26.9 2.0 2.3

Newborns affected by maternal complications 

of pregnancy 35 37 26.2 27.7 41.8 34.2 0.7 0.8

Newborns affected by complications of placenta, 

cord, and membranes 31 31 23.2 23.2 25.1 21.2 0.9 1.1

Disease of the circulatory system 26 29 19.4 21.7 14.0 11.5 1.6 1.9

Bacteria sepsis of newborn 26 27 19.4 20.2 16.5 13.4 1.2 1.5

Homicide 20 26 14.9 19.4 7.8 6.3 2.5 3.1

Necrotizing entercolitis of newborn 20 24 14.9 17.9 8.9 9.6 2.0 1.9

Pneumonia and influenza 24 22 17.9 16.4 5.5 4.7 3.0 3.5

Diseases of the digestive system 17 22 12.7 16.4 8.3 5.7 2.0 2.9

All other causes 269 308

Neonatal Deaths

All Causes 400 470 299.1 351.4 428.7 362.0 0.8 1.0

Congenital malformations, deformations, and 

chromosomal abnormalities 124 149 92.7 111.4 94.1 94.7 1.2 1.2

Disorders relating to short gestation and low birthweight 88 106 65.8 79.3 109.1 78.8 0.7 1.0

Newborns affected by maternal complications 

of pregnancy 35 37 26.2 27.7 41.3 33.7 0.7 0.8

Newborns affected by complications of placenta, cord, 

and membranes 31 31 23.2 23.2 24.9 20.9 0.9 1.1

Bacteria sepsis of newborn 23 25 17.2 18.7 15.9 13.0 1.2 1.4

Necrotizing entercolitis of newborn 16 20 12.0 15.0 11.0 8.4 1.4 1.8

Respiratory distress syndrome 12 16 9.0 12.0 14.7 11.9 0.8 1.0

Neonatal hemorrhage 11 14 8.2 10.5 12.7 10.7 0.8 1.0

Atelectasis 9 11 6.7 8.2 7.7 6.7 1.1 1.2

Intrauterine hypoxia and birth asphyxia 7 9 5.2 6.7 8.4 7.5 0.8 0.9

All other causes 44 52

Postneonatal Deaths

All Causes 420 492 314.0 359.6 231.8 193.1 1.6 1.9

Sudden infant death syndrome 113 137 84.5 102.4 50.5 42.9 2.0 2.4

Congenital malformations, deformations, and 

chromosomal abnormalities 84 95 62.8 71.0 39.6 37.3 1.8 1.9

Unintentional injuries 66 71 49.3 53.1 27.9 24.2 1.9 2.2

Homicide 19 26 14.2 19.4 7.3 5.8 2.7 3.3

Pneumonia and influenza 242 222 17.92 16.42 5.3 4.7 3.1 3.5

Diseases of the circulatory system 20 22 14.9 16.4 11.5 9.2 1.4 1.8

Diseases of the digestive system 17 20 12.7 15.0 12.2 8.8 1.2 1.7

Diseases of the nervous system (including meningitis) 16 16 12.0 12.0 7.8 7.3 1.5 1.6

Other and unspecified diseases of respiratory system 9 13 6.7 9.7 5.6 4.0 1.7 2.4

Certain infectious and parasitic diseases 

(including septicemia) 12 13 9.0 6.8 5.1 5.1 1.3 1.3

All other causes 40 57

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 The AI/AN adjusted numbers and rates for pneumonia and influenza is lower than the unadjusted rate because the linked birth/infant death file (used to obtain the adjusted counts of infant deaths) 

had fewer deaths for this cause then did the unadjusted mortality file (2007-2009 data).

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
50

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for ages 1 to 

4 were unintentional injuries and 

homicide. Unintentional injury 

deaths were 3.9 times higher 

for AI/AN than U.S. all races 

and 4 times higher than 

U.S. white populations.

Chart 4.1 Death Rates, Leading Causes: Ages 1 to 4 Years

 

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 234 337 52.7 75.9 29.3 27.2 2.6 2.8

Unintentional injuries 103 158 23.2 35.6 9.1 8.9 3.9 4.0

 Motor vehicle 49 72 11.0 16.2 2.6 2.5 6.2 6.5

 Other unintentional injuries 54 86 12.2 19.4 6.5 6.4 3.0 3.0

Homicide 17 23 3.8 5.2 2.6 2.0 2.0 2.6

Congenital abnormalies 16 21 3.6 4.7 0.0 0.0 * *

Diseases of the heart 11 17 2.5 3.8 1.2 0.9 3.2 4.2

Malignant neoplasms 7 11 1.6 2.5 2.4 2.6 1.0 1.0

Pneumonia and influenza 6 7 1.4 1.6 0.9 0.7 1.8 2.3

Cerebrovascular 2 3 0.5 0.7 0.4 0.4 1.8 1.8

Meningococcal infections 2 3 0.5 0.7 0.0 0.0 * *

Conditions originating in prenatal period 2 2 0.5 0.5 0.3 0.3 1.7 1.7

Chronic lower respiratory diseases 2 2 0.5 0.5 0.3 0.3 1.7 1.7

All other causes 66 90

*

Figure does not meet standard of reliability or precision.

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/

Table 4.1 Ten Leading Causes of Death for Decedents 1 to 4 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)
51

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN

deaths (2007-2009) for ages 5 

to 14 years were unintentional 

injuries and suicide. For the U.S. 

all races and white populations 

(2008) the two leading causes of 

death were unintentional injuries 

and malignant neoplasms.

Chart 4.2 Death Rates, Leading Causes: Ages 5 to 14 Years

 

Table 4.2 Ten Leading Causes of Death for Decedents 5 to 14 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 261 324 26.4 32.8 13.9 13.0 2.4 2.5

Unintentional injuries 103 129 10.4 13.0 4.6 4.5 2.8 2.9

 Motor vehicle 58 76 5.9 7.7 2.5 2.6 3.1 3.0

 Other unintentional injuries 45 53 4.5 5.3 2.1 1.9 2.5 2.8

Suicide 32 33 3.2 3.3 0.5 0.5 6.6 6.6

Malignant neoplasms 18 23 1.8 2.3 2.2 2.2 1.0 1.0

Congenital anamolies 12 18 1.2 1.8 0.4 0.3 4.5 6.0

Homicide 10 12 1.0 1.2 0.8 0.5 1.5 2.4

Septicemia 8 9 0.8 0.9 0.2 0.1 4.5 9.0

Pneumonia and influenza 7 9 0.7 0.9 0.2 0.2 4.5 4.5

Diseases of the heart 6 8 0.6 0.8 0.6 0.5 1.3 1.6

Chronic lower respiratory disease 3 3 0.3 0.3 0.3 0.1 1.0 3.0

Aortic aneurysm and dissection 3 3 0.3 0.3 0.1 0.1 3.0 3.0

All other causes 59 77 5.7 6.6

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
52

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN

deaths (2007-2009) and the 

U.S. white populations (2008) 

for ages 15 to 24 years were 

unintentional injuries and suicide. 

For the U.S. all races population 

(2008) the two leading causes of 

death were unintentional injuries 

and homicide.

Chart 4.3 Death Rates, Leading Causes: Ages 15 to 24 Years

 

Table 4.3 Ten Leading Causes of Death for Decedents 15 to 24 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 1,599 2,013 150.0 188.9 74.2 71.0 2.5 2.7

Unintentional injuries 802 1047 75.3 98.3 32.5 36.1 3.0 2.7

 Motor vehicle 538 723 50.5 67.9 20.6 22.4 3.3 3.0

 Other unintentional injuries 264 324 24.8 30.4 11.9 13.7 2.6 2.2

Suicide 350 423 32.8 39.7 9.9 10.6 4.0 3.7

Homicide 154 180 14.5 16.9 12.2 6.3 1.4 2.7

Malignant neoplasms 34 41 3.2 3.8 3.8 3.9 1.0 1.0

Diseases of the heart 33 41 3.1 3.8 2.5 1.9 1.5 2.0

Congenital anomalies 20 25 1.9 2.3 0.4 0.3 5.8 7.7

Pneumonia and influenza 11 16 1.0 1.5 0.5 0.5 3.0 3.0

Chronic liver disease and cirrhosis 8 10 0.8 0.9 0.1 0.1 9.0 9.0

Cerebrovascular 5 8 0.5 0.7 0.4 0.4 1.8 1.8

Pregnancy childbirth peurperium 6 6 0.6 0.6 0.4 0.3 1.5 2.0

All other causes 176 215

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
53

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for ages 25 

to 44 years were unintentional 

injuries and chronic liver disease 

and cirrhosis. For the U.S. all races 

and U.S. white populations (2008) 

the two leading causes of death 

were unintentional injuries and 

malignant neoplasms.

Chart 4.4 Death Rates, Leading Causes: Ages 25 to 44 Years

 

Table 4.4 Ten Leading Causes of Death for Decedents 25 to 44 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 4,763 5,768 308.0 373.0 144.0 137.7 2.6 2.7

Unintentional injuries 1,525 1,924 98.6 124.4 37.2 40.5 3.3 3.1

 Motor vehicle 695 880 44.9 56.9 14.8 15.4 3.8 3.7

 Other unintentional injuries 830 1,044 53.7 67.5 22.4 25.1 3.0 2.7

Chronic liver disease and cirrhosis 512 615 33.1 39.8 3.6 3.9 11.1 10.2

Diseases of the heart 415 499 26.8 32.3 17.7 15.7 1.8 2.1

Suicide 384 448 24.8 29.0 14.6 16.4 2.0 1.8

Malignant neoplasms 275 318 17.9 20.6 19.7 19.3 1.0 1.1

Homicide 258 302 16.7 19.5 9.1 5.5 2.1 3.5

Diabetes mellitus 136 173 8.8 11.2 2.9 2.5 3.9 4.5

Pneumonia and influenza 85 97 5.5 6.3 1.5 1.4 4.2 4.5

Septicemia 62 68 4.0 4.4 1.5 1.3 2.9 3.4

HIV 61 68 3.9 4.4 4.6 2.4 1.0 1.8

All other causes 1,050 1,256

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
54

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for ages 45 

to 54 years were diseases of the 

heart and malignant neoplasms. 

In 2008, the U.S. all races and 

U.S. white populations; the two 

leading causes of death were 

malignant neoplasms and 

diseases of the heart.

Chart 4.5 Death Rates, Leading Causes: Ages 45 to 54 Years

 

Table 4.5 Ten Leading Causes of Death for Decedents 45 to 54 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 4,625 5,225 661.6 747.4 419.6 399.8 1.8 1.9

Diseases of the heart 704 809 100.7 115.7 85.2 79.0 1.4 1.5

Malignant neoplasms 726 802 103.9 114.7 113.4 109.9 1.0 1.0

Unintentional injuries 710 797 101.6 114.0 45.8 47.7 2.5 2.4

 Motor vehicle 231 258 33.0 36.9 13.7 14.0 2.7 2.6

 Other unintentional injuries 479 539 68.6 77.1 32.1 33.7 2.4 2.3

Chronic liver disease and cirrhosis 590 689 84.4 98.6 18.5 19.5 5.3 5.1

Diabetes mellitus 230 267 32.9 38.2 12.6 11.2 3.0 3.4

Cerebrovascular diseases 122 139 17.5 19.9 13.7 10.7 1.5 1.9

Suicide 111 115 15.9 16.5 18.6 21.4 0.9 0.8

Septicemia 98 109 14.0 15.6 5.7 4.8 2.7 3.3

Vital hepatitis 88 106 12.6 15.2 6.1 6.3 2.5 2.4

Pneumonia and influenza 97 105 13.9 15.0 5.1 4.7 2.9 3.2

All other causes 1,149 1,287

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
55

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for ages 55 

to 64 years were malignant 

neoplasms and diseases of the 

heart. In 2008, the two leading 

causes of death for both the 

U.S. all races and U.S. white 

populations (2008) were 

malignant neoplasm and 

diseases of the heart.

Chart 4.6 Death Rates, Leading Causes: Ages 55 to 64 Years

 

Table 4.6 Ten Leading Causes of Death for Decedents 55 to 64 Years of Age

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 5,332 6,170 1,158.3 1,340.4 867.1 833.5 1.5 1.6

Malignant neoplasms 1,316 1,546 285.9 335.9 304.7 300.0 1.1 1.1

Diseases of the heart 1,080 1,266 234.6 275.0 195.3 183.1 1.4 1.5

Diabetes mellitus 406 486 88.2 105.6 33.3 30.0 3.2 3.5

Chronic liver disease and cirrhosis 414 475 89.9 103.2 25.0 25.7 4.1 4.0

Unintentional injuries 329 357 71.5 77.6 37.4 37.7 2.1 2.1

 Motor vehicle 113 121 24.5 26.3 12.7 13.0 2.1 2.0

 Other unintentional injuries 216 236 47.0 51.3 24.7 24.7 2.1 2.1

Chronic lower respiratory diseases 204 241 44.3 52.4 41.1 43.5 1.3 1.2

Cerebrovascular diseases 170 201 36.9 43.7 30.6 25.8 1.4 1.7

Nephritis, nephrotic syndrome, 

and nephrosis 128 146 27.8 31.7 14.1 10.9 2.2 2.9

Pneumonia and influenza 104 113 22.6 24.5 10.9 10.1 2.2 2.4

Septicemia 91 98 19.8 21.3 13.3 11.7 1.6 1.8

All other causes 1,093 1,241

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
56

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for 65 years of 

age and older were diseases of the 

heart and malignant neoplasms. 

For the U.S. all races and U.S. white 

populations (2008) diseases of the 

heart and malignant neoplasms 

were also the two leading causes 

of death. Diabetes mellitus was 

the third leading cause of death 

for AI/AN.

Chart 4.7 Death Rates, Leading Causes: Ages 65 Years of Age and Older

 

Table 4.7 Ten Leading Causes of Death for Decedents 65 Years of Age and Older

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Causes 15,086 17,218 3,682.7 4,203.2 4,641.4 4,728.6 0.9 0.9

Diseases of the heart 3,459 4,018 844.4 980.8 1,278.4 1,301.4 0.8 0.8

Malignant neoplasms 3,234 3,721 789.5 908.8 1,010.2 1,021.4 0.9 0.9

Diabetes mellitus 1,118 1,335 272.9 325.9 131.2 122.5 2.5 2.7

Chronic lower respiratory disease 927 1,105 226.3 269.7 312.6 334.9 0.9 0.8

Cerebrovascular diseases 811 936 198.0 228.5 295.3 295.7 0.8 0.8

Pneumonia and influenza 472 513 115.2 125.2 124.8 127.1 1.0 1.0

Unintentional injuries 480 507 117.2 123.8 101.5 107.0 1.2 1.2

 Motor vehicle 110 119 26.9 29.1 16.8 17.1 1.7 1.7

 Other unintentional injuries 370 388 90.3 94.7 84.7 89.9 1.1 1.1

Nephritis, nephrotic syndrome, 

and nephrosis 451 506 110.1 123.5 102.9 98.0 1.2 1.3

Alzheimer’s disease 376 419 91.8 102.3 210.4 223.3 0.5 0.5

Septicemia 313 342 76.4 83.5 69.7 66.3 1.2 1.3

All other causes 3,445 3,816

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
57

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of AI/AN 

deaths (2007-2009) for all ages 

were diseases of the heart and 

malignant neoplasms.

Chart 4.8 Death Rates for Leading Causes for All Ages

American Indians and Alaska Natives (2007-2009)

 

Table 4.8 Ten Leading Causes of Death for Decedents of All Ages

American Indians and Alaska Natives, IHS Service Area, 2007-2009

(Crude Rate per 100,000 Population)

Number Rate

Cause of Death Unadjusted Adjusted1 Unadjusted Adjusted1

All Causes 32,867 38,170 574.5 667.2

Diseases of the heart 5,729 6,679 100.2 116.8

Malignant neoplasms 5,612 6,464 98.1 113.0

Unintentional injuries 4,128 5,001 72.2 87.4

 Motor vehicle 1,809 2,262 31.6 39.5

 Other unintentional injuries 2,319 2,739 40.6 47.9

Diabetes mellitus 1,894 2,267 33.1 39.6

Chronic liver disease and cirrhosis 1,764 2,046 30.8 35.8

Chronic lower respiratory diseases 1,250 1,492 22.0 26.1

Cerebrovascular diseases 1,162 1,347 20.3 23.5

Suicide 950 1,096 16.6 19.2

Pneumonia and influenza 805 881 14.1 15.4

Nephritis 700 647 12.4 14.0

All other causes 8,873 10,250

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Causes of death listed are based on the order of adjusted rate of deaths.
58

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The two leading causes of deaths 

for AI/AN males (2007-2009) 

were diseases of the heart and 

malignant neoplasms.

Chart 4.9 Death Rates, Leading Causes: Males

American Indians and Alaska Natives (2007-2009)

 

The two leading causes of deaths 

for AI/AN females (2007-2009) 

were malignant neoplasms and 

diseases of the heart.

Chart 4.10 Death Rates, Leading Causes: Females

American Indians and Alaska Natives (2007-2009)

 
59

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.9 Leading Causes of Death by Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009

(Rate per 100,000 Population)

Number Rate

Cause of Death Unadjusted Adjusted1 Unadjusted Adjusted1

MALE

All Causes 18,084 20,998 640.3 743.5

Diseases of the heart 3,314 3,916 117.3 138.7

Malignant neoplasms 2,898 3,352 102.6 118.7

Unintentional injuries 2,775 3,268 98.3 115.7

 Motor vehicle 1,185 1,441 42.0 51.0

 Other unintentional injuries 1,590 1,827 56.3 64.7

Diabetes mellitus 969 1,163 34.3 41.2

Chronic liver disease and cirrhosis 988 1,143 35.0 40.5

Suicide 725 829 25.7 29.4

Chronic lower respiratory diseases 615 732 21.8 25.9

Cerebrovascular diseases 531 629 18.8 22.3

Homicide 436 503 15.4 17.8

Pneumonia and influenza 395 438 14.0 15.5

All other causes 4,438 5,025

FEMALE

All Causes 14,787 17,173 510.5 592.9

Malignant neoplasms 2,714 3,112 93.7 107.4

Diseases of the heart 2,415 2,763 83.4 95.4

Unintentional injuries 1,353 1,733 46.7 59.8

 Motor vehicle 624 821 21.5 28.3

 Other unintentional injuries 729 912 26.4 33.1

Diabetes mellitus 925 1,104 31.9 38.1

Chronic liver disease and cirrhosis 776 903 26.8 31.2

Chronic lower respiratory diseases 643 760 22.2 26.2

Cerebrovascular diseases 631 718 21.8 24.8

Nephritis, nephrotic syndrome, 

and nephrosis 413 466 14.3 16.1

Pneumonia and influenza 410 443 14.2 15.3

Septicemia 317 349 10.9 12.1

All other causes 3,830 4,822

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.
60

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted death 

rates for all causes of death for 

years 2007-2009 is 1.2 times 

the rate for U.S. all races (2008); 

tuberculosis (5.5 times), chronic 

liver disease and cirrhosis 

(4.7 times), diabetes (3.1 times), 

unintentional injuries (2.4) and 

homicide (1.9). AI/AN rates were 

below those of the U.S. all races for 

Alzheimer’s disease (0.5 times), 

HIV infection (0.9 times), and 

major cardiovascular disease 

(0.9 times). These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

the state death certificates.

Chart 4.11 Selected Age-Adjusted Death Rates

Ratio of American Indians and Alaska Natives (2007-2009) to U.S. All Races (2008)

 

Table 4.11 Age-Adjusted Death Rates

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008 

(Rate per 100,000 Population)

American Indian 

and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1

 to:

Rate

Rate Rate

U.S. 

All Races

U.S. 

Cause of Death Unadjusted Adjusted White 1

All Causes 818.0 943.0 774.9 767.2 1.2 1.2

Major cardiovascular diseases 204.1 235.9 250.9 298.9 0.9 0.8

 Diseases of the heart 156.9 182.4 192.1 189.3 0.9 1.0

 Cerebrovascular diseases 33.8 39.1 42.1 40.4 0.9 1.0

 Atherosclerosis 2.0 2.4 2.4 2.5 1.0 1.0

 Hypertension 8.1 9.0 10.0 8.6 0.9 1.0

Malignant neoplasms 148.7 170.8 176.4 175.9 1.0 1.0

Unintentional injuries 79.5 94.5 38.8 40.7 2.4 2.3

 Motor vehicle 32.0 39.3 12.9 13.3 3.0 3.0

 Other unintentional injuries 47.5 55.2 25.9 27.4 2.1 2.0

Diabetes mellitus 51.0 61.0 20.0 20.2 3.1 3.0

Chronic lower respiratory diseases 36.5 43.2 44.7 47.1 1.0 0.9

Chronic liver disease and cirrhosis 37.4 43.1 9.2 9.6 4.7 4.5

Pneumonia and influenza 22.1 24.1 16.9 16.7 1.4 1.4

Suicide 16.2 18.5 11.6 12.9 1.6 1.4

Alzheimer’s disease 13.1 11.6 24.4 26.7 0.5 0.4

Homicide 9.6 11.0 5.9 3.7 1.9 3.0

Human immunodeficiency virus (HIV) infection 2.8 3.0 3.3 1.7 0.9 1.8

Tuberculosis, all forms 1.1 1.1 0.2 0.1 5.5 11.0

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
61

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific death rate for

AI/AN (2007-2009) was more 

than double the U.S. all races 

rate (2008) for age groups 1 

through 44. The AI/AN rate was 

less than the U.S. all races rate 

for only one age group, 85 years 

and older. These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on the 

state death certificates.

Chart 4.12 Age-Specific Death Rates

Ratio of American Indians and Alaska Natives (2007-2009) to U.S. All Races (2008)

 

The age-specific death rate for 

AI/AN (2007-2009) was more 

than double the U.S. white rate 

(2008) for age groups 1 through 

44. The AI/AN rate was less than 

the U.S. white rate for only one 

age group, 85 years and older. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race on 

the state death certificates.

Chart 4.13 Age-Specific Death Rates

Ratio of American Indians and Alaska Natives (2007-2009) to U.S. White (2008)

 
62

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.12 Age-Specific Death Rates

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and Selected U.S. Populations, 2008

(Rate per 100,000 Population)

American Indian and Alaska Native U.S. Rate

Ratio of American 

Indian and Alaska 

Native1

 to:

Number Rate

All Races White Black

U.S. 

All Races

U.S. 

Age Ggroup Unadjusted Adjusted White 1 Unadjusted Adjusted1

Under 1 967 1,112 908.7 1,045.0 678.9 581.6 1,225.8 1.5 1.8

 1-4 234 337 52.7 75.9 29.3 27.2 42.4 2.6 2.8

 5-14 261 324 26.4 32.8 13.9 13.0 19.3 2.4 2.5

15-24 1,599 2,013 150.1 188.9 74.2 71.0 102.3 2.5 2.7

25-34 1,843 2,340 222.0 281.9 105.1 100.0 163.0 2.7 2.8

35-44 2,920 3,428 407.7 478.6 181.0 172.9 276.5 2.6 2.8

45-54 4,625 5,225 661.6 747.4 419.6 399.8 644.3 1.8 1.9

55-64 5,332 6,170 1,158.3 1,340.4 867.1 833.5 1,328.1 1.5 1.6

65-74 5,754 6,772 2,365.7 2,784.3 1,958.4 1,927.3 2,630.9 1.4 1.4

75-84 5,499 6,435 4,532.9 5,304.4 4,998.1 5,017.4 5,663.6 1.1 1.1

85+ 3,833 4,014 8,497.0 8,898.2 14,332.4 14,530.0 13,786.7 0.6 0.6

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races, U.S. White and U.S. Black: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/

Of all AI/AN people who died 

during 2007-2009, 25 percent 

were under 45 years of age. These 

AI/AN rates have been adjusted 

to compensate for misreporting 

of AI/AN race on the state death 

certificates. This compared to 

8 percent for the U.S. all races 

population (2008).

Chart 4.14 Deaths by Age

 
63

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Twenty-five (25) percent of AI/AN 

deaths (2007-2009) were for those 

with ages under 45. This compared 

with fifteen (15) percent of black 

decedents and seven (7) percent 

of white decedents in 2008 who 

were under 45 years of age. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race on 

the state death certificates.

Chart 4.15 Deaths by Age and Race

 

Twenty-nine (29) percent of 

AI/AN male deaths (2007-2009) 

pertained to ages under 45. 

This compared with 21 percent 

for AI/AN female deaths. These 

AI/AN rates have been adjusted 

to compensate for misreporting 

of AI/AN race on the state 

death certificates.

Chart 4.16 Deaths by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
64

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.14 Number and Percent Distribution of Deaths by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and Selected U.S. Populations, 2008

American Indian and Alaska Native

Both Sexes Male Female

Number Percent Number Percent Number Percent

Age Ggroup Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

All Ages 32,871 38,178 100.0 100.0 18,084 20,998 100.0 100.0 14,787 17,173 100.0 100.0

Under 1 967 1,112 2.9 2.9 544 626 3.0 3.0 423 486 2.9 2.8

 1 to 4 234 337 0.7 0.9 130 188 0.7 0.9 104 149 0.7 0.9

 5 to 14 261 324 0.8 0.8 147 181 0.8 0.9 114 143 0.8 0.8

15 to 24 1,599 2,013 4.9 5.3 1,135 1,360 6.3 6.5 464 653 3.1 3.8

25 to 34 1,843 2,340 5.6 6.1 1,261 1,535 7.0 7.3 582 805 3.9 4.7

35 to 44 2,920 3,428 8.9 9.0 1,821 2,100 10.1 10.0 1,099 1,328 7.4 7.7

45 to 54 4,625 5,225 14.1 13.7 2,811 3,141 15.5 15.0 1,814 2,084 12.3 12.1

55 to 64 5,332 6,170 16.2 16.2 3,100 3,563 17.1 17.0 2,232 2,607 15.1 15.2

65 to 74 5,754 6,772 17.5 17.7 3,083 3,641 17.0 17.3 2,671 3,131 18.1 18.2

75 to 84 5,499 6,435 16.7 16.9 2,682 3,193 14.8 15.2 2,817 3,239 19.1 18.9

85 and over 3,833 4,014 11.7 10.5 1,369 1,469 7.6 7.0 2,464 2,545 16.7 14.8

Age Not Stated 4 4 0.0 0.0 1 1 0.0 0.0 3 3 0.0 0.0

United States

Age Ggroup All Races White Black

Number of Deaths, All Ages 2,471,984 2,120,233 289,072

Percent Distribution, All Ages 100.0 100.0 100.0

Under 1 1.1 0.9 3.0

 1 to 4 0.2 0.2 0.4

 5 to 14 0.2 0.2 0.4

15 to 24 1.3 1.1 2.5

25 to 34 1.7 1.5 3.2

35 to 44 3.1 2.7 5.5

45 to 54 7.5 6.8 12.4

55 to 64 12.0 11.3 16.9

65 to 74 16.2 16.0 17.9

75 to 84 26.4 27.3 20.5

85 and over 30.1 32.1 17.4

Age Not Stated 0.0 0.0 0.0

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.
65

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

death rate due to poisoning 

in 2007-2009 (29.3 deaths 

per 100,000 population) is 

2.7 times higher than what it 

was in 1972-1974 (10.9). The 

2007-2009 rate is 2.2 times 

the U.S. all races rate of 13.4 

for 2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on the state death certificates.

Chart 4.17 Age-Adjusted Poisoning Death Rates

 
66

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.17 Poisoning Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1972-2008

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 466 573

2007-2009 (2008) 447 550 23.8 29.3 13.4 14.9 2.2 2.0

2006-2008 (2007) 345 436 21.1 26.0 13.2 14.5 2.0 1.8

2005-2007 (2006) 313 384 17.7 21.7 12.4 13.4 1.8 1.6

2004-2006 (2005) 253 309 14.7 17.4 11.0 11.8 1.6 1.5

2003-2005 (2004) 252 304 13.5 15.8 10.3 11.2 1.5 1.4

2002-2004 (2003) 217 252 13.5 15.9 9.9 10.6 1.6 1.5

2001-2003 (2002) 178 210 11.7 13.4 9.2 9.7 1.5 1.4

2000-2002 (2001) 147 166 10.1 11.5 7.8 8.1 1.5 1.4

1999-2001 (2000) 137 154 9.7 11.1 7.2 7.4 1.5 1.5

1998-2000 (1999) 154 185 9.6 11.0 7.0 7.2 1.6 1.5

1997-1999 (1998) 135 154 9.9 11.5 6.7 6.8 1.7 1.7

1996-1998 (1997) 130 153 9.7 11.4 6.5 6.5 1.8 1.8

1995-1997 (1996) 129 162 9.2 10.8 6.2 6.2 1.7 1.7

1994-1996 (1995) 97 109 9.0 10.5 6.2 6.1 1.7 1.7

1993-1995 (1994) 96 109 7.3 8.3 6.2 6.1 1.3 1.4

1992-1994 (1993) 74 86 7.1 8.0 6.1 6.0 1.3 1.3

1991-1993 (1992) 81 94 6.6 7.5 5.6 5.6 1.3 1.3

1990-1992 (1991) 72 83 7.2 8.2 5.3 5.2 1.5 1.6

1989-1991 (1990) 83 95 7.1 8.2 5.1 5.1 1.6 1.6

1988-1990 (1989) 73 85 7.2 8.2 5.5 5.4 1.5 1.5

1987-1989 (1988) 69 79 6.6 7.5 5.6 5.5 1.3 1.4

1986-1988 (1987) 62 71 6.8 7.5 5.5 5.5 1.4 1.4

1985-1987 (1986) 72 77 6.2 6.8 5.5 5.7 1.2 1.2

1984-1986 (1985) 50 54 6.3 6.9 5.1 5.3 1.4 1.3

1983-1985 (1984) 57 66 6.7 7.5 5.0 5.1 1.5 1.5

1982-1984 (1983) 65 75 7.8 8.9 5.0 5.2 1.8 1.7

1981-1983 (1982) 61 67 7.9 9.1 5.0 5.1 1.8 1.8

1980-1982 (1981) 47 57 6.8 7.7 5.1 5.2 1.5 1.5

1979-1981 (1980) 44 47 6.4 7.4 5.1 5.2 1.5 1.4

1972-1974 (1973) 158 174 9.8 10.9 6.1 6.2 1.8 1.8

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified. one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
67

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific death rate due 

to poisoning for AI/AN males 

(2007-2009) was higher than 

AI/AN females. The AI/AN male 

rate was higher for all age groups 

except those males ages under 1, 

1 to 4, and 85 years and older. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race on 

the state death certificates.

Chart 4.18 Poisoning Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
68

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.18 Poisoning Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 3.82 1.92 3.72 1.82 3.82 1.92

1-4 years 1.1 1.8 0.4 0.9 1.8 2.7

5-14 years 0.5 0.5 0.6 0.6 0.4 0.4

15-24 years 16.1 20.8 22.8 27.4 9.3 14.1

25-34 years 31.7 43.4 40.4 52.1 22.7 34.4

35-44 years 47.3 58.8 59.1 71.8 35.8 46.1

45-54 years 45.6 53.4 55.4 63.5 36.7 44.1

55-64 years 25.9 29.5 29.9 33.6 22.2 25.9

65-74 years 8.6 8.6 14.4 14.4 3.8 3.8

75-84 years 5.8 5.8 11.8 11.8 1.4 1.4

85 years + 8.9 8.9 6.7 6.7 9.9 9.9

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 0.0 0.0 0.0 0.0 0.0 0.0

1-4 years 0.2 0.3 0.0 0.2 0.0 0.0

5-14 years 0.2 0.2 0.1 0.1 0.2 0.0

15-24 years 8.1 12.4 3.7 9.8 15.0 4.3

25-34 years 15.7 23.4 8.0 18.5 27.3 9.4

35-44 years 19.0 25.0 13.1 21.3 27.6 14.8

45-54 years 22.7 28.8 16.7 24.1 30.0 18.2

55-64 years 11.4 14.9 8.1 11.2 14.1 8.5

65-74 years 4.2 5.3 3.3 4.1 4.9 3.4

75-84 years 3.4 4.0 2.9 3.4 4.0 3.0

85 years + 4.2 4.3 4.2 4.2 4.3 4.2

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 The adjusted rate for age less than one year is the same or lower than the unadjusted rate because the linked birth/infant death file (used to obtain 

the adjusted counts of infant deaths) had the same or fewer deaths for this cause than did the unadjusted mortality file (2007-2009 data).

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
69

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

unintentional injury death rate 

(156.4) was 66 percent greater 

for years 1979-1981 than the 

2007-2009 rate (94.5). The 

2007-2009 rate is 2.4 times 

the U.S. all races rate (39.2) for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on the state death certificates.

Chart 4.19 Age-Adjusted Unintentional Injury Death Rates

 
70

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.19 Unintentional Injury Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. All Races

Rate

U.S. White 

Rate

Total Death Number

All Unintentional 

Injuries Rate Motor Vehicle Rate All 

Unintentional 

Injuries

Motor 

Vehicle

All 

Unintentional 

Injuries

Motor 

Calendar Year(s) Unadjusted Adjusted Vehicle 1 Unadjusted Adjusted1 Unadjusted Adjusted1

 (2009) 1,398 1,677

2007-2009 (2008) 1,369 1,661 79.5 94.5 32.0 39.3 39.2 12.8 41.4 13.3

2006-2008 (2007) 1,361 1,663 80.2 95.3 35.1 42.9 40.4 14.3 42.1 14.8

2005-2007 (2006) 1,390 1,671 80.4 95.0 36.8 44.7 40.2 14.9 41.7 15.4

2004-2006 (2005) 1,325 1,577 80.4 93.8 38.6 46.5 39.5 15.1 40.7 15.6

2003-2005 (2004) 1,223 1,442 81.0 93.7 40.0 47.6 38.1 15.1 39.2 15.5

2002-2004 (2003) 1,287 1,516 81.9 94.7 42.4 51.0 37.6 15.2 38.6 15.6

2001-2003 (2002) 1,242 1,468 81.6 93.8 42.2 50.7 37.1 15.6 37.9 16.0

2000-2002 (2001) 1,097 1,280 78.8 90.1 41.9 49.9 35.7 15.2 36.1 15.4

1999-2001 (2000) 1,101 1,274 78.1 88.9 40.5 48.1 34.9 15.2 35.1 15.5

1998-2000 (1999) 1,091 1,287 81.2 92.6 40.3 47.5 35.3 15.1 35.2 15.2

1997-1999 (1998) 1,087 1,272 85.3 97.1 38.4 45.1 35.8 15.8 35.6 15.8

1996-1998 (1997) 1,103 1,277 85.5 97.1 37.2 43.2 35.5 15.9 35.0 16.0

1995-1997 (1996) 1,055 1,212 83.8 95.1 37.0 43.0 35.7 16.2 35.3 16.3

1994-1996 (1995) 1,016 1,180 85.7 97.2 37.8 44.0 35.5 16.3 34.9 16.3

1993-1995 (1994) 1,022 1,173 84.5 96.1 36.9 42.9 35.3 16.1 34.5 16.2

1992-1994 (1993) 1,007 1,168 87.8 99.4 37.9 43.8 35.4 16.0 34.6 16.1

1991-1993 (1992) 977 1,126 91.0 103.2 39.7 46.2 34.4 15.8 33.6 15.9

1990-1992 (1991) 988 1,154 91.3 103.2 39.9 46.3 35.8 17.0 35.0 17.1

1989-1991 (1990) 970 1,101 93.4 104.9 40.4 46.5 37.5 18.4 36.7 18.5

1988-1990 (1989) 969 1,097 96.4 107.6 41.2 47.1 39.0 18.8 37.9 19.0

1987-1989 (1988) 1,012 1,148 101.1 112.7 43.3 49.5 40.2 19.5 39.1 19.7

1986-1988 (1987) 1,000 1,135 103.0 115.5 45.3 52.0 39.6 19.2 38.7 19.5

1985-1987 (1986) 983 1,120 101.4 113.8 44.8 51.5 40.0 19.1 39.1 19.3

1984-1986 (1985) 913 1,034 103.0 115.9 44.5 51.2 39.9 18.6 39.0 18.8

1983-1985 (1984) 921 1,049 107.5 121.2 45.2 52.5 40.1 18.8 39.4 19.2

1982-1984 (1983) 907 1,038 118.4 133.9 48.9 56.7 40.4 18.2 39.5 18.5

1981-1983 (1982) 999 1,136 122.7 138.5 52.7 60.9 41.4 18.9 40.7 19.2

1980-1982 (1981) 975 1,101 132.9 149.3 58.9 67.4 44.7 21.3 44.0 21.8

1979-1981 (1980) 1,058 1,195 141.2 156.4 63.4 71.5 47.7 22.3 46.5 22.6

1972-1974 (1973) 3,001 3,292 204.1 223.2 90.6 100.4 59.5 26.7 57.5 26.2

1954-1956 (1955) 714 184.0 97.6 54.3 24.6 52.2 24.3

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and county 

data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. white columns 

present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified. one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
71

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific death rate for 

unintentional injuries for AI/AN 

males (2007-2009) was higher for 

all age groups in comparison with 

AI/AN females. For the 75-84 years 

age group, the AI/AN male rate 

was 2.6 times the AI/AN female 

rate. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.20 Unintentional Injury Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
72

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.20 Unintentional Injury Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 69.5 77.1 88.7 96.0 49.7 57.4

1-4 years 23.2 35.6 28.5 43.2 17.8 27.8

5-14 years 10.4 13.0 12.9 15.9 7.8 10.1

15-24 years 75.3 98.3 104.4 128.4 45.3 67.2

25-34 years 89.5 118.8 124.3 156.4 53.7 79.9

35-44 years 109.5 131.0 148.5 173.6 71.4 89.3

45-54 years 101.6 114.0 144.4 159.1 62.4 72.8

55-64 years 71.5 77.6 106.7 114.1 39.9 44.9

65-74 years 83.9 88.4 111.6 117.9 60.6 63.6

75-84 years 141.8 154.1 213.7 239.2 89.6 92.5

85 years + 230.5 232.8 261.6 268.3 215.2 215.2

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 31.8 34.6 29.0 27.1 30.3 23.8

1-4 years 9.1 10.9 7.2 8.9 10.7 7.0

5-14 years 4.6 5.7 3.4 4.5 5.6 3.3

15-24 years 32.5 47.8 16.4 36.1 53.0 18.1

25-34 years 36.3 55.6 16.8 39.9 60.6 18.5

35-44 years 38.1 53.9 22.4 41.1 57.4 24.5

45-54 years 45.8 63.5 28.6 47.7 65.2 30.4

55-64 years 37.4 54.0 22.0 37.7 53.5 22.7

65-74 years 43.9 60.1 29.9 44.3 60.1 30.5

75-84 years 105.7 135.1 84.9 110.5 139.4 89.7

85 years + 318.3 394.5 282.4 333.8 411.4 297.0

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
73

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted suicide 

death rate (18.5) for 1979-1981 

is equal to the age-adjusted rate 

for years 2007-2009. The highest 

suicide rate (19.8) was for years 

2004-2006 and is 7 percent higher 

than the current age-adjusted rate 

(18.5). The 2007-2009 rate (18.5) 

is 1.6 times greater than the 

U.S. all races rate (11.6) for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.21 Age-Adjusted Suicide Death Rates

 
74

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.21 Suicide Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 336 390

2007-2009 (2008) 311 368 16.2 18.5 11.6 12.9 1.6 1.4

2006-2008 (2007) 292 338 16.2 18.6 11.3 12.5 1.6 1.5

2005-2007 (2006) 326 376 16.4 19.0 10.9 12.2 1.7 1.6

2004-2006 (2005) 317 374 17.0 19.8 10.9 12.1 1.8 1.6

2003-2005 (2004) 315 369 16.2 18.8 11.0 12.0 1.7 1.6

2002-2004 (2003) 255 289 15.6 17.9 10.8 11.8 1.7 1.5

2001-2003 (2002) 261 303 15.2 17.1 10.9 12.0 1.6 1.4

2000-2002 (2001) 258 286 15.3 17.3 10.7 11.7 1.6 1.5

1999-2001 (2000) 238 273 15.2 17.0 10.4 11.3 1.6 1.5

1998-2000 (1999) 235 265 15.0 16.9 10.5 11.3 1.6 1.5

1997-1999 (1998) 252 283 15.2 17.2 12.2 11.1 1.4 1.5

1996-1998 (1997) 234 273 16.7 17.9 11.2 12.1 1.6 1.5

1995-1997 (1996) 225 262 15.1 17.2 11.5 12.4 1.5 1.4

1994-1996 (1995) 205 228 16.1 17.9 11.8 12.7 1.5 1.4

1993-1995 (1994) 242 263 15.5 17.0 11.9 12.7 1.4 1.3

1992-1994 (1993) 204 226 15.9 17.6 12.1 12.9 1.5 1.4

1991-1993 (1992) 193 219 15.1 16.8 12.0 12.8 1.4 1.3

1990-1992 (1991) 184 200 15.1 16.8 12.3 13.2 1.4 1.3

1989-1991 (1990) 195 218 15.2 16.9 12.5 13.3 1.4 1.3

1988-1990 (1989) 192 217 15.6 17.4 12.3 13.1 1.4 1.3

1987-1989 (1988) 185 206 15.7 17.6 12.5 13.3 1.4 1.3

1986-1988 (1987) 187 206 15.5 17.0 12.8 13.7 1.3 1.2

1985-1987 (1986) 158 168 15.3 16.8 13.0 13.9 1.3 1.2

1984-1986 (1985) 172 193 14.5 15.9 12.5 13.4 1.3 1.2

1983-1985 (1984) 148 165 15.1 16.8 12.6 13.5 1.3 1.2

1982-1984 (1983) 161 177 15.4 16.9 12.4 13.2 1.4 1.3

1981-1983 (1982) 154 164 16.6 17.8 12.5 13.3 1.4 1.3

1980-1982 (1981) 157 166 16.2 17.3 12.3 13.1 1.4 1.3

1979-1981 (1980) 146 156 17.2 18.5 12.2 13.0 1.5 1.4

1972-1974 (1973) 351 374 27.6 29.4 13.2 13.9 2.2 2.1

1954-1956 (1955) 39 11.9 9.9 10.4

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
75

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific suicide death 

rate (2007-2009) for AI/AN males 

was higher for all age groups in 

comparison with AI/AN females. 

The AI/AN male rate peaked 

at (58.7 deaths per 100,000 

population) for age group 

15-24 years which is 2.9 times 

that of the AI/AN female rate 

(20.2). The greatest disparity 

between males and females 

was for age group 65-74 years 

whereas males were 11.4 times 

more likely to die from suicide 

than females. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.22 Suicide Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
76

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.22 Suicide Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years 3.2 3.3 3.4 3.6 3.1 3.1

15-24 years 32.8 39.7 50.2 58.7 15.0 20.2

25-34 years 26.9 31.8 40.4 48.0 12.9 15.1

35-44 years 22.5 25.7 36.8 41.6 8.5 10.2

45-54 years 15.9 16.5 24.0 25.2 8.5 8.5

55-64 years 9.6 10.0 14.3 15.2 5.4 5.4

65-74 years 7.8 8.6 15.3 17.1 1.5 1.5

75-84 years 5.8 5.8 13.7 13.7 —* —*

85 years + 6.7 6.7 13.4 13.4 3.3 3.3

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years 0.5 0.7 0.3 0.5 0.8 0.3

15-24 years 9.9 16.0 3.5 10.6 17.2 3.6

25-34 years 13.2 21.2 5.2 14.5 23.1 5.6

35-44 years 15.9 24.5 7.5 18.3 27.7 8.7

45-54 years 18.7 28.6 9.1 21.4 32.5 10.5

55-64 years 16.0 25.8 6.9 18.1 28.8 8.0

65-74 years 13.7 24.4 4.4 14.9 26.4 4.8

75-84 years 16.2 33.6 3.8 17.5 36.1 4.0

85 years + 16.6 43.4 4.0 17.7 46.3 4.1

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
77

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted homicide 

death rate (23.5) was 114 percent 

greater for 1979 1981 than the 

11.0 rate for 2007-2009. The 

2007-2009 rate of 11.0 is two 

times higher than the U.S. all 

races rate of 5.9 for 2008. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN races 

on state death certificates.

Chart 4.23 Age-Adjusted Homicide Death Rates

 
78

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.23 Homicide Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 197 234

2007-2009 (2008) 197 226 9.6 11.0 5.9 3.7 1.9 3.0

2006-2008 (2007) 165 187 9.7 11.1 6.1 3.7 1.8 3.0

2005-2007 (2006) 199 233 9.7 11.1 6.2 3.7 1.8 3.0

2004-2006 (2005) 190 221 9.9 11.3 6.1 3.7 1.9 3.1

2003-2005 (2004) 165 187 10.0 11.2 5.9 3.6 1.9 3.1

2002-2004 (2003) 194 218 10.5 11.8 6.1 3.7 1.9 3.2

2001-2003 (2002) 202 236 10.7 12.0 6.1 3.7 2.0 3.2

2000-2002 (2001) 160 186 10.1 11.4 6.1 3.8 1.9 3.0

1999-2001 (2000) 143 162 10.1 11.4 5.9 3.6 1.9 3.2

1998-2000 (1999) 181 206 10.9 12.3 6.0 3.8 2.1 3.2

1997-1999 (1998) 172 199 11.8 13.6 6.4 3.9 2.1 3.5

1996-1998 (1997) 181 217 11.0 12.6 7.0 4.3 1.8 2.9

1995-1997 (1996) 161 178 11.8 13.5 7.5 4.5 1.8 3.0

1994-1996 (1995) 198 231 12.4 14.0 8.3 5.0 1.7 2.8

1993-1995 (1994) 176 201 12.4 14.2 9.1 5.3 1.6 2.7

1992-1994 (1993) 168 190 12.2 13.8 9.6 5.5 1.4 2.5

1991-1993 (1992) 168 185 13.3 15.0 9.4 5.6 1.6 2.7

1990-1992 (1991) 199 229 13.5 15.4 9.9 5.8 1.6 2.7

1989-1991 (1990) 153 180 14.3 16.3 9.4 5.5 1.7 3.0

1988-1990 (1989) 177 205 13.6 15.3 8.7 5.2 1.8 2.9

1987-1989 (1988) 160 178 14.4 16.1 8.4 5.1 1.9 3.2

1986-1988 (1987) 162 185 15.0 16.9 8.2 5.1 2.1 3.3

1985-1987 (1986) 184 213 15.3 17.5 8.5 5.4 2.1 3.2

1984-1986 (1985) 151 174 15.3 17.2 7.9 5.3 2.2 3.2

1983-1985 (1984) 146 156 15.9 17.8 8.0 5.3 2.2 3.4

1982-1984 (1983) 172 198 16.3 18.3 8.3 5.4 2.2 3.4

1981-1983 (1982) 146 166 18.0 20.3 9.3 6.1 2.2 3.3

1980-1982 (1981) 166 178 19.2 21.4 10.0 6.5 2.1 3.3

1979-1981 (1980) 174 198 21.3 23.5 10.3 6.7 2.3 3.5

1972-1974 (1973) 368 398 24.7 26.6 10.3 5.7 2.6 4.7

1954-1956 (1955) 77 23.8 4.8 2.4

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
79

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific homicide death 

rate (2007-2009) for AI/AN males 

was generally higher for most 

age groups. Males in age group 

25-34 years were 4.6 times more 

likely to die from homicide than 

females in the same age group. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates.

Chart 4.24 Homicide Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
80

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.24 Homicide Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 18.8 24.4 20.3 29.6 17.2 19.1

1-4 years 3.8 5.2 3.6 4.5 4.1 5.9

5-14 years 1.0 1.2 1.0 1.4 1.0 1.0

15-24 years 14.5 16.9 22.0 25.4 6.7 8.2

25-34 years 17.8 21.4 29.9 34.9 5.4 7.6

35-44 years 15.4 17.3 23.2 26.0 7.7 8.8

45-54 years 9.6 10.2 15.3 16.5 4.4 4.4

55-64 years 3.9 3.9 4.6 4.6 3.3 3.3

65-74 years 4.9 4.9 6.3 6.3 3.8 3.8

75-84 years 0.8 0.8 2.0 2.0 —* —*

85 years + 4.4 4.4 —* —* 6.6 6.6

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 8.4 9.4 7.5 6.9 7.8 6.0

1-4 years 2.6 2.8 2.4 2.0 2.1 1.8

5-14 years 0.8 0.9 0.6 0.5 0.7 0.4

15-24 years 12.2 20.6 3.3 6.3 10.2 2.2

25-34 years 11.5 19.4 3.6 6.5 9.9 2.8

35-44 years 7.0 10.8 3.1 4.8 6.9 2.6

45-54 years 4.9 7.4 2.4 3.6 5.2 2.1

55-64 years 3.0 4.5 1.5 2.4 3.5 1.4

65-74 years 2.4 3.2 1.7 2.0 2.6 1.5

75-84 years 2.0 2.7 1.5 1.8 2.3 1.4

85 years + 2.7 2.7 2.7 2.5 2.3 2.6

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
81

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted firearm 

injury death rate decreased from 

26.2 for the three year period 

1979-1981 to 11.9 in 2007-2009. 

The rate (11.9) for 2007-2009 is 

1.2 times greater than the U.S. 

all races rate of 10.3 for 2008. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race on 

state death certificates.

Chart 4.25 Age-Adjusted Firearm Injury Death Rates

 
82

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.25 Firearm Injury1 Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1979-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native2 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 2 Unadjusted Adjusted2

 (2009) 222 266

2007-2009 (2008) 210 251 10.1 11.9 10.3 9.2 1.2 1.3

2006-2008 (2007) 175 205 10.1 12.0 10.3 9.0 1.2 1.3

2005-2007 (2006) 222 269 10.5 12.4 10.3 8.9 1.2 1.4

2004-2006 (2005) 233 274 11.1 13.2 10.3 9.0 1.3 1.5

2003-2005 (2004) 198 237 11.2 13.0 10.1 8.9 1.3 1.5

2002-2004 (2003) 214 242 11.4 13.2 10.4 9.1 1.3 1.5

2001-2003 (2002) 224 269 11.6 13.4 10.5 9.2 1.3 1.5

2000-2002 (2001) 191 225 11.0 12.9 10.4 9.3 1.2 1.4

1999-2001 (2000) 167 199 10.8 12.4 10.2 9.0 1.2 1.4

1998-2000 (1999) 192 220 12.0 13.9 10.4 9.1 1.3 1.5

1997-1999 (1998) 213 251 13.1 15.3 13.6 11.1 1.1 1.4

1996-1998 (1997) 202 244 13.3 15.6 11.9 12.3 1.3 1.3

1995-1997 (1996) 188 214 13.8 15.9 12.6 10.8 1.3 1.5

1994-1996 (1995) 227 261 15.2 17.3 13.4 11.4 1.3 1.5

1993-1995 (1994) 230 264 15.7 17.9 14.5 12.0 1.2 1.5

1992-1994 (1993) 204 232 15.5 17.6 15.1 12.3 1.2 1.4

1991-1993 (1992) 181 204 15.8 18.0 14.5 12.1 1.2 1.5

1990-1992 (1991) 221 253 15.2 17.4 14.9 12.3 1.2 1.4

1989-1991 (1990) 172 200 16.2 18.6 14.6 12.4 1.3 1.5

1988-1990 (1989) 215 252 16.0 18.3 13.8 11.8 1.3 1.6

1987-1989 (1988) 205 227 16.9 19.0 13.6 11.8 1.4 1.6

1986-1988 (1987) 182 203 16.5 18.3 13.3 11.9 1.4 1.5

1985-1987 (1986) 186 206 16.7 18.5 13.6 12.2 1.4 1.5

1984-1986 (1985) 186 208 16.6 18.2 13.1 12.0 1.4 1.5

1983-1985 (1984) 169 183 17.3 19.4 13.2 12.0 1.5 1.6

1982-1984 (1983) 185 216 18.5 20.9 13.2 11.9 1.6 1.8

1981-1983 (1982) 210 232 21.3 23.9 14.1 12.6 1.7 1.9

1980-1982 (1981) 210 226 22.0 24.2 14.7 12.7 1.6 1.9

1979-1981 (1980) 195 211 24.0 26.2 14.8 12.7 1.5 2.1

 (1979) 229 250

1

 Includes deaths with ICD-10 codes: U01.4, terrorism involving firearms (homicide); W32-W34, accidental discharge of firearms; X72-X74, intentional self-harm (suicide) by discharge of firearms; X93-X95, 

assault (homicide) by discharge of firearms; Y22-Y24, discharge of firearms, undetermined intent; and Y35.0, legal intervention involving firearm discharge.

2

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Firearm death data are introduced in 1978 for the IHS service area. The AI/AN death rate columns present data for the three-year period specified and are are age-adjusted to the 2000 standard 

population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
83

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific firearm injury 

death rate (2007-2009) for 

AI/AN males are higher for all 

ages except under 5 years in 

comparison with AI/AN females. 

The AI/AN male rate peaked at 

41.1 deaths per 100,000 

population for the 15-24 year 

age group; 8.2 times greater 

than the rate for females in 

same age-group. These AI/AN 

rates have been adjusted to 

compensate for misreporting 

of AI/AN race on state 

death certificates.

Chart 4.26 Firearm Injury Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
84

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.26 Firearm Injury1 Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted2 Unadjusted Adjusted2 Unadjusted Adjusted2

Under 1 year —* —* —* —* —* 1.9 

1-4 years 0.2 0.2 —* —* 0.5 0.5 

5-14 years 0.7 0.8 1.4 1.6 —* —*

15-24 years 19.1 23.3 34.2 41.1 3.4 5.0 

25-34 years 17.1 21.6 28.8 35.9 5.1 6.8 

35-44 years 13.3 15.6 22.9 26.9 3.9 4.7 

45-54 years 10.3 11.0 16.8 18.3 4.4 4.4 

55-64 years 6.5 7.0 10.6 11.5 2.9 2.9 

65-74 years 7.8 8.6 14.4 16.2 2.3 2.3 

75-84 years 5.8 5.8 13.7 13.7 —* —*

85 years + 6.7 6.7 13.4 13.4 3.3 3.3 

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years 0.5 0.6 0.4 0.4 0.5 0.0

5-14 years 0.7 1.0 0.4 0.5 0.8 0.3

15-24 years 15.4 27.0 3.2 10.2 17.7 2.3

25-34 years 15.4 27.1 3.6 11.3 19.1 3.3

35-44 years 11.8 19.6 4.0 11.3 18.2 4.2

45-54 years 11.5 19.4 3.9 12.3 20.3 4.4

55-64 years 10.8 19.0 3.1 11.8 20.6 3.4

65-74 years 10.7 20.3 2.4 11.6 21.9 2.6

75-84 years 13.2 29.0 2.0 14.3 31.2 2.1

85 years + 12.5 35.5 1.6 13.3 37.9 1.7

0.0 Quantity more than zero but less than 0.05.

—* Represents zero.

1

 Includes deaths with ICD-10 codes: U01.4, terrorism involving firearms (homicide); W32-W34, accidental discharge of firearms; X72-X74, 

intentional self-harm (suicide) by discharge of firearms; X93-X95, assault (homicide) by discharge of firearms; Y22-Y24, discharge of firearms, 

undetermined intent; and Y35.0, legal intervention involving firearm discharge.

2

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
85

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-adjusted alcohol-related 

death rate for AI/AN decreased 

from 77.5 (1979-1981) to 

49.6 (2007-2009). The 2007-2009 

rate of 49.6 is over six times the 

U.S. all races rate of 8.0 for 2008. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates.

Chart 4.27 Age-Adjusted Alcohol-Related Death Rates

 
86

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.27 Alcohol-Related Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1980-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 692 794

2007-2009 (2008) 722 842 42.8 49.6 8.0 8.6 6.2 5.8

2006-2008 (2007) 665 784 41.9 48.7 7.7 8.3 6.3 5.9

2005-2007 (2006) 602 693 38.8 44.9 7.4 7.9 6.1 5.7

2004-2006 (2005) 537 616 37.5 43.1 7.3 7.7 5.9 5.6

2003-2005 (2004) 538 626 37.6 43.0 7.2 7.6 6.0 5.7

2002-2004 (2003) 557 630 37.9 43.5 7.1 7.4 6.1 5.9

2001-2003 (2002) 499 578 37.8 43.6 7.0 7.3 6.2 6.0

2000-2002 (2001) 483 573 36.3 42.1 7.1 7.2 5.9 5.8

1999-2001 (2000) 441 504 37.4 43.2 7.0 7.0 6.2 6.2

1998-2000 (1999) 497 570 38.6 42.2 7.0 6.9 6.0 6.1

1997-1999 (1998) 465 536 39.7 45.5 6.1 6.3 7.5 7.2

1996-1998 (1997) 435 500 39.0 45.0 6.3 6.0 7.1 7.5

1995-1997 (1996) 456 527 40.4 46.8 6.4 6.0 7.3 7.8

1994-1996 (1995) 460 543 43.8 51.1 6.7 6.2 7.6 8.2

1993-1995 (1994) 427 494 41.4 48.4 6.8 6.2 7.1 7.8

1992-1994 (1993) 395 458 41.2 47.6 6.7 6.1 7.1 7.8

1991-1993 (1992) 402 458 40.9 47.0 6.8 6.1 6.9 7.7

1990-1992 (1991) 367 417 41.1 47.0 6.8 6.0 6.9 7.8

1989-1991 (1990) 350 403 41.8 48.2 7.2 6.2 6.7 7.8

1988-1990 (1989) 376 436 43.6 51.0 7.3 6.2 7.0 8.2

1987-1989 (1988) 375 441 41.6 48.9 7.0 5.9 7.0 8.3

1986-1988 (1987) 264 310 37.6 44.5 6.8 5.8 6.5 7.7

1985-1987 (1986) 264 310 34.1 39.9 6.7 5.7 6.0 7.0

1984-1986 (1985) 274 315 37.7 43.9 7.0 5.8 6.3 7.6

1983-1985 (1984) 302 348 42.1 49.0 7.0 5.9 7.0 8.3

1982-1984 (1983) 295 345 46.5 54.6 7.0 6.0 7.8 9.1

1981-1983 (1982) 293 343 50.5 60.8 7.2 6.2 8.4 9.8

1980-1982 (1981) 344 424 56.9 68.7 7.8 6.6 8.8 10.4

1979-1981 (1980) 369 436 63.7 77.5 8.4 6.9 9.2 11.2

 (1979) 377 454

1

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: For all years 1979-1998 the causes of death (ICD-9 codes) that define alcohol-related deaths were expanded to include alcoholic polyneuropathy and the entire code group for unintentional 

poisoning by alcohol, as defined by the National Center for Health Statistics, Centers for Disease Control and Prevention. Years 1999-2004 used ICD-10 codes–-these codes were expanded in 2003. The 

AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and the U.S. white columns present data for a one-year 

period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
87

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Drinking has taken a great toll on 

AI/AN males compared to AI/AN 

females as evidenced by alcohol 

related death rates. The age 

specific alcohol related death 

rate (2007-2009) for AI/AN males 

was either equal to or higher for 

all age groups in comparison 

with AI/AN females. However, 

the AI/AN female rate is much 

higher than the rate of females 

in the U.S. all races and white 

populations. The U.S. female 

rate never exceeded 10.2 for 

any age group in 2008, whereas 

the AI/AN female rate for years 

2007-2009 ranged from 22.2 to 

79.9 for age groups 25 through 

74 years. These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on 

state death certificates.

Chart 4.28 Alcohol-Related Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
88

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.28 Alcohol-Related Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years 4.8 5.4 6.8 7.2 2.3 3.2

25-34 years 25.4 31.0 32.3 37.6 16.9 22.2

35-44 years 72.9 86.1 89.7 104.9 54.6 65.6

45-54 years 97.8 112.9 128.2 147.7 69.0 79.9

55-64 years 90.6 105.1 119.6 139.9 64.2 73.7

65-74 years 57.1 63.7 85.5 99.0 31.8 32.5

75-84 years 37.9 41.2 54.9 62.7 25.6 25.6

85 years + 15.5 15.5 20.1 20.1 13.2 13.2

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years 0.0 0.0 0.0 0.0 0.0 0.0

15-24 years 0.4 0.7 0.2 0.5 0.7 0.2

25-34 years 2.0 3.0 1.0 2.1 3.2 1.0

35-44 years 7.6 10.7 4.5 8.0 11.3 4.7

45-54 years 18.6 27.7 9.7 19.8 29.4 10.2

55-64 years 20.7 33.6 8.7 21.1 34.1 8.8

65-74 years 15.3 25.7 6.4 15.5 25.6 6.6

75-84 years 9.4 17.1 4.0 9.6 17.2 4.1

85 years + 5.2 10.8 2.5 5.3 11.1 2.5

—* Represents zero.

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
89

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AIAN age-adjusted chronic 

liver disease and cirrhosis death 

rate (72.4) for years 1979-1981 

has decreased to 43.1 for years 

2007-2009. The 2007-2009 rate 

of 43.1 is 4.7 times higher than 

the U.S. all races population rate 

of 9.2 for 2008. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.29 Age-Adjusted Chronic Liver Disease and Cirrhosis Death Rates

 
90

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.29 Chronic Liver Disease and Cirrhosis Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Population, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 570 654

2007-2009 (2008) 600 696 37.4 43.1 9.2 9.6 4.7 4.5

2006-2008 (2007) 594 696 36.8 42.6 9.1 9.5 4.7 4.5

2005-2007 (2006) 487 563 34.8 40.1 8.8 9.1 4.6 4.4

2004-2006 (2005) 472 539 33.6 38.3 8.9 9.2 4.3 4.2

2003-2005 (2004) 470 534 33.8 38.1 9.0 9.2 4.2 4.1

2002-2004 (2003) 454 511 34.6 39.0 9.3 9.6 4.2 4.1

2001-2003 (2002) 447 511 34.2 38.9 9.4 9.6 4.1 4.1

2000-2002 (2001) 418 487 35.1 39.9 9.5 9.6 4.2 4.2

1999-2001 (2000) 428 484 35.5 40.6 9.5 9.6 4.3 4.2

1998-2000 (1999) 423 491 36.1 41.1 9.6 9.6 4.3 4.3

1997-1999 (1998) 375 433 34.9 40.0 9.6 9.3 4.2 4.3

1996-1998 (1997) 339 390 34.3 39.0 9.5 9.5 4.1 4.1

1995-1997 (1996) 339 386 35.6 40.2 9.6 9.5 4.2 4.2

1994-1996 (1995) 372 420 38.3 42.5 9.9 9.6 4.3 4.4

1993-1995 (1994) 329 377 37.3 41.2 10.1 9.8 4.1 4.2

1992-1994 (1993) 312 358 36.3 41.7 10.2 9.9 4.1 4.2

1991-1993 (1992) 299 336 36.8 41.0 10.4 10.0 3.9 4.1

1990-1992 (1991) 288 326 36.2 42.9 10.7 10.2 4.0 4.2

1989-1991 (1990) 267 307 37.5 43.4 11.1 10.5 3.9 4.1

1988-1990 (1989) 299 344 37.5 42.8 11.6 10.9 3.7 3.9

1987-1989 (1988) 267 314 36.6 39.6 11.6 10.9 3.4 3.6

1986-1988 (1987) 224 264 33.9 38.9 11.7 11.0 3.3 3.5

1985-1987 (1986) 224 256 33.5 41.8 11.8 11.1 3.5 3.8

1984-1986 (1985) 237 276 36.3 45.8 12.3 11.4 3.7 4.0

1983-1985 (1984) 243 279 39.6 48.5 12.7 11.9 3.8 4.1

1982-1984 (1983) 236 273 41.9 54.1 12.8 12.1 4.2 4.5

1981-1983 (1982) 230 267 46.0 54.1 13.2 12.5 4.1 4.3

1980-1982 (1981) 284 341 46.0 63.4 14.2 13.2 4.5 4.8

1979-1981 (1980) 324 380 60.4 72.4 15.1 13.9 4.8 5.2

1972-1974 (1973) 717 810 69.6 79.0 18.4 16.9 4.3 4.7

1954-1956 (1955) 26.9 9.4 9.4

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and 

U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
91

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Except for age groups under 15 

years and greater than 85 years, 

the age-specific chronic liver 

disease and cirrhosis death rate 

(2007-2009) for AI/AN males 

was higher for all age groups in 

comparison with AI/AN females. 

The AI/AN highest male rate 

122.8 deaths per 100,000 

population was for age group 

55-64 years and is 1.4 times the 

female rate (85.6) for the same 

age-group. These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on 

state death certificates.

Chart 4.30 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
92

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.30 Chronic Liver Disease and Cirrhosis Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years 0.8 0.9 1.3 1.7 0.2 0.2

25-34 years 14.8 18.3 16.6 20.2 12.9 16.4

35-44 years 54.3 64.6 61.9 72.4 46.9 57.1

45-54 years 84.4 98.6 103.1 119.0 67.3 79.9

55-64 years 89.9 103.2 105.8 122.8 75.7 85.6

65-74 years 67.0 72.8 77.4 85.5 58.3 62.1

75-84 years 47.8 50.3 51.0 54.9 45.5 46.9

85 years + 42.1 42.1 40.2 40.2 43.0 43.0

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years —* —* —* —* —* —*

25-34 years 1.1 1.4 0.7 1.1 1.5 0.6

35-44 years 6.1 8.0 4.1 6.5 8.7 4.3

45-54 years 18.5 26.4 10.8 19.5 27.9 11.3

55-64 years 25.0 37.1 13.7 25.7 38.0 14.1

65-74 years 26.3 35.6 18.3 27.6 36.8 19.4

75-84 years 28.0 34.7 23.3 29.5 36.3 24.6

85 years + 21.9 30.4 17.9 22.4 31.2 18.3

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
93

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted malignant 

neoplasm death rate (147.8) 

for 1979-1981 has increased to 

170.8 for years 2007-2009. The 

U.S. all races rate (176.4) for 

2008 is 1.0 times higher than the 

comparable AI/AN rate (170.8) 

for 2007-2009. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.31 Age-Adjusted Malignant Neoplasm Death Rates 
94

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.31 Malignant Neoplasm Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 1,913 2,213

2007-2009 (2008) 1,910 2,192 148.7 170.8 176.4 175.9 1.0 1.0

2006-2008 (2007) 1,789 2,059 148.0 169.5 179.3 178.5 0.9 0.9

2005-2007 (2006) 1,674 1,917 148.2 170.3 181.8 181.0 0.9 0.9

2004-2006 (2005) 1,711 1,986 153.6 176.2 185.1 183.9 1.0 1.0

2003-2005 (2004) 1,691 1,947 156.6 179.2 186.8 185.3 1.0 1.0

2002-2004 (2003) 1,500 1,708 159.2 180.7 190.9 189.2 0.9 1.0

2001-2003 (2002) 1,523 1,737 160.8 181.7 194.3 192.5 0.9 0.9

2000-2002 (2001) 1,513 1,717 162.4 183.5 196.5 194.3 0.9 0.9

1999-2001 (2000) 1,325 1,506 162.8 184.0 199.6 197.2 0.9 0.9

1998-2000 (1999) 1,299 1,484 159.9 181.4 200.8 197.9 0.9 0.9

1997-1999 (1998) 1,255 1,451 161.6 184.2 210.0 200.7 0.9 0.9

1996-1998 (1997) 1,256 1,439 164.2 187.0 203.5 200.0 0.9 0.9

1995-1997 (1996) 1,226 1,400 165.5 187.0 206.7 203.3 0.9 0.9

1994-1996 (1995) 1,141 1,278 167.9 189.6 209.8 206.2 0.9 0.9

1993-1995 (1994) 1,046 1,201 158.0 178.3 211.7 208.0 0.8 0.9

1992-1994 (1993) 1,025 1,169 157.0 178.1 213.5 209.3 0.8 0.9

1991-1993 (1992) 1,026 1,174 161.2 183.0 213.5 209.5 0.9 0.9

1990-1992 (1991) 1,021 1,175 155.9 176.7 215.2 210.9 0.8 0.8

1989-1991 (1990) 859 969 154.1 174.9 216.0 211.6 0.8 0.8

1988-1990 (1989) 913 1,049 147.6 167.2 214.2 209.9 0.8 0.8

1987-1989 (1988) 831 954 146.2 165.4 212.5 208.4 0.8 0.8

1986-1988 (1987) 768 863 141.7 160.8 211.7 207.7 0.8 0.8

1985-1987 (1986) 756 881 137.9 156.8 211.5 207.6 0.7 0.8

1984-1986 (1985) 714 820 140.8 162.4 211.3 207.3 0.8 0.8

1983-1985 (1984) 713 836 140.7 161.4 210.8 206.7 0.8 0.8

1982-1984 (1983) 662 757 142.5 163.4 209.1 205.2 0.8 0.8

1981-1983 (1982) 617 706 137.6 156.6 208.3 204.7 0.8 0.8

1980-1982 (1981) 578 661 136.7 154.7 206.4 202.7 0.7 0.8

1979-1981 (1980) 567 635 130.8 147.8 207.9 204.2 0.7 0.7

1972-1974 (1973) 1,142 1,293 132.2 150.0 202.2 199.3 0.7 0.8

1954-1956 (1955) 296 95.0 125.8 125.8

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and 

U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
95

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific malignant 

neoplasm death rate (2007-2009) 

for AI/AN males was 67 percent 

greater than AI/AN females in age 

group 85 years and over. However, 

for the age group 35 to 44 years, 

the female rate was 46 percent 

greater than the male rate. The 

onset of a rate increase for 

AI/AN males and females began 

at age 15. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.32 Malignant Neoplasm Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
96

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.32 Malignant Neoplasm Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 1.9 1.9 3.7 3.7 —* —*

1-4 years 1.6 2.5 1.8 2.2 1.4 2.7

5-14 years 1.8 2.3 1.6 1.6 2.1 3.1

15-24 years 3.2 3.8 4.1 5.2 2.3 2.5

25-34 years 7.6 10.0 9.0 10.7 6.1 9.3

35-44 years 29.6 32.8 24.9 26.6 34.2 38.9

45-54 years 103.9 114.7 113.6 124.3 95.0 105.9

55-64 years 285.9 335.9 325.7 379.5 250.3 296.8

65-74 years 637.3 751.2 738.0 873.9 552.6 648.0

75-84 years 990.8 1,154.0 1,209.5 1,442.8 832.1 944.5

85 years + 1,068.5 1,095.1 1,422.2 1,495.9 894.0 897.3

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 1.7 2.3 1.1 1.6 2.0 0.0

1-4 years 2.4 2.6 2.2 2.6 2.8 2.5

5-14 years 2.2 2.2 2.2 2.2 2.2 2.2

15-24 years 3.8 4.6 3.0 3.9 4.7 3.1

25-34 years 8.8 8.8 8.7 8.7 8.8 8.6

35-44 years 30.1 26.2 34.0 29.2 25.6 32.8

45-54 years 113.4 117.7 109.2 109.9 113.9 106.0

55-64 years 304.7 349.3 349.3 300.0 340.4 261.7

65-74 years 688.4 817.0 577.3 689.2 811.1 581.9

75-84 years 1,230.9 1,563.1 995.9 1,239.7 1,560.4 1,008.3

85 years + 1,724.6 2,444.1 1,385.9 1,729.5 2,437.8 1,393.2

—* Represents zero.

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
97

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted lung 

cancer death rate (47.6) for 

2007-2009 was 74 percent higher 

than the 1979-1981 rate (27.3). 

The U.S. all races rate (49.5) for 

2008 is three percent than the 

2007-2009 AI/AN rate (47.6). 

AI/AN rates have been adjusted 

to compensate for misreporting 

of AI/AN race on state 

death certificates. 

Chart 4.33 Age-Adjusted Lung Cancer Death Rates

 
98

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.33 Lung Cancer1 Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native2 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 2 Unadjusted Adjusted2

 (2009) 456 567

2007-2009 (2008) 501 619 38.5 47.6 49.5 50.2 1.0 0.9

2006-2008 (2007) 450 556 38.4 47.4 50.6 51.2 0.9 0.9

2005-2007 (2006) 405 501 37.3 46.3 51.5 52.1 0.9 0.9

2004-2006 (2005) 425 538 38.8 48.1 52.7 53.2 0.9 0.9

2003-2005 (2004) 443 548 39.8 49.3 53.5 53.6 0.9 0.9

2002-2004 (2003) 369 458 40.5 49.7 54.1 54.5 0.9 0.9

2001-2003 (2002) 375 462 40.0 49.3 55.0 55.3 0.9 0.9

2000-2002 (2001) 362 451 39.8 48.8 55.4 55.6 0.9 0.9

1999-2001 (2000) 309 378 39.9 49.1 56.1 56.2 0.9 0.9

1998-2000 (1999) 330 411 39.9 48.8 55.5 55.4 0.9 0.9

1997-1999 (1998) 325 399 40.9 50.0 56.0 57.1 0.9 0.9

1996-1998 (1997) 305 370 40.2 48.8 57.5 57.4 0.8 0.9

1995-1997 (1996) 290 351 39.8 47.8 57.9 57.7 0.8 0.8

1994-1996 (1995) 286 342 40.4 48.5 58.4 58.2 0.8 0.8

1993-1995 (1994) 264 321 39.5 47.4 58.6 58.3 0.8 0.8

1992-1994 (1993) 260 316 38.0 45.6 59.3 58.9 0.8 0.8

1991-1993 (1992) 233 278 37.5 44.9 59.1 58.5 0.8 0.8

1990-1992 (1991) 235 284 34.3 40.6 59.2 58.7 0.7 0.7

1989-1991 (1990) 188 220 33.5 39.8 59.3 58.6 0.7 0.7

1988-1990 (1989) 207 251 32.7 38.9 58.1 57.4 0.7 0.7

1987-1989 (1988) 209 253 31.5 37.6 57.2 56.6 0.7 0.7

1986-1988 (1987) 152 181 32.3 38.5 56.4 55.8 0.7 0.7

1985-1987 (1986) 194 235 30.0 36.0 55.2 54.5 0.7 0.7

1984-1986 (1985) 155 184 31.2 37.1 54.6 53.9 0.7 0.7

1983-1985 (1984) 146 173 28.0 33.6 53.6 52.9 0.6 0.6

1982-1984 (1983) 134 165 27.2 32.6 52.6 52.0 0.6 0.6

1981-1983 (1982) 124 147 26.1 31.2 51.7 51.1 0.6 0.6

1980-1982 (1981) 113 134 25.1 29.4 50.3 49.6 0.6 0.6

1979-1981 (1980) 103 120 23.7 27.3 49.9 49.2 0.5 0.6

1972-1974 (1973) 136 152 15.2 16.9 40.9 40.3 0.4 0.4

1

 Lung cancer deaths includes deaths due to cancers of the trachea, bronchus and lung.

2

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Starting in 1972 data are first available and are shown above for the specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified 

and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year 

period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
99

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific lung cancer death 

rate (2007-2009) for AI/AN males 

and females was similar for age 

groups 1 to 34 years. For age group 

75 to 84, the rate for AI/AN males 

(462.6) is 67 percent greater than 

the AI/AN rate (277.4) for females. 

The rate decreased for AI/AN males 

(369.0) and (162.2) for AI/AN 

females for ages 85 and older but 

the percent difference between 

AI/AN males and females increased 

to 127 percent. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.34 Lung Cancer Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
100

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.34 Lung Cancer1 Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All 

Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted2 Unadjusted Adjusted2 Unadjusted Adjusted2

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years —* —* —* —* —* —*

25-34 years —* —* —* —* —* —*

35-44 years 1.8 2.0 1.1 1.1 2.5 2.8

45-54 years 16.3 19.2 18.9 21.6 14.0 17.0

55-64 years 75.6 94.9 87.9 109.0 64.6 82.3

65-74 years 202.3 255.7 243.9 306.9 167.3 212.7

75-84 years 283.6 355.3 358.7 462.6 229.0 277.4

85 years + 212.8 230.5 322.0 369.0 158.9 162.2

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years 0.1 0.1 0.0 0.1 0.0 0.1

25-34 years 0.4 0.4 0.3 0.4 0.4 0.3

35-44 years 3.9 4.1 3.7 3.9 4.0 3.7

45-54 years 29.0 33.2 24.9 28.7 31.9 24.7

55-64 years 93.7 115.3 73.5 94.1 113.2 76.0

65-74 years 249.3 309.1 197.6 255.7 311.6 206.5

75-84 years 394.2 520.1 305.1 402.0 522.8 314.9

85 years + 360.5 554.8 249.1 363.9 554.0 273.6

—* Represents zero.

0.0 Quantity more than zero but less than 0.05.

1

 Lung cancer deaths includes deaths due to cancers of the trachea, bronchus and lung, ICD-10 codes C33 to C34.9.

2

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
101

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The leading site for cancer deaths 

among AI/AN in 2007-2009 was 

trachea, bronchus, and lung. Over 

2.9 times as many AI/AN people 

died of this type of cancer than the 

next leading site, colon, rectum 

and anus. The third and fourth 

leading sites were liver and breast, 

respectively. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.35 Death Rates for Leading Cancer Sites

American Indians and Alaska Natives (2007-2009)

 
102

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.35 Leading Sites for Cancer Deaths for Decedents of All Ages

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

(Crude Rate per 100,000 Population)

Number Rate

Site of Cancer Death Unadjusted Adjusted1 Unadjusted Adjusted1

All Sites 5,612 6,464 98.1 113.0

Trachea, bronchus and lung 1,407 1,742 24.6 30.5

Colon, rectum, and anus 522 603 9.1 10.5

Liver/intraehepatic bile ducts 365 412 6.4 7.2

Breast 344 396 5.3 6.9

Pancreas 303 338 4.2 5.9

Kidney and renal pelvis 339 259 3.5 4.5

Stomach 200 209 3.1 3.7

Leukemia 177 200 2.8 3.5

Non-Hodgkin lymphoma 161 177 2.1 3.1

Esophagus 121 135 2.0 2.4

Brain, meninges, central nervous system 115 130 1.8 2.3

Multiple myeloma 103 111 1.7 1.9

Other and ill-defined digestive organs 98 107 1.5 1.9

Rectum 86 97 1.3 1.7

Urinary bladder 76 82 1.3 1.4

Lip, oral cavity, and pharynx 76 79 1.1 1.4

Melanoma of skin 58 64 1.0 1.1

Gallbladder 62 64 1.1 1.1

Mesothelioma 41 47 0.7 0.8

Larynx 33 35 0.6 0.6

Thyroid/endrocrine 24 28 0.4 0.5

Bone 18 21 0.3 0.4

Small intestine 10 11 0.2 0.2

Hodgkin's disease 6 7 0.1 0.1

Genital 6 6 0.1 0.1

All other sites 861 1,104

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: See appendix titled “Method Used to Rank Leading Sites of Cancer Deaths.” Causes of death listed are based on the order of adjusted number 

of deaths.
103

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The leading site for cancer deaths 

among AI/AN males for 2007-2009 

was trachea, bronchus, and lung. 

Over three times as many AI/AN 

males died of this type of cancer 

than the next leading site, colon, 

rectum, and anus. These AI/AN 

rates have been adjusted to 

compensate for misreporting 

of AI/AN race on state 

death certificates.

Chart 4.36 Death Rates, Leading Cancer Sites: Males

American Indians and Alaska Natives (2007-2009)

 
104

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.36 Leading Sites for Cancer Deaths for Males

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

(Rate per 100,000 Population)

Number Rate

Site of Cancer Death Unadjusted Adjusted1 Unadjusted Adjusted1

All Sites 2,898 3,352 102.6 118.7

Trachea, bronchus and lung 760 945 26.9 33.5

Colon, rectum, and anus 249 289 8.8 10.2

Liver/intraehepatic bile ducts 237 273 8.4 9.7

Prostate 231 266 8.2 9.4

Pancreas 156 172 5.5 6.1

Kidney and renal pelvis 151 164 5.3 5.8

Stomach 120 128 4.2 4.5

Leukemia 105 121 3.7 4.3

Esophagus 96 109 3.4 3.9

Non-Hodgkin lymphoma 82 89 2.9 3.2

Brain, meninges, central nervous system 60 66 2.1 2.3

Multiple myeloma 57 62 2.0 2.2

Urinary bladder 57 62 2.0 2.2

Lip, oral cavity, and pharynx 53 56 1.9 2.0

Other and ill-defined digestive organs 49 53 1.7 1.9

Rectum 47 50 1.7 1.8

Melanoma of skin 36 40 1.3 1.4

Mesothelial and soft tissue 26 31 0.9 1.1

Larynx 28 30 1.0 1.1

Gallbladder 16 17 0.6 0.6

Bone and joints 12 13 0.4 0.5

Thyroid/endrocrine 11 12 0.4 0.4

Testis 11 12 0.4 0.4

Penis 7 8 0.2 0.3

Small intestine 7 8 0.2 0.3

Hodgkin's disease 6 7 0.2 0.2

Breast 5 5 0.2 0.2

All other sites 223 264

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: See appendix titled “Method Used to Rank Leading Sites of Cancer Deaths.” Causes of death listed are based on the order of adjusted number 

of deaths.
105

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The leading site for cancer 

deaths among AI/AN females 

for 2007-2009 was trachea, 

bronchus, and lung. Two (2.0) 

times more AI/AN females died of 

this type of cancer than the next 

leading site, breast. In turn, the 

likelihood of dying from breast 

cancer was about 8 percent 

greater than the next leading 

type of cancer (colon, rectum, 

and anus). These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.37 Death Rates, Leading Cancer Sites: Females

American Indians and Alaska Natives (2007-2009)

 
106

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.37 Leading Sites for Cancer Deaths for Females

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

(Rate per 100,000 Population)

Number Rate

Site of Cancer Death Unadjusted Adjusted1 Unadjusted Adjusted1

All Sites 2,714 3,112 93.7 107.4

Trachea, bronchus and lung 647 797 22.3 27.5

Breast 339 391 11.7 13.5

Colon, rectum, and anus 313 363 10.8 12.5

Small intestine 246 279 8.5 9.6

Pancreas 147 166 5.1 5.7

Ovary 138 151 4.8 5.2

Cervical 92 107 3.2 3.6

Kidney and renal pelvis 88 95 3.0 3.3

Non-Hodgkin lymphoma 79 88 2.7 3.0

Liver/intraehepatic bile ducts 79 84 2.7 2.9

Stomach 80 81 2.8 2.8

Leukemia 72 79 2.5 2.7

Uterus 61 67 2.1 2.3

Brain, meninges, central nervous system 54 64 1.9 2.2

Multiple myeloma 46 49 1.6 1.7

Gallbladder 35 36 1.2 1.2

Esophagus 25 26 0.9 0.9

Other connective and soft tissue 19 23 0.7 0.8

Lip, oral cavity, and pharynx 23 23 0.8 0.8

Urinary bladder 19 20 0.7 0.7

Melanoma of skin 14 15 0.5 0.5

Thyroid/endrocrine 10 12 0.3 0.4

Mesothelioma 8 8 0.3 0.3

Bone and joints 6 8 0.2 0.3

Vulva 6 6 0.2 0.2

Larynx 5 5 0.2 0.2

All other sites 63 69

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: See appendix titled “Method Used to Rank Leading Sites of Cancer Deaths.” Causes of death listed are based on the order of adjusted number 

of deaths.
107

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The leading site for cancer deaths 

among AI/AN, 55 years of age and 

older for the 2007-2009 three-year 

period was trachea, bronchus, 

and lung. Nearly three times as 

many AI/AN people in this age 

group died of this type of cancer 

than the next leading site, colon, 

rectum, and anus. The third and 

fourth leading sites were genital 

organs and breast, respectively. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates.

Chart 4.38 Death Rates, Leading Cancer Sites: 55 Years of Age and Older

 
108

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.38 Leading Sites for Cancer Deaths for Decedents 55 Years of Age and Older

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008 

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Site of Cancer Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

All Sites 4,550 5,267 523.0 605.4 679.8 690.4 0.9 0.9

Trachea, bronchus, and lung 1,280 1,594 147.1 183.2 199.0 204.8 0.9 0.9

Colon, rectum, and anus 469 541 53.9 62.2 66.9 66.6 0.9 0.9

Genital organs 439 490 50.1 56.3 70.4 68.9 0.8 0.8

Breast 257 296 29.5 34.0 47.3 47.3 0.7 0.7

Pancreas 246 278 28.3 32.0 44.3 44.5 0.7 0.7

Liver and intraepithelial bile duct 199 227 22.9 26.1 21.2 19.9 1.2 1.3

Kidney, renal pelvis 183 201 21.0 23.1 16.4 17.1 1.4 1.4

Stomach 151 158 17.4 18.2 13.2 11.6 1.4 1.6

Non-Hodgkin lymphoma 140 156 16.1 17.9 26.8 28.8 0.7 0.6

Leukemia 114 127 13.1 14.6 27.7 29.3 0.5 0.5

Esophagus 98 109 11.3 12.5 16.9 17.4 0.7 0.7

Multiple myeloma 90 97 10.3 11.2 14.6 13.9 0.8 0.8

Brain, meninges, central nervous system 63 71 7.2 8.2 13.7 14.9 0.6 0.6

Urinary bladder 63 68 7.2 7.8 19.9 21.4 0.4 0.4

Lip, oral cavity, pharynx 61 64 7.0 7.4 9.9 9.9 0.7 0.7

Gallbladder 39 40 4.5 4.6 2.5 2.4 1.8 1.9

Larynx 32 34 3.7 3.9 5.0 4.8 0.8 0.8

Soft tissue including the heart 27 30 3.1 3.4 4.0 4.0 0.9 0.9

Melanoma of the skin 26 28 3.0 3.2 9.8 11.2 0.3 0.3

Mesothelioma 22 26 2.5 3.0 3.3 3.7 0.9 0.8

Thyroid, endocrine 14 15 1.6 1.7 2.5 2.5 0.7 0.7

Hodgkin lymphoma 4 5 0.5 0.6 1.2 1.3 0.5 0.5

Bones and joints 5 5 0.5 0.6 1.0 1.1 0.6 0.5

All other sites 528 607

1

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: See appendix titled “Method Used to Rank Leading Sites of Cancer Deaths.” Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
109

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The leading site for cancer deaths 

among AI/AN males, 55 years 

and older, in 2007-2009 was 

trachea, bronchus, and lung. 

About 3.4 times as many AI/AN 

males in this age group died of 

this type of cancer than the next 

leading site of prostate. These 

AI/AN rates have been adjusted 

for misreporting of AI/AN race 

on state death certificate.

Chart 4.39 Death Rates, Leading Cancer Sites: Males, 55 Years of Age and Older

 

The leading site for cancer deaths 

among American Indian and 

Alaska Native (AI/AN) females, 

55 years and older, in 2007-2009 

was trachea, bronchus, and lung. 

Nearly 2.5 times as many AI/AN 

females in this age group died of 

this type of cancer than the next 

leading site, breast. These AI/AN 

rates have been adjusted for 

misreporting of AI/AN race 

on state death certificates.

Chart 4.40 Death Rates, Leading Cancer Sites: Females, 55 Years of Age and Older

 
110

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.39 Leading Sites for Cancer Deaths by Sex 55 Years of Age and Older

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and U.S. All Races and White Populations, 2008 

(Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Site of Cancer Death Unadjusted Adjusted White 1 Unadjusted Adjusted1

MALE

All Sites 2,310 2,703 585.7 685.3 788.1 793.7 0.9 0.9

Trachea, bronchus, and lung 693 869 175.7 220.3 252.6 255.2 0.9 0.9

Prostate 224 259 56.8 65.7 84.7 80.7 0.8 0.8

Colon, rectum, and anus 221 253 56.0 64.1 70.5 69.6 0.9 0.9

Liver and intraepithelial bile duct 130 153 33.0 38.8 30.1 27.8 1.3 1.4

Pancreas 118 132 29.9 33.5 46.8 47.2 0.7 0.7

Kidney, renal pelvis 110 121 27.9 30.7 21.4 22.1 1.4 1.4

Stomach 95 101 24.1 25.6 17.1 15.1 1.5 1.7

Esophagus 78 89 19.8 25.6 28.4 29.4 0.9 0.9

Non-Hodgkin lymphoma 68 75 17.2 19.0 29.1 31.1 0.7 0.6

Leukemia 65 74 16.5 18.8 32.7 34.5 0.6 0.5

Multiple myeloma 49 53 12.4 13.4 16.2 15.5 0.8 0.9

Urinary bladder 47 51 11.9 12.9 28.1 30.5 0.5 0.4

Lip, oral cavity, and pharynx 42 45 10.6 11.4 13.3 13.1 0.9 0.9

Brain, meninges, central nervous system 34 39 8.6 9.9 16.1 17.4 0.6 0.6

Larynx 27 29 6.8 7.4 7.8 7.4 0.9 1.0

Mesothelioma 16 20 4.1 5.1 5.8 6.4 0.9 0.8

Melanoma of the skin 18 19 4.6 4.8 13.8 15.8 0.3 0.3

Gallbladder 7 7 1.8 1.8 1.8 1.7 1.0 1.1

Thyroid, endocrine 7 7 1.8 1.8 1.8 1.9 1.0 0.9

Hodgkin lymphoma 4 5 1.0 1.3 1.2 1.3 1.1 1.0

Breast 5 5 1.3 1.3 1.2 1.1 1.1 1.2

Bones and joints 3 3 0.8 0.8 1.2 1.2 0.7 0.7

All other sites 249 294

FEMALE

All Sites 2,144 2,464 450.8 518.1 590.1 603.6 0.9 0.9

Trachea, bronchus, and lung 587 725 123.4 152.5 162.3 169.8 0.9 0.9

Breast 252 291 53.0 61.2 80.7 81.1 0.8 0.8

Colon, rectum, and anus 248 288 52.1 60.6 58.0 57.9 1.0 1.0

Pancreas 128 146 26.9 30.7 41.0 41.1 0.7 0.7

Ovary 115 124 24.2 26.1 30.9 32.6 0.8 0.8

Non-Hodgkin lymphoma 72 81 15.1 17.0 21.6 23.3 0.8 0.7

Kidney, renal pelvis 73 80 15.4 16.8 10.6 11.1 1.6 1.5

Liver and intraepithelial bile duct 69 74 14.5 15.6 13.3 12.6 1.2 1.2

Stomach 56 57 11.8 12.0 9.9 8.7 1.2 1.4

Leukemia 49 53 10.3 11.1 20.6 21.8 0.5 0.5

Uterus 43 47 9.0 9.9 9.5 8.9 1.0 1.1

Cervix 43 45 9.0 9.5 5.7 5.0 1.7 1.9

Multiple Myeloma 41 44 8.6 9.3 11.2 10.5 0.8 0.9

Gallbladder 32 33 6.7 6.9 3.0 3.0 2.3 2.3

Brain, meninges, central nervous system 29 32 6.1 6.7 11.3 12.4 0.6 0.5

Esophagus 20 20 4.2 4.2 6.5 6.5 0.6 0.6

Lip, oral cavity, and pharynx 19 19 4.0 4.0 5.4 5.6 0.7 0.7

Urinary bladder 16 17 3.4 3.6 10.1 10.6 0.4 0.3

Soft tissue including the heart 14 16 2.9 3.4 3.6 3.6 0.9 0.9

Melanoma of the skin 8 9 1.7 1.9 5.8 6.6 0.3 0.3

Thyroid, endocrine 7 8 1.5 1.7 2.2 2.2 0.8 0.8

Mesothelioma 6 6 1.3 1.3 1.2 1.4 1.1 0.9

Larynx 5 5 1.1 1.1 1.8 1.7 0.6 0.6

Vulva 4 4 0.8 0.8 2.1 2.3 0.4 0.3

Bones and joints 2 2 0.4 0.4 0.9 0.9 0.4 0.4

All other sites 206 238

1

 Adjusted - specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: See appendix titled “Method Used to Rank Leading Sites of Cancer Deaths.” Causes of death listed are based on the order of adjusted number of deaths.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
111

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

pneumonia and influenza death 

rate varied between 38.7 and 

24.1 between 1979-1981 and 

2007-2009. The 2007-2009 rate 

(24.1) is 1.4 times greater than 

the U.S. all races rate (17.6) for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.41 Age-Adjusted Pneumonia and Influenza Death Rates

 
112

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.41 Pneumonia and Influenza Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 291 318

2007-2009 (2008) 298 330 22.1 24.1 17.6 17.4 1.4 1.4

2006-2008 (2007) 216 233 20.7 22.5 16.8 16.6 1.4 1.4

2005-2007 (2006) 208 223 22.3 24.3 18.4 18.2 1.4 1.3

2004-2006 (2005) 284 315 24.7 27.1 21.0 20.9 1.3 1.3

2003-2005 (2004) 230 253 30.0 32.9 20.4 20.1 1.7 1.6

2002-2004 (2003) 304 334 29.9 32.4 22.6 22.4 1.5 1.5

2001-2003 (2002) 233 249 31.2 33.3 23.1 23.0 1.5 1.5

2000-2002 (2001) 232 244 29.3 31.1 22.2 21.9 1.4 1.4

1999-2001 (2000) 218 234 31.6 33.6 23.7 23.5 1.4 1.4

1998-2000 (1999) 254 273 31.9 34.1 23.5 23.3 1.5 1.5

1997-1999 (1998) 301 319 31.7 33.8 33.2 34.6 1.0 1.0

1996-1998 (1997) 266 287 29.1 31.3 33.3 33.0 0.9 0.9

1995-1997 (1996) 278 309 29.0 31.2 32.9 32.5 0.9 1.0

1994-1996 (1995) 265 282 32.5 34.9 33.4 33.0 1.0 1.1

1993-1995 (1994) 297 321 32.3 34.5 33.6 33.3 1.0 1.0

1992-1994 (1993) 265 286 31.8 33.9 35.0 34.6 1.0 1.0

1991-1993 (1992) 241 256 30.3 32.3 32.8 32.5 1.0 1.0

1990-1992 (1991) 237 257 31.2 33.3 34.7 34.3 1.0 1.0

1989-1991 (1990) 259 286 32.8 35.2 36.8 36.4 1.0 1.0

1988-1990 (1989) 248 242 32.6 35.2 35.9 35.4 1.0 1.0

1987-1989 (1988) 221 238 31.1 33.7 37.3 37.1 0.9 0.9

1986-1988 (1987) 220 238 29.0 31.5 33.8 33.5 0.9 0.9

1985-1987 (1986) 174 189 29.3 32.1 34.8 34.5 0.9 0.9

1984-1986 (1985) 206 232 29.8 32.4 34.5 34.3 0.9 0.9

1983-1985 (1984) 200 215 30.5 33.0 30.6 30.3 1.1 1.1

1982-1984 (1983) 170 182 31.6 33.5 29.7 29.6 1.1 1.1

1981-1983 (1982) 202 217 32.1 34.4 26.5 26.2 1.3 1.3

1980-1982 (1981) 181 198 36.5 39.5 30.0 29.7 1.3 1.3

1979-1981 (1980) 215 233 35.6 38.7 31.4 30.9 1.2 1.3

1972-1974 (1973) 690 743 47.4 50.5 38.4 37.3 1.3 1.4

1954-1956 (1955) 384 64.4 21.0 18.4

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and 

U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
113

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific pneumonia and 

influenza death rate (2007-2009) 

for AI/AN males and females 

increased sharply starting at 

age 75 years as it did for U.S. 

all races males and females. 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race 

on state death certificates.

Chart 4.42 Pneumonia and Influenza Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
114

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.42 Pneumonia and Influenza Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 21.62 19.72 22.22 18.52 21.0 21.02

1-4 years 1.4 1.6 0.9 1.3 1.8 1.8

5-14 years 0.7 0.9 0.6 0.8 0.8 1.0

15-24 years 1.0 1.5 0.9 0.1 1.1 1.9

25-34 years 3.4 3.9 4.3 4.8 2.4 2.9

35-44 years 8.0 9.1 9.1 10.2 6.9 8.0

45-54 years 13.9 15.0 16.8 18.3 11.2 12.0

55-64 years 22.6 24.5 26.7 29.9 18.9 19.8

65-74 years 46.0 51.8 42.3 47.7 49.2 55.3

75-84 years 140.1 155.8 182.3 207.8 109.5 118.1

85 years + 421.1 438.9 462.9 496.4 400.6 410.6

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 5.5 5.9 5.0 4.7 5.1 4.3

1-4 years 0.9 0.8 0.9 0.7 0.7 0.8

5-14 years 0.2 0.2 0.2 0.2 0.2 0.2

15-24 years 0.5 0.6 0.4 0.5 0.6 0.3

25-34 years 0.9 1.0 0.8 0.9 0.9 0.8

35-44 years 2.1 2.3 1.9 1.9 2.1 1.8

45-54 years 5.1 5.7 4.5 4.7 5.2 4.2

55-64 years 10.9 13.2 8.8 10.1 12.1 8.3

65-74 years 30.5 36.3 25.4 29.2 34.8 24.2

75-84 years 118.6 142.6 101.7 117.2 139.4 101.2

85 years + 512.3 595.9 473.0 519.2 601.1 480.3

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 The adjusted rate for age less than one year is lower than the unadjusted rate because the linked birth/infant death file (used to obtain the 

adjusted counts of infant deaths) had fewer deaths for this cause then did the unadjusted mortality file (2007-2009 data).

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
115

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

tuberculosis death rate has 

dropped from 6.8 deaths in 1979 

1981 to 1.1 for years 2007-2009. 

The 2007-2009 rate (1.1) is 5.5 

times the U.S. all races rate (0.2) 

for 2008. These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on 

state death certificates.

Chart 4.43 Age-Adjusted Tuberculosis Death Rates

 
116

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.43 Tuberculosis Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

2007-2009 (2008) 17 17 1.1 1.1 0.2 0.1 5.5 11.0

2006-2008 (2007) 10 10 1.0 1.0 0.2 0.1 5.0 10.0

2005-2007 (2006) 13 13 1.2 1.2 0.2 0.1 6.0 12.0

2004-2006 (2005) 14 14 1.2 1.2 0.2 0.2 6.0 6.0

2003-2005 (2004) 12 12 1.2 1.2 0.2 0.2 6.0 6.0

2002-2004 (2003) 11 11 1.7 1.7 0.2 0.2 8.5 8.5

2001-2003 (2002) 24 25 1.8 1.8 0.3 0.2 6.0 9.0

2000-2002 (2001) 12 13 2.0 2.1 0.3 0.2 7.0 10.5

1999-2001 (2000) 14 15 1.8 1.9 0.3 0.2 6.3 9.5

1998-2000 (1999) 17 18 1.9 2.0 0.3 0.2 6.7 10.0

1997-1999 (1998) 17 18 2.1 2.2 0.7 0.4 3.1 5.5

1996-1998 (1997) 20 21 2.0 2.0 0.4 0.3 5.0 6.7

1995-1997 (1996) 14 14 2.1 2.0 0.5 0.3 4.0 6.7

1994-1996 (1995) 18 19 2.6 2.7 0.5 0.4 5.4 6.8

1993-1995 (1994) 30 30 3.0 3.1 0.6 0.4 5.2 7.8

1992-1994 (1993) 24 24 3.2 3.2 0.7 0.4 4.6 8.0

1991-1993 (1992) 19 19 3.2 3.2 0.7 0.5 4.6 6.4

1990-1992 (1991) 25 25 3.3 3.3 0.7 0.5 4.7 6.6

1989-1991 (1990) 24 25 4.0 4.2 0.8 0.5 5.3 8.4

1988-1990 (1989) 33 36 4.0 4.2 0.9 0.6 4.7 7.0

1987-1989 (1988) 25 25 4.5 4.6 0.9 0.6 5.1 7.7

1986-1988 (1987) 28 28 4.1 4.2 0.8 0.5 5.3 8.4

1985-1987 (1986) 24 26 4.0 4.1 0.8 0.6 5.1 6.8

1984-1986 (1985) 18 18 3.4 3.6 0.8 0.6 4.5 6.0

1983-1985 (1984) 17 18 4.1 4.1 0.8 0.6 5.1 6.8

1982-1984 (1983) 31 31 4.7 4.9 0.9 0.6 5.4 8.2

1981-1983 (1982) 22 23 5.7 5.9 0.9 0.6 6.6 9.8

1980-1982 (1981) 30 30 5.9 6.1 1.0 0.7 6.1 8.7

1979-1981 (1980) 31 33 6.7 6.8 1.0 0.7 6.8 9.7

1972-1974 (1973) 143 147 10.5 10.8 1.7 1.3 6.4 8.3

1954-1956 (1955) 253 57.9 8.4 6.2

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
117

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted diabetes 

mellitus death rate for 2007-2009 

was 61.0 which is 34 percent 

higher than the earlier rate of 

45.5 for the 1979-1981 three 

year period. This latest rate of 

61.0 is 2.8 times higher than 

the U.S. all races rate of 22.0 for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.44 Age-Adjusted Diabetes Mellitus Death Rates

 
118

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.44 Diabetes Mellitus Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 643 770

2007-2009 (2008) 614 741 51.0 61.0 22.0 20.2 2.8 3.0

2006-2008 (2007) 637 756 52.0 62.3 22.8 20.7 2.7 3.0

2005-2007 (2006) 631 765 55.1 65.6 23.6 21.4 2.8 3.1

2004-2006 (2005) 645 775 56.9 68.1 24.9 22.8 2.7 3.0

2003-2005 (2004) 602 722 59.8 71.9 24.7 22.5 2.9 3.2

2002-2004 (2003) 627 771 61.9 74.2 25.5 23.2 2.9 3.2

2001-2003 (2002) 607 718 62.6 75.2 25.6 23.3 2.9 3.2

2000-2002 (2001) 521 631 61.5 73.1 25.4 23.1 2.9 3.2

1999-2001 (2000) 499 598 64.9 77.7 25.0 22.8 3.1 3.4

1998-2000 (1999) 595 720 67.1 79.4 25.0 22.6 3.2 3.5

1997-1999 (1998) 516 604 71.9 84.8 24.1 21.7 3.5 3.9

1996-1998 (1997) 546 649 66.0 77.1 23.7 21.3 3.3 3.6

1995-1997 (1996) 449 527 64.8 75.6 23.8 21.5 3.2 3.5

1994-1996 (1995) 426 497 61.5 71.5 23.2 20.9 3.1 3.4

1993-1995 (1994) 399 467 57.8 66.9 22.6 20.4 3.0 3.3

1992-1994 (1993) 354 412 54.4 62.7 21.9 19.8 2.9 3.2

1991-1993 (1992) 324 373 49.8 57.2 20.7 18.7 2.8 3.1

1990-1992 (1991) 275 320 47.4 54.3 20.7 18.7 2.6 2.9

1989-1991 (1990) 285 330 48.3 55.5 20.7 18.8 2.7 3.0

1988-1990 (1989) 301 349 49.3 56.6 20.5 18.6 2.8 3.0

1987-1989 (1988) 260 303 46.9 54.7 18.0 16.3 3.0 3.4

1986-1988 (1987) 227 274 41.5 49.0 17.5 15.9 2.8 3.1

1985-1987 (1986) 195 234 39.0 46.2 17.2 15.6 2.7 3.0

1984-1986 (1985) 208 245 38.7 45.3 17.4 15.9 2.6 2.8

1983-1985 (1984) 189 222 39.3 45.8 17.2 15.8 2.7 2.9

1982-1984 (1983) 180 212 38.3 44.9 17.6 16.3 2.6 2.8

1981-1983 (1982) 164 197 37.1 43.7 17.2 16.0 2.5 2.7

1980-1982 (1981) 156 185 37.5 44.3 17.6 16.2 2.5 2.7

1979-1981 (1980) 173 206 38.6 45.5 18.1 16.7 2.5 2.7

1972-1974 (1973) 356 418 40.3 47.2 23.2 21.6 2.0 2.2

1954-1956 (1955) 64 17.0 13.0 12.6

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
119

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific diabetes mellitus 

death rate (2007-2009) for AI/AN 

increased sharply with age. For age 

group 75-84 years the diabetes 

rate for females was 16 percent 

greater than for males, whereas 

the diabetes male rate for this 

same age group for U.S. all races 

was 28 percent greater than for 

females. These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on 

state death certificates.

Chart 4.45 Diabetes Mellitus Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
120

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.45 Diabetes Mellitus Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years 0.4 0.6 0.6 0.9 0.2 0.2

25-34 years 3.5 4.8 4.8 6.2 2.2 3.4

35-44 years 14.9 18.6 20.4 24.6 9.7 12.7

45-54 years 32.9 38.2 41.0 47.0 25.5 30.1

55-64 years 88.2 105.6 118.2 141.7 61.3 73.3

65-74 years 203.9 250.8 225.9 274.5 185.5 230.9

75-84 years 353.6 431.1 315.6 394.0 381.2 458.0

85 years + 427.8 447.8 456.2 496.4 413.9 423.8

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years 0.1 0.1 0.0 0.1 0.0 0.0

15-24 years 0.5 0.6 0.4 0.4 0.5 0.3

25-34 years 1.4 1.6 1.3 1.2 1.4 1.0

35-44 years 4.4 5.4 3.4 3.8 4.7 2.8

45-54 years 12.6 16.0 9.4 11.2 14.5 8.0

55-64 years 33.3 40.6 26.5 30.0 37.2 23.2

65-74 years 74.7 87.8 63.4 67.1 81.0 54.9

75-84 years 153.0 175.7 137.4 141.9 165.6 124.8

85 years + 298.9 341.6 278.8 282.7 332.1 259.3

—* Represents zero.

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
121

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted heart 

disease death rate has been 

decreasing since 1979 1981. 

The AI/AN rate (318.8) for the 

three-year period of 1979-1981 

was 22.6 percent lower than the 

U.S. all races rate (412.1) for 

1980. The AI/AN race (182.4) 

for 2007-2009 was only one-half 

(0.5) of a percent lower than the 

U.S. all races rate (192.1) for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 4.46 Age-Adjusted Heart Disease Death Rates

 
122

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.46 Heart Disease Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1955-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 1,986 2,311

2007-2009 (2008) 1,905 2,288 156.9 182.4 192.1 189.3 0.9 1.0

2006-2008 (2007) 1,838 2,140 158.7 185.2 196.1 192.8 0.9 1.0

2005-2007 (2006) 1,861 2,180 165.3 191.9 205.5 202.0 0.9 1.0

2004-2006 (2005) 1,831 2,120 177.7 206.3 216.8 213.2 1.0 1.0

2003-2005 (2004) 1,823 2,127 189.6 218.8 221.6 217.6 1.0 1.0

2002-2004 (2003) 1,859 2,157 199.7 231.1 236.3 231.9 1.0 1.0

2001-2003 (2002) 1,768 2,066 202.8 234.3 240.6 240.4 1.0 1.0

2000-2002 (2001) 1,667 1,936 204.6 236.2 249.5 245.1 0.9 1.0

1999-2001 (2000) 1,607 1,861 212.2 243.8 257.6 253.4 0.9 1.0

1998-2000 (1999) 1,678 1,940 225.0 255.8 266.5 261.9 1.0 1.0

1997-1999 (1998) 1,684 1,964 233.0 268.7 271.3 266.8 1.0 1.0

1996-1998 (1997) 1,683 1,970 234.1 271.5 277.7 273.4 1.0 1.0

1995-1997 (1996) 1,600 1,877 235.7 274.7 285.7 281.4 1.0 1.0

1994-1996 (1995) 1,573 1,852 242.3 281.5 293.4 288.6 1.0 1.0

1993-1995 (1994) 1,515 1,754 239.5 277.5 297.5 292.9 0.9 0.9

1992-1994 (1993) 1,524 1,779 242.7 281.8 308.1 302.9 0.9 0.9

1991-1993 (1992) 1,484 1,764 247.3 289.3 304.0 299.0 1.0 1.0

1990-1992 (1991) 1,416 1,682 242.4 285.5 312.5 307.4 0.9 0.9

1989-1991 (1990) 1,349 1,599 246.1 288.9 321.8 317.0 0.9 0.9

1988-1990 (1989) 1,408 1,661 247.9 290.5 332.0 326.6 0.9 0.9

1987-1989 (1988) 1,359 1,600 253.5 296.7 352.5 347.6 0.8 0.9

1986-1988 (1987) 1,312 1,553 247.5 289.0 355.9 351.5 0.8 0.8

1985-1987 (1986) 1,190 1,389 245.3 285.7 365.1 360.9 0.8 0.8

1984-1986 (1985) 1,223 1,422 251.6 291.5 374.9 371.4 0.8 0.8

1983-1985 (1984) 1,206 1,405 258.5 299.8 378.8 376.0 0.8 0.8

1982-1984 (1983) 1,117 1,306 263.4 305.9 388.9 386.1 0.8 0.8

1981-1983 (1982) 1,102 1,285 255.6 297.7 389.0 387.4 0.8 0.8

1980-1982 (1981) 1,000 1,162 262.4 307.2 397.0 395.1 0.8 0.8

1979-1981 (1980) 1,096 1,300 272.0 318.8 412.1 409.4 0.8 0.8

1972-1974 (1973) 2,275 2,689 283.2 335.1 491.5 490.0 0.7 0.7

1954-1956 (1955) 223.0 291.3 285.6

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Reservation State data for 1955, the year IHS was established, are presented above. Data from 1972 forward are drawn from specific counties in the IHS service area. Reservation State data and 

county data are not directly comparable. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. 

white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
123

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific heart disease 

death rate (2007-2009) for AI/AN 

males for age groups 25 and older 

was higher in comparison to 

AI/AN females. U.S. all races rate 

(4,598.4) for both sexes was 

99 percent higher than the AI/AN 

rate (2,307.7) and the U.S. white 

rate (4,680.7) was 103 percent 

higher than the AI/AN rate for 85 

years and over. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.47 Heart Disease Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
124

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.47 Heart Disease Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 17.92 17.92 18.52 16.62 17.2 19.1

1-4 years 2.5 3.8 2.2 3.1 2.7 4.6

5-14 years 0.6 0.8 1.0 1.4 0.2 0.2

15-24 years 3.1 3.8 3.1 3.7 3.0 4.0

25-34 years 13.9 17.2 20.9 25.7 6.6 8.5

35-44 years 41.9 49.7 58.3 68.2 25.9 31.7

45-54 years 100.7 115.7 147.1 167.5 58.3 68.4

55-64 years 234.6 275.0 337.2 395.6 142.8 167.1

65-74 years 504.1 608.1 681.3 828.9 355.0 422.4

75-84 years 1,031.2 1,234.8 1,272.2 1,564.3 856.3 995.7

85 years + 2,176.9 2,307.7 2,368.0 2,589.4 2,082.6 2,168.7

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 9.6 10.3 8.8 8.2 8.5 7.9

1-4 years 1.2 1.2 1.1 0.9 0.9 0.8

5-14 years 0.6 0.6 0.5 0.5 0.5 0.5

15-24 years 2.5 3.3 1.6 1.9 2.6 1.2

25-34 years 8.1 10.8 5.4 6.7 9.1 4.1

35-44 years 26.9 37.4 16.4 24.2 34.4 13.9

45-54 years 85.2 122.9 48.8 79.0 117.1 41.3

55-64 years 195.3 280.8 115.6 183.1 266.9 103.4

65-74 years 441.1 594.0 309.7 424.3 573.9 292.6

75-84 years 1,271.7 1,584.3 1,050.4 1,265.8 1,580.9 1,038.5

85 years + 4,598.4 5,038.6 4,370.0 4,680.7 5,192.6 4,437.7

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 The adjusted rate for age less than one year is the same or lower than the unadjusted rate because the linked birth/infant death file (used to obtain 

the adjusted counts of infant deaths) had the same or fewer deaths for this cause than did the unadjusted mortality file (2007-2009 data).

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
125

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

cerebrovascular death rate has 

been decreasing during the last 

few years. The AI/AN rate (81.1) 

for 1979-1981 when compared to 

the AI/AN rate (39.1) 2007-2009 

was 107.4 percent higher. The 

U.S. all races rate (42.1) for 

2008 is 0.9 times greater than 

the comparable AI/AN 2007-2009 

rate (39.1). These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.48 Age-Adjusted Cerebrovascular Diseases Death Rates

 
126

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.48 Cerebrovascular Diseases Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 409 478

2007-2009 (2008) 353 401 33.8 39.1 42.1 40.4 0.9 1.0

2006-2008 (2007) 400 468 33.9 38.8 43.5 41.6 0.9 0.9

2005-2007 (2006) 375 424 38.0 43.8 44.8 42.9 1.0 1.0

2004-2006 (2005) 429 501 40.4 46.6 48.0 46.0 1.0 1.0

2003-2005 (2004) 389 455 42.7 49.6 51.2 49.2 1.0 1.0

2002-2004 (2003) 368 429 43.9 50.9 54.6 52.4 0.9 1.0

2001-2003 (2002) 386 449 47.2 54.6 57.2 55.2 1.0 1.0

2000-2002 (2001) 416 482 51.5 59.9 58.4 56.2 1.0 1.1

1999-2001 (2000) 406 481 55.1 63.7 60.9 58.8 1.0 1.1

1998-2000 (1999) 387 442 55.7 63.2 61.6 59.6 1.0 1.1

1997-1999 (1998) 347 380 56.3 62.3 59.3 57.2 1.1 1.1

1996-1998 (1997) 348 380 54.4 62.7 61.1 59.0 1.0 1.1

1995-1997 (1996) 366 404 59.5 65.3 62.5 60.2 1.0 1.1

1994-1996 (1995) 358 402 60.6 66.8 63.1 60.7 1.1 1.1

1993-1995 (1994) 305 337 56.8 62.6 62.6 60.3 1.0 1.0

1992-1994 (1993) 305 335 54.4 59.8 62.7 60.4 1.0 1.0

1991-1993 (1992) 288 320 55.4 60.9 61.5 59.2 1.0 1.0

1990-1992 (1991) 294 329 55.2 61.0 62.9 60.3 1.0 1.0

1989-1991 (1990) 275 307 55.5 61.3 65.3 62.8 0.9 1.0

1988-1990 (1989) 270 301 55.2 61.5 67.0 64.2 0.9 1.0

1987-1989 (1988) 275 310 56.9 64.0 70.6 67.8 0.9 0.9

1986-1988 (1987) 282 327 55.8 62.7 71.6 69.1 0.9 0.9

1985-1987 (1986) 232 253 56.2 62.3 73.1 70.5 0.9 0.9

1984-1986 (1985) 254 276 56.1 61.1 76.4 73.7 0.8 0.8

1983-1985 (1984) 245 268 59.5 65.4 78.7 76.1 0.8 0.9

1982-1984 (1983) 236 268 62.6 70.0 81.2 78.5 0.9 0.9

1981-1983 (1982) 237 269 66.1 74.3 84.2 81.5 0.9 0.9

1980-1982 (1981) 241 268 68.3 76.3 89.5 86.7 0.9 0.9

1979-1981 (1980) 225 252 72.0 81.1 96.2 93.2 0.8 0.9

1972-1974 (1973) 682 770 95.5 107.2 136.2 132.8 0.8 0.8

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard population; the U.S. all races and U.S. white columns present data for a 

one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
127

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific cerebrovascular 

diseases death rate (2007-2009) 

was relatively close for AI/AN males 

and females for each age group. 

The rate for both AI/AN genders 

increased with age beginning with 

the 25-34 year age group. The 

U.S. all races rate (1,071.0) for 85 

years and older for both sexes was 

65 percent higher than the AI/AN 

(649.5) and the U.S. white rate 

(1,077.9) was 66 percent higher 

than the AI/AN. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.49 Cerebrovascular Diseases Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
128

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.49 Cerebrovascular Diseases Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 2.8 4.7 —* 5.5 5.72 3.82

1-4 years 0.5 0.7 —* —* 0.9 1.4

5-14 years —* —* —* —* —* —*

15-24 years 0.5 0.8 0.4 0.4 0.6 1.1

25-34 years 0.7 0.7 0.7 0.7 0.7 0.7

35-44 years 6.0 6.8 6.2 7.1 5.8 6.6

45-54 years 17.5 19.9 21.3 24.6 14.0 15.6

55-64 years 36.9 43.7 39.6 45.5 34.6 42.0

65-74 years 92.9 110.6 106.2 129.6 81.8 94.6

75-84 years 254.7 308.3 296.0 366.6 224.7 266.0

85 years + 611.8 649.5 523.2 563.5 655.6 692.0

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 3.4 3.3 3.6 3.0 2.9 3.2

1-4 years 0.4 0.4 0.4 0.4 0.3 0.4

5-14 years 0.2 0.2 0.2 0.2 0.2 0.3

15-24 years 0.4 0.5 0.4 0.4 0.5 0.4

25-34 years 1.3 1.5 1.2 1.2 1.4 1.0

35-44 years 4.8 5.2 4.5 3.9 4.2 3.6

45-54 years 13.7 15.3 12.2 10.7 12.0 9.5

55-64 years 30.6 35.5 26.1 25.8 29.9 21.9

65-74 years 87.3 96.6 78.4 80.0 88.2 72.8

75-84 years 313.3 320.4 308.2 306.7 313.3 302.0

85 years + 1,071.0 965.2 1,120.8 1,077.9 968.9 1,129.7

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 The adjusted rate for age less than one year is the same or lower than the unadjusted rate because the linked birth/infant death file (used to obtain 

the adjusted counts of infant deaths) had the same or fewer deaths for this cause than did the unadjusted mortality file (2007-2009 data).

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
129

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

Alzheimer’s disease rate (1.0) 

for years 1979-1981 increased 

to 14.6 for 2007-2009. The U.S. 

all races rate (24.4) for 2008 is 

0.6 times the 2007-2009 rate 

(14.6). These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on the state death certificates.

Chart 4.50 Age-Adjusted Alzheimer’s Disease Death Rates

 
130

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.50 Alzheimer’s Disease Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1980-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 124 137

2007-2009 (2008) 131 148 13.1 14.6 24.4 26.7 0.6 0.5

2006-2008 (2007) 127 140 12.9 14.5 22.7 24.6 0.6 0.6

2005-2007 (2006) 111 123 13.5 15.0 22.6 24.5 0.7 0.6

2004-2006 (2005) 121 133 12.4 13.6 22.9 24.7 0.6 0.6

2003-2005 (2004) 67 71 12.2 13.3 21.8 23.3 0.6 0.6

2002-2004 (2003) 82 89 10.8 11.6 21.4 22.9 0.5 0.5

2001-2003 (2002) 76 83 11.1 11.9 20.8 21.6 0.6 0.6

2000-2002 (2001) 61 64 10.4 11.2 19.3 20.0 0.6 0.6

1999-2001 (2000) 58 63 9.7 10.2 18.1 18.8 0.6 0.5

1998-2000 (1999) 54 55 5.5 6.0 16.5 17.2 0.4 0.3

1997-1999 (1998) 17 20 4.9 4.9 8.6 8.9 0.6 0.6

1996-1998 (1997) 18 24 5.3 6.8 8.7 9.1 0.8 0.7

1995-1997 (1996) 18 24 5.5 6.8 8.5 8.8 0.8 0.8

1994-1996 (1995) 18 19 5.3 6.2 8.4 8.7 0.7 0.7

1993-1995 (1994) 13 15 4.5 5.0 7.7 8.0 0.6 0.6

1992-1994 (1993) 12 14 4.2 4.7 7.1 7.4 0.7 0.6

1991-1993 (1992) 12 13 3.7 4.1 6.3 6.6 0.7 0.6

1990-1992 (1991) 8 9 3.2 3.5 6.3 6.6 0.6 0.5

1989-1991 (1990) 8 9 2.8 3.0 6.4 6.6 0.5 0.5

1988-1990 (1989) 8 8 2.8 3.1 6.1 6.4 0.5 0.5

1987-1989 (1988) 7 9 3.0 3.5 5.8 6.1 0.6 0.6

1986-1988 (1987) 10 13 3.0 3.8 5.5 5.7 0.7 0.7

1985-1987 (1986) 9 12 2.5 3.2 4.6 4.9 0.7 0.7

1984-1986 (1985) 3 4 1.7 2.2 4.1 4.3 0.5 0.5

1983-1985 (1984) 2 2 1.4 1.5 3.1 3.3 0.5 0.5

1982-1984 (1983) 4 4 1.0 1.0 2.2 2.4 0.5 0.4

1981-1983 (1982) —* —* 1.1 1.4 1.3 1.4 1.1 1.0

1980-1982 (1981) 2 4 0.4 0.8 0.9 0.9 0.9 0.9

1979-1981 (1980) 1 1 0.6 1.0 0.7 0.7 1.4 1.4

 (1979) 2 2

—* Represents zero.

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Alzheimer’s death data are introduced in 1979 for the IHS service area. The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 standard 

population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
131

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific Alzheimer’s death 

rate (2007-2009) for AI/AN females 

was higher than AI/AN males in all 

age groups except in age group 55 

to 64 years. In age group 85 years 

and over, the AI/AN female rate 

(493.3) was 55.3 percent lower 

than the U.S. all races female rate 

(1,104.8) and over 56.8 percent 

lower than U.S. white female rate 

(1,142.1). These AI/AN rates have 

been adjusted to compensate for 

misreporting of AI/AN race on state 

death certificates.

Chart 4.51 Alzheimer’s Disease Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
132

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.51 Alzheimers Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years —* —* —* —* —* —*

25-34 years —* —* —* —* —* —*

35-44 years —* —* —* —* —* —*

45-54 years 0.1 0.1 —* —* 0.3 0.3

55-64 years 1.1 1.1 1.4 1.4 0.8 0.8

65-74 years 17.3 17.7 10.8 10.8 22.7 23.5

75-84 years 109.6 131.1 96.1 109.8 119.5 146.5

85 years + 445.6 481.0 409.2 456.2 463.5 493.3

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years —* —* —* —* —* —*

25-34 years —* —* —* —* —* —*

35-44 years —* —* —* —* —* —*

45-54 years 0.2 0.2 0.3 0.2 0.2 0.3

55-64 years 2.2 2.0 2.3 2.3 2.2 2.5

65-74 years 21.1 19.6 22.4 21.9 20.1 23.6

75-84 years 192.5 170.1 208.4 200.4 176.1 217.9

85 years + 1,002.2 784.1 1,104.8 1,035.4 810.7 1,142.1

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
133

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted 

Parkinson’s death rate (7.0) for 

years 1999-2001 decreased to 

5.1 for 2007-2009. The U.S. all 

races rate (6.7) for 2008 is 1.3 

times the 2007-2009 rate (5.1). 

These AI/AN rates have been 

adjusted to compensate for 

misreporting of AI/AN race on 

the state death certificates.

Chart 4.52 Age-Adjusted Parkinson’s Disease Death Rates

 

Table 4.52 Parkinson’s Disease Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 2000-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 46 49

2007-2009 (2008) 52 54 4.8 5.1 6.7 8.0 0.8 0.6

2006-2008 (2007) 47 50 4.9 5.2 6.7 7.8 0.8 0.7

2005-2007 (2006) 44 47 5.0 5.3 6.6 7.7 0.8 0.7

2004-2006 (2005) 47 51 4.8 5.1 6.6 7.8 0.8 0.7

2003-2005 (2004) 31 32 5.3 5.6 6.1 7.2 0.9 0.8

2002-2004 (2003) 49 51 5.1 5.3 6.2 7.2 0.9 0.7

2001-2003 (2002) 34 36 5.0 5.2 5.9 6.9 0.9 0.8

2000-2002 (2001) 24 25 4.7 4.9 5.8 6.8 0.8 0.7

1999-2001 (2000) 38 41 6.7 7.0 5.6 6.5 1.3 1.1

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: The AI/AN death rate columns present data for the three-year period specified and are age-adjusted to the 2000 population; the U.S. all races and U.S. white columns present data for a one-year 

period. The number columns indicate total AI/AN deaths for one-year period specified.
134

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The 2007-2009 AI/AN age-adjusted 

enterocolitis due to clostridium 

difficile death rate (1.9) has 

increased 138 percent since the 

1999-2001 rate of 0.8 deaths 

per 100,000 population. The 

2007-2009 rate (1.9 deaths per 

100,000 population) is 21 percent 

lower than the U.S. all races rate 

of 2.4 for 2008. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.53 Age-Adjusted Enterocolitis Due to Clostridium Difficile Death Rates

 

Table 4.53 Enterocolitis Due to Clostridium Difficile Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 2000-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 24 25

2007-2009 (2008) 21 22 1.9 1.9 2.4 2.5 0.8 0.8

2006-2008 (2007) 21 22 1.9 1.9 2.0 2.1 1.0 0.9

2005-2007 (2006) 20 21 1.8 1.9 2.0 2.1 1.0 0.9

2004-2006 (2005) 15 16 1.4 1.5 1.8 1.9 0.8 0.8

2003-2005 (2004) —* —* 0.9 0.9 1.4 1.5 0.6 0.6

2002-2004 (2003) —* —* 0.6 0.6 1.0 1.0 0.6 0.6

2001-2003 (2002) —* —* 0.7 0.7 0.8 0.8 0.9 0.9

2000-2002 (2001) —* —* 0.7 0.7 0.5 0.5 1.4 1.4

1999-2001 (2000) —* —* 0.8 0.8 0.4 0.4 2.0 2.0

—* Represents zero.

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: The number of deaths from Enterocolitis due to Clostridium, difficile (C, difficile) (ICD-10 code A04.7) has increased dramatically in recent years, from 793 deaths in 1999 to 7,476 deaths in 2008. 

Because of the increasing importance of this cause of death, beginning with data year 2006, data for C. difficile has been added to the list of rankable causes. The AI/AN death rate columns present data for 

the three-year period specified and are age-adjusted to the 2000 population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths 

for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
135

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted HIV 

disease death rate (1.2) for years 

1987-1989 increased to 3.0 for 

2007-2009. The U.S. all races 

rate (3.3) for 2008 is 0.9 times 

greater than the 2007-2009 rate 

(3.0). These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on the state death certificates.

Chart 4.54 Human Immunodeficiency Virus (HIV) Disease Death Rates

 
136

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.54 Human Immunodeficiency Virus (HIV) Disease Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1988-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 2 Unadjusted Adjusted2

 (2009) 39 41

2007-2009 (2008) 43 46 2.8 3.0 3.3 1.7 0.9 1.8

2006-2008 (2007) 54 60 2.8 3.1 3.7 1.9 0.8 1.6

2005-2007 (2006) 39 42 2.9 3.2 4.0 2.1 0.8 1.5

2004-2006 (2005) 45 51 2.8 3.1 4.2 2.2 0.7 1.4

2003-2005 (2004) 45 50 3.0 3.3 4.5 2.3 0.7 1.4

2002-2004 (2003) 46 51 2.9 3.1 4.7 2.5 0.7 1.2

2001-2003 (2002) 39 41 2.8 3.1 4.9 2.6 0.6 1.2

2000-2002 (2001) 40 48 2.4 2.8 5.0 2.6 0.6 1.1

1999-2001 (2000) 30 37 2.6 3.1 5.2 2.8 0.6 1.1

1998-2000 (1999) 49 55 2.7 3.0 5.3 2.9 0.6 1.0

1997-1999 (1998) 33 41 2.8 3.1 4.9 2.7 0.6 1.1

1996-1998 (1997) 27 30 2.9 3.3 6.0 3.4 0.6 1.0

1995-1997 (1996) 52 59 4.2 4.9 11.5 7.5 0.4 0.7

1994-1996 (1995) 84 100 5.3 6.2 16.1 11.5 0.4 0.5

1993-1995 (1994) 62 75 5.0 5.9 16.0 11.6 0.4 0.5

1992-1994 (1993) 39 45 3.3 3.9 14.3 10.9 0.3 0.4

1991-1993 (1992) 20 21 2.7 3.0 13.1 10.2 0.2 0.3

1990-1992 (1991) 38 42 2.2 2.3 11.7 9.4 0.2 0.2

1989-1991 (1990) 16 17 2.1 2.3 10.2 8.3 0.2 0.3

1988-1990 (1989) 16 16 1.4 1.4 9.0 7.3 0.2 0.2

1987-1989 (1988) 13 13 1.2 1.2 6.9 5.5 0.2 0.2

 (1987) 8 10

1

 Adjustment factors are only available for the AI/AN population residing in the IHS service area, for that reason, AI/AN numbers and rates for the entire United States (shown above) are based on 

unadjusted numbers of deaths.

2

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Includes cause of death with ICD-9 codes 042-044, first classified in 1987 and ICD10 codes B20-B24 beginning in 1999. For all years portrayed above the AI/AN death rate columns present data 

for the three-year period specified and are age-adjsuted to the 2000 standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total 

AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
137

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The age-specific HIV death rate for 

the three-year period 2007-2009 

for AI/AN males was greater for age 

group 45-54 years when reporting 

deaths in comparison to AI/AN 

females. In this age group, the HIV 

rate for AI/AN males (12.0) was 

118 percent higher than the AI/AN 

female rate (5.5). These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 4.55 Human Immunodeficiency Virus (HIV) Disease Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
138

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.55 Human Immunodeficiency Virus (HIV) Disease Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009, and 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year —* —* —* —* —* —*

1-4 years —* —* —* —* —* —*

5-14 years —* —* —* —* —* —*

15-24 years 0.2 0.2 0.2 0.2 0.2 0.2

25-34 years 1.4 1.4 2.4 2.4 0.5 0.5

35-44 years 6.8 7.8 9.6 11.0 4.1 4.7

45-54 years 8.0 8.6 10.8 12.0 5.5 5.5

55-64 years 3.0 3.0 5.1 5.1 1.2 1.2

65-74 years 0.8 0.8 1.8 1.8 --* --*

75-84 years 0.8 0.8 --* --* 1.4 1.4

85 years + —* —* —* —* —* —*

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year —* —* —* —* —* —*

1-4 years 0.0 0.0 0.0 —* —* —*

5-14 years 0.0 0.0 0.0 0.0 0.0 0.0

15-24 years 0.4 0.4 0.4 0.2 0.2 0.1

25-34 years 2.4 3.0 1.8 1.1 1.6 0.6

35-44 years 6.7 9.3 4.2 3.7 5.7 1.6

45-54 years 8.4 12.6 4.3 4.5 7.3 1.7

55-64 years 5.6 9.1 2.3 2.8 4.9 0.8

65-74 years 2.5 4.1 1.1 1.3 2.3 0.4

75-84 years 0.9 1.6 0.4 0.5 1.0 0.0

85 years + 0.6 0.0 0.0 0.0 0.0 0.0

—* Represents zero.

0.0 Quantity more than zero but less than 0.05.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
139

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted asthma 

death rate has increased steadily 

from 1979-1981 to 2007-2009 

(0.9 to 1.3 respectively). The 

2007-2009 rate (1.3) is 1.2 times 

higher than the U.S. all races rate 

(1.1). The AI/AN rates have been 

adjusted for misreporting of race 

on the state death certificates.

Chart 4.56 Age-Adjusted Asthma Death Rates

 
140

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.56 Asthma Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 15 16

2007-2009 (2008) 15 18 1.2 1.3 1.1 0.9 1.2 1.4

2006-2008 (2007) 25 26 1.2 1.3 1.1 0.9 1.2 1.4

2005-2007 (2006) 13 14 1.5 1.6 1.2 1.0 1.3 1.6

2004-2006 (2005) 25 27 1.2 1.3 1.1 0.9 1.2 1.4

2003-2005 (2004) 23 14 1.7 1.7 1.1 0.8 1.5 2.1

2002-2004 (2003) 26 27 1.7 1.8 1.2 1.0 1.5 1.8

2001-2003 (2002) 22 25 2.2 2.3 1.3 1.0 1.8 2.3

2000-2002 (2001) 24 25 2.1 2.3 1.3 1.0 1.8 2.3

1999-2001 (2000) 22 26 2.1 2.2 1.4 1.1 1.6 2.0

1998-2000 (1999) 18 18 1.7 1.8 1.5 1.2 1.2 1.5

1997-1999 (1998) 13 13 1.8 1.8 2.0 1.7 0.9 1.1

1996-1998 (1997) 22 23 1.7 1.7 2.0 1.7 0.9 1.0

1995-1997 (1996) 17 19 1.9 1.9 2.2 1.8 0.9 1.1

1994-1996 (1995) 18 18 1.7 1.8 2.2 1.9 0.8 0.9

1993-1995 (1994) 14 14 1.8 1.9 2.2 1.9 0.9 1.0

1992-1994 (1993) 18 21 1.8 1.9 2.1 1.8 0.9 1.1

1991-1993 (1992) 12 12 1.8 1.8 2.0 1.8 0.9 1.0

1990-1992 (1991) 12 12 1.7 1.7 2.1 1.9 0.8 0.9

1989-1991 (1990) 14 14 1.6 1.6 2.1 1.8 0.8 0.9

1988-1990 (1989) 10 14 1.7 1.8 2.1 1.8 0.9 1.0

1987-1989 (1988) 16 18 1.4 1.6 2.0 1.7 0.8 0.9

1986-1988 (1987) 8 9 1.5 1.7 1.9 1.7 0.9 1.0

1985-1987 (1986) 10 12 1.1 1.2 1.8 1.5 0.7 0.8

1984-1986 (1985) 5 5 1.2 1.3 1.8 1.6 0.7 0.8

1983-1985 (1984) 9 10 1.2 1.3 1.6 1.4 0.8 0.9

1982-1984 (1983) 7 7 1.3 1.3 1.7 1.5 0.8 0.9

1981-1983 (1982) 5 5 1.1 1.1 1.5 1.3 0.7 0.8

1980-1982 (1981) 4 4 1.1 1.1 1.5 1.3 0.7 0.8

1979-1981 (1980) 6 6 0.9 0.9 1.4 1.3 0.6 0.7

1972-1974 (1973) 11 11 1.2 1.2 1.4 1.2 0.9 1.0

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 and forward are drawn from specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified and age-adjusted to the 

2000 standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
141

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The AI/AN age-adjusted mortality 

rate (1,216.7) for all causes of 

death was 1.3 times higher for 

years 1979-1981 as compared 

to the 2007-2009 three year rate 

(943.0). The AI/AN for 2007-2009 

(943.0) was 1.2 times greater than 

the comparable U.S. all races rate 

(774.9) for 2008. The AI/AN 

rates have been adjusted for 

misreporting of race on the 

state death certificates.

Chart 4.57 Age-Adjusted Mortality for All Causes Death Rates

 
142

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.57 Mortality for All Causes Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

All Races

U.S. 

Calendar Year(s) Unadjusted Adjusted White 1 Unadjusted Adjusted1

 (2009) 11,243 13,026

2007-2009 (2008) 11,024 12,816 818.0 943.0 774.9 767.2 1.2 1.2

2006-2008 (2007) 10,604 12,329 816.0 940.8 775.3 764.3 1.2 1.2

2005-2007 (2006) 10,268 11,905 831.1 956.5 791.8 779.3 1.2 1.2

2004-2006 (2005) 10,257 11,896 854.0 981.1 815.0 801.1 1.2 1.2

2003-2005 (2004) 9,688 11,237 884.5 1,012.4 813.7 798.5 1.2 1.3

2002-2004 (2003) 9,673 11,126 899.9 1,027.1 843.5 827.1 1.2 1.2

2001-2003 (2002) 9,284 10,702 915.2 1,041.7 855.9 839.0 1.2 1.2

2000-2002 (2001) 8,837 10,170 914.7 1,039.9 858.8 840.7 1.2 1.2

1999-2001 (2000) 8,314 9,547 933.6 1,058.8 869.0 849.8 1.2 1.2

1998-2000 (1999) 8,458 9,714 943.5 1,069.0 875.6 854.6 1.2 1.3

1997-1999 (1998) 8,055 9,245 957.3 1,084.9 870.1 848.9 1.2 1.3

1996-1998 (1997) 7,891 9,057 945.8 1,071.7 877.7 855.4 1.2 1.3

1995-1997 (1996) 7,562 8,662 944.6 1,068.8 893.7 868.7 1.2 1.2

1994-1996 (1995) 7,430 8,462 969.5 1,095.7 909.5 882.0 1.2 1.2

1993-1995 (1994) 7,151 8,180 942.0 1,064.1 913.2 885.3 1.2 1.2

1992-1994 (1993) 7,011 8,017 940.4 1,063.1 925.8 896.8 1.1 1.2

1991-1993 (1992) 6,731 7,720 946.7 1,067.8 905.3 877.5 1.2 1.2

1990-1992 (1991) 6,487 7,434 923.9 1,046.2 921.9 893.0 1.1 1.2

1989-1991 (1990) 6,211 7,109 927.7 1,050.8 938.0 909.2 1.1 1.2

1988-1990 (1989) 6,386 7,297 935.1 1,048.3 949.9 919.8 1.1 1.1

1987-1989 (1988) 6,072 6,938 915.3 1,038.1 975.1 947.2 1.1 1.1

1986-1988 (1987) 5,878 6,720 931.7 1,056.6 969.6 943.2 1.1 1.1

1985-1987 (1986) 5,563 6,366 905.6 1,026.0 978.4 952.8 1.0 1.1

1984-1986 (1985) 5,448 6,218 921.3 1,042.2 987.8 963.4 1.1 1.1

1983-1985 (1984) 5,346 6,101 945.4 1,069.6 982.1 959.4 1.1 1.1

1982-1984 (1983) 5,247 5,994 986.3 1,115.7 990.0 967.4 1.1 1.2

1981-1983 (1982) 5,291 6,014 998.3 1,130.5 984.9 963.5 1.1 1.2

1980-1982 (1981) 5,181 5,889 1,040.8 1,177.9 1,007.0 984.0 1.2 1.2

1979-1981 (1980) 5,407 6,151 1,073.9 1,216.7 1,038.7 1,012.5 1.2 1.2

1972-1974 (1973) 13,472 15,035 1,281.1 1,433.8 1,209.9 1,180.8 1.2 1.2

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 and forward are drawn from specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified and age-adjusted to the 2000 

standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
143

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Life expectancy at birth for 

American Indians and Alaska 

Natives (AI/AN) for the threeyear period of 1972-1974 was 

63.6 years. By 2007-2009 life 

expectancy increased to 73.7 

years; 4 years less than the U.S. 

all races life expectancy of 78.1 

years for 2008. The 2007-2009 

AI/AN life expectancy of 73.7 years 

is 4.8 years less than for the U.S. 

white life expectancy of 78.5 years 

for 2008. The AI/AN rates have 

been adjusted for misreporting of 

race on the state death certificates.

Chart 4.58 Life Expectancy at Birth

 
144

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The years of potential life lost 

(YPLL) rate for American Indians 

and Alaska Natives (AI/AN) for the 

three-year period 2007-2009 is 

89.3 per 1,000 population, and 

it is 53 percent lower than the 

YPLL rate (191.3) for 1972-1974. 

The 2007-2009 AI/AN YPLL rate 

is 104 percent greater than the 

U.S. all races YPLL rate of 43.7 for 

2008 and 117 percent greater than 

the 2008 YPLL rate of 41.1 for U.S. 

whites. The AI/AN rates have been 

adjusted for misreporting of race 

on the state death certificates.

Chart 4.59 Years of Potential Life Lost (YPLL)

 

The AI/AN age-adjusted death rate 

for all causes of death decreased 

52 percent from the rate of 1,433.7 

for the three-year period 1972-1974 

to the 2007-2009 rate of 943.0. 

The U.S. all races rate decreased 

60 percent from 1973 to 2008, 

whereas the U.S. white rate 

decreased 59 percent during the 

same time period. The AI/AN 

2007-2009 rate (943.0) is 

24 percent higher than the 2008 

U.S. all races rate (758.3) and 

26 percent higher than U.S. white 

rate (750.3). The AI/AN rates have 

been adjusted for misreporting of 

race on the state death certificates.

Chart 4.60 Age-Adjusted Death Rate

 
145

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.58 Overall Measures of Indian Health

IHS Service Area Population Compared with the U.S. All Races and U.S. White Populations

Life Expectancy At Birth (Years)

Years of Potential Life Lost 

(Rate per 1,000 Population4)

Age-Adjusted Death Rate 

(per 100,000 Population)

Calendar Year(s) Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

IHS Service Area:

 2007-2009 76.3 73.7 74.2 89.32 818.0 943.0

 1999-2001 74.4 72.3 69.4 81.82 1,046.9 1,059.8

 1996-1998 72.9 70.6 72.1 84.02 1,010.3 1,070.8

 1972-1974 63.6 — 173.73 191.33 1,281.1 1,433.7

U.S. All Races:

 2008 78.1 43.7 758.3

 2000 76.9 45.7 869.0

 1997 76.5 47.1 878.1

 1973 71.4 78.9 1,209.9

U.S. White:

 2008 78.5 41.1 750.3

 2000 77.4 41.4 849.8

 1997 77.2 42.2 855.7

 1973 72.2 70.8 1,193.35

RATIO: IHS to U.S. All Races:

 2007-2009 (2008) 0.98 0.94 1.70 2.04 1.08 1.24

 1999-2001 (2000) 0.97 0.94 1.52 1.79 1.20 1.22

 1996-1998 (1997) 0.95 0.92 1.53 1.78 1.15 1.22

 1972-1974 (1973) 0.89 — 2.20 2.42 1.06 1.18

RATIO: IHS to U.S. White:

 2007-2009 (2008) 0.97 0.94 1.81 2.17 1.09 1.26

 1999-2001 (2000) 0.96 0.93 1.68 1.98 1.23 1.25

 1996-1998 (1997) 0.94 0.91 1.71 1.99 1.18 1.25

 1972-1974 (1973) 0.88 — 2.45 2.70 1.07 1.20

— Data not available. Adjusted data for Life Expectancy for the IHS Service Area population is unavailable for 1972-1974.

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 Years of Potential Life Lost (YPLL) is a mortality indicator which measures the burden of premature deaths. YPLL is presented for persons under 65 years of age because the average life expectancy for AI/AN 

is over 65 years. The number of deaths for each age group is multiplied by the years of life lost, calculated as the difference between age 65 years and the midpoint of the age group. This calculation was 

performed through the use of age groups under one, one to four, and five-year age groups through 55 to 64 years. Years of potential life lost is derived by summing years of life lost over all age groups. 3

 Years of Potential Life Lost (YPLL) is a mortality indicator which measures the burden of premature deaths. YPLL is presented for persons under 65 years of age because the average life expectancy for AI/AN 

is over 65 years. The number of deaths for each age group is multiplied by the years of life lost, calculated as the difference between age 65 years and the midpoint of the age group. This calculation was 

performed through the use of age groups under one, one to four, and 10-year age groups through 55 to 64 years. Years of potential life lost is derived by summing years of life lost over all age groups. 4

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

5

 US white rate is based on the year 1970 not 1973.
146

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

The health status of AI/AN has 

experienced major improvements 

since 1972-1974. Some of the 

positive changes are evident 

from the lower mortality rates. 

For example, tuberculosis mortality 

has declined 90 percent and 

deaths due to cerebrovascular 

disease have declined 64 percent. 

Additional reduced age-adjusted 

mortality rates include: homicide 

(59 percent), unintentional injuries 

(58 percent), pneumonia influenza 

(52 percent), and heart disease 

(46 percent).

Chart 4.61 IHS Program Accomplishments Since 1973 (Adjusted Mortality Data)

 

The health status of AI/AN has 

experienced major improvements 

since 1996-1998. Some of the 

positive changes are evident from 

the lower mortality rates. For 

example, tuberculosis mortality 

has declined 45 percent and 

deaths due to cerebrovascular 

disease have declined 38 percent. 

Additional reduced age-adjusted 

mortality rates include: heart 

disease (33 percent), pneumonia 

influenza (23 percent), diabetes 

(21 percent), and homicide 

(13 percent).

Chart 4.62 IHS Program Accomplishments Since 1997 (Adjusted Mortality Data)

 
147

trends in indian health 2014 edition: general mortality statistics

indian health service, u.s. department of health and human services

Table 4.61 IHS Program Accomplishments

IHS Service Area

Health Improvements

Rate 

Adjusted1

(1972-1974)

Rate 

Adjusted1

(1996-1998)

2007-2009 Rate Percent Change to 2007-2009

Unadjusted Adjusted1

Adjusted1

(from 1972-1974)

Adjusted1

(from 1996-1998)

Death Rates

 Cerebrovascular 107.2 62.7 33.8 39.1 -63.5 -37.6

 Diabetes 47.2 77.1 51.0 61.0 29.23 -20.9

 Heart disease 335.1 271.5 156.9 182.4 -45.6 -32.8

 Human immunodeficiency 

 virus (HIV) disease2 1.2 3.3 2.8 3.0 150.0 -9.1

 Homicide 26.8 12.6 9.6 11.0 -58.6 -12.7

 Malignant neoplasm3 150.0 187.0 148.7 170.8 13.93 -8.7

 Pneumonia and Influenza 50.5 31.3 22.1 24.1 -52.3 -23.0

 Suicide 29.4 17.9 16.2 18.5 -37.1 3.4

 Tuberculosis 10.8 2.0 1.1 1.1 -89.8 -45.0

 Unintentional injuries 223.2 97.1 79.5 94.5 -57.7 -2.7

1

 Adjusted - specifies a rate or percent adjusted to compensate for misreporting of AI/AN race on state death certificates.

2

 Rate of HIV deaths represents the 1987-1989 three year period. The percent change represents an increased AI/AN death rate from 1987-1989 to 1996-1998. This death rate then decreased from 

1996-1998 to 2007-2009 for AI/ANs.

3

 Diabetes and malignant neoplasm deaths increased for AI/ANs from 1972-1974 to 1996-1998 but then decreased from 1996-1998 to the 2007-2009 three year period.

NOTE: The trend for suicide deaths has been on the decline for many years but in recent years the rates indicate a slight increase. ICD-10 codes were introduced in 1999. Comparability ratios have been 

applied to the 1996-1998 age-adjusted data. ICD-9 codes were introduced in 1979. Comparability ratios have been applied to the 1972-1974 age-adjusted rate. All rates have been adjusted to the 2000 

standard population. 
During FY 2013, Indian Health 

Service contract awards were 

$664.2 million dollars. Grants 

awards for FY 2013 were 

$265.9 million dollars.

Chart 5.1 IHS Tribal and Urban Health Contract, Grant, and Compact Awards

 

148

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.1 IHS Tribal and Urban Health Contract, Grant, and Compact Awards 

Fiscal Year 1990-2013 (Millions of Dollars)

P.L. 93-638 Program

Fiscal Year

Commercial 

Contracts1 Grants3

Title 1 

Contract Funding

Title V 

Compact Funding

2013 644.1 265.9 743.8 1,560.9

2012 478.0 270.7 709.9 1,497.8

2011 402.8 260.9 681.4 1,350.1

2010 471.7 262.0 698.7 1,376.0

2009 458.5 251.9 566.6 1,236.3

2008 318.8 245.2 527.1 1,111.8

2007 437.8 236.8 492.1 1,053.8

2006 432.3 265.9 596.4 1,014.4

2005 295.6 168.7 575.1 974.1

2004 374.6 169.6 529.3 917.8

2003 296.1 126.8 522.6 898.5

2002 453.3 956.9 818.4 796.9

2001 404.3 886.4 390.1 734.3

2000 629.9 2 738.8 348.9 659.8

1995 297.5 335.0

1990 320.7 27.4

1

 Contract awards data includes those of IHS Area Offices, IHS Headquarters and the Office of Engineering Services. The total acquisition dollars 

include small business awards, new contracts and contract modifications, purchase orders below $25,000, and exclude purchases below $2,500 

when the government-wide commercial purchase card is used.

2

 Data henceforth does not include 638 contracts.

3

 Includes Urban Indian Health Programs IHCIA Contracts Title V and 4-in-1 Grants.

SOURCE: IHS HQs-Division of Acquisition Policy and Division of Grants Management, OMS 

 IHS HQs-Office of Urban Indian Health Programs, Office of Tribal Self-Governance and Office of Direct Service and Contracting Tribes, OD

 IHS HQ-Division of Health Professions Support, OPHS

149

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
IHS health contracts are awarded 

through P.L. 93-638 and 

commercial contracts. In FY 2013, 

P.L. 93-638 contracts had $2,304.7 

billion dollars awarded to Title I 

(Contracts) and Title V (Compacts). 

IHS reported $664.1 million dollars 

in total commercial contracts and 

$238.7 million dollars to small 

business or 35.9 percent.

Chart 5.2 IHS Tribal and Urban Health Contract and Compact Awards by Type

Fiscal Year 2013

 

IHS grants administers various 

grant categories for statutorily 

mandated/discretionary grant 

programs in three main program 

areas; Tribal, research, and 

recruitment grants. The grant 

types used to administer and 

support these grant programs 

are; demonstration, project, 

training, and research grants. 

The highest is the Other Tribal 

Program Grants with $174.5 million 

dollars. The lowest was P.L. 93-638 

projects grants with $2.9 million 

dollars. The Office of Urban Indian 

Health Programs provides contracts 

and grants to the Urban Indian 

health programs under Title V of 

the IHCIA. Contracts for FY 2013 

totaled $28.1 million and grants 

totaled $9.5 million.

Chart 5.3 IHS Tribal and Urban Health Grant and Compact Awards by Type

Fiscal Year 2013

 

150

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.2 IHS Tribal and Urban Health Contract and Grant Awards by Type

Fiscal Year 2013

Type of Contract or Grant Total $ Awarded (Millions) Percent Distribution

Commercial Contracts Total1 644.1 100.0

 Small Business Contracts2 238.7 37.1

P.L. 93-638 Programs 2,304.7 100.0

 Title I, Contracts 743.8 32.3

 Title V, Compacts 1,560.9 67.7

Grant and Contract Total 265.9 100.0

 Other Tribal Program Grants3 174.5 65.6

 Urban Indian Health Programs4 37.6 14.1

 IHCIA Contracts, Title V 28.1 10.6

 4-in-1 Grants 9.5 3.6

 IHS Loan Repayment Program 30.2 11.4

 Section 108 and H&C Funding 30.2 7.3

 IHS Scholarship Program 17.2 6.5

 Section 103 and 104 Funding 16.1 6.1

 Section 105 Funding 1.1 0.4

 University Program Grants5 3.5 1.3

 P.L. 93-638 Project Grants6 2.9 1.1

1

 Contract awards data includes those of IHS Area Offices, IHS Headquarters and the Office of Engineering Services. The total acquisition dollars 

include small business awards, new contracts and contract modifications, purchase orders below $25,000, and exclude purchases below 

$2,500 when the government-wide commercial purchase card is used.

2

 Includes awards to Buy Indian small business, HUBZone business concerns, 8(a) program participants, small disadvantaged business, 

women-owned small business, veteran and service disabled veteran owned small businesses.

3

 IHS grants administers various grant categories for statutorily mandated/discretionary grant programs in three main program areas; Tribal, 

research, and recruitment grants. The grant types used to administer and support these grant programs are; demonstration, project, training, 

and research grants.

4

 Urban Indian Health program grants for alcohol/substance abuse, mental health, HP/DP, and immunization, also known as 4-in-1 grants.

5

 Includes grants to universities that conduct recruitment and training program.

6

 Includes Tribal management grants and self-governance cooperative Agreements.

SOURCE: 

IHS HQs-Division of Acquisition Policy and Division of Grants Management, OMS 

IHS HQs-Office of Urban Indian Health Programs, Office of Tribal Self-Governance and Office of Direct Service and Contracting Tribes, OD 

IHS HQ-Division of Health Professions Support, OPHS

151

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
The appropriation for the Urban 

Indian Health Program has 

increased 46 percent since 

FY 2000. The workload reported 

increased eight percent during 

this time period. In FY 2013, the 

appropriation for the program 

was $40.7 million, and there were 

526,016 patient encounters.

Chart 5.4 Urban Indian Health Program Workload and Appropriation

 

152

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.4 Urban Indian Health Program Workload and Appropriation, FY 1985-2013 

Fiscal Year

Total 

Workload Medical

Community 

and Enabling 

Services1 Dental Other2

Appropriation 

($ Thousands)

20133 526,016 247,126 61,118 72,918 144,854 40,729

2012 507,987 230,123 68,018 65,110 144,736 42,984

20114 544,103 248,824 75,545 75,351 144,383 43,053

2010 529,314 237,988 78,089 63,072 150,165 43,139

20094 464,379 217,447 69,590 45,049 132,293 36,189

20084 453,561 210,486 64,937 54,934 123,204 34,547

2007 929,788 233,052 148,809 53,496 494,431 34,546

2006 963,164 218,314 175,799 51,371 517,680 32,744

2005 846,616 220,253 148,017 46,325 432,021 31,816

2004 805,782 195,016 129,374 43,605 437,787 37,112

2003 745,949 210,056 157,671 53,215 325,007 36,149

2002 784,234 190,425 119,663 42,251 431,895 33,976

2001 621,512 178,807 129,081 40,539 273,085 28,621

2000 483,441 161,573 107,804 36,653 177,411 27,813

1999 423,049 153,876 82,777 36,291 150,105 26,382

1998 482,919 166,649 96,387 48,823 171,060 25,379

1997 435,019 153,616 80,056 50,455 150,892 24,800

1996 553,029 182,552 106,680 47,624 216,173 23,360

1995 649,611 271,397 134,828 55,128 188,258 16,450

1994 657,150 277,984 135,952 60,748 182,466 14,112

19935 784,581 229,737 151,139 88,845 314,860 20,965

1992 757,606 192,921 142,658 82,076 339,951 17,195

1991 802,335 172,297 138,204 76,028 415,806 15,687

1990 530,228 181,974 137,200 72,470 138,584 13,049

1989 459,684 150,472 106,940 102,886 99,386 9,962

1988 370,943 128,000 102,481 64,609 75,853 9,624

19876 451,988 146,228 116,898 62,377 126,485 9,000

1986 471,757 163,004 124,783 57,663 126,307 9,644

1985 504,799 170,913 153,761 60,956 119,169 9,800

1

 Visits for Community and Enabling Services is derived from total enabling visits reported on Table 5 Line 29 column b of the UDS report. In the 

enabling services category of the UDS, Case Managers and Community Education specialists generate countable visits per the UDS definition of 

visit. If Case Managers or Health Education staff conduct group activities they aren’t counted as visits and are not included in the total visit count. 

Likewise, Outreach workers, Transportation staff, Eligibility Assistance workers, Interpretation staff and Other Enabling services staff which are all 

part of the enabling section of the UDS do not generate countable visits on the UDS report.

2

 The Other category include total visits in the UDS for Mental Health, Substance Abuse Services, Other Professional Services and Vision Services. 

“Other programs and services” are reported on Table 5 Line 29a of the UDS report. Staff in this category are those that provide other services. The 

activities do not count visits in the UDS. Services provided by staff in this category may include (but not limited to) programs such as WIC, after school 

tutoring, summer youth camps, senior activities, fitness classes, and other services not related to the delivery of direct health care by providers.

3

 Data is preliminary and has not yet been finalized for CY 2013.

4

 In FYs 2008-2009, vision was reported under the Other Professional category. In FY 2011 a vision service category was added as a separate service category. 

5

 Includes $2.0 million in urban alcohol programs transferred to the IHS Urban Program Branch from the IHS Alcohol and Substance Abuse Program Branch.

6

 Beginning in Fiscal Year 1987 and thereafter, the Tulsa and Oklahoma City Urban Programs are excluded since they were funded as demonstration 

projects under the IHS hospitals and clinics activity. Both of these programs were made permanent IHS programs in 2010 by the Affordable Care 

Act and are funded through the IHS Hospitals and Clinics line item.

NOTE: The UDS report is a calendar year report (Jan. 1-Dec. 31) of the corresponding calendar year (vs. fiscal year as noted in the columnyear as 

noted in the column header from the UIHP Workload and Appropriation form).

SOURCE: IHS Office of Urban Indian Health Programs

153

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
As shown on the chart, total 

hospital admissions peaked 

in FY 1978 at about 112,000. 

In FY 2013, there were 

70,673 total admissions.

Chart 5.5 Number of Hospital Admissions

IHS and Tribal Direct and Contract General Hospitals

 

154

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.5 Number of Hospital Admissions

IHS and Tribal Direct and Contract General Hospitals, Fiscal Years 1955-2013

Total IHS and 

Tribal Admissions

Indian Health Service Tribal

Fiscal Year Total Direct Contract1 Total Direct Contract

2013 70,673 34,258 23,939 10,319 36,415 29,170 7,245

2012 72,416 34,336 24,064 10,272 38,080 30,202 7,878

2011 74,567 36,357 26,817 9,540 38,210 30,197 8,013

2010 76,873 38,373 29,437 8,936 38,500 30,889 7,611

2009 74,558 37,758 28,936 8,822 36,800 31,070 5,730

2008 76,684 39,460 31,873 7,587 37,224 31,562 5,662

2007 80,266 42,294 34,163 8,131 37,972 32,474 5,498

2006 76,054 51,868 39,625 12,243 24,186 17,587 6,599

2005 78,958 54,615 41,990 12,625 24,343 16,460 7,883

2004 80,925 56,417 42,790 13,627 24,508 16,982 7,526

2003 80,833 57,038 42,288 14,750 23,795 16,894 6,901

2002 80,218 58,769 43,859 14,910 21,449 15,964 5,485

2001 82,595 61,542 45,913 15,629 21,053 15,853 5,200

2000 82,806 60,929 47,079 13,850 21,877 17,758 4,119

1999 85,328 63,602 49,753 13,849 21,726 17,255 4,471

1998 87,129 72,651 57,114 15,537 14,478 11,539 2,939

1997 86,231 71,879 56,219 15,660 14,352 12,188 2,164

1996 86,898 69,725 55,656 14,069 17,173 11,908 5,265

1995 88,549 71,898 56,796 15,102 16,651 11,034 5,617

1990 96,539 83,462 65,972 17,490 13,077 7,022 6,055

1985 108,777 98,245 78,423 19,822 10,532 3,678 6,8542

1980 108,242 106,992 77,798 29,194 1,250 1,250

1975 105,735 105,735 74,594 31,141

1970 92,710 92,710 67,877 24,833

1965 91,744 91,744 67,744 24,000

1960 76,674 76,674 56,874 19,800

1955 50,143 50,143 42,762 7,381

1

 Number of discharges used as estimate for number of admissions (1955-1996).

2

 Comparable Tribal contract health services data not available prior to FY 1985. 

SOURCE: IHS National Data Warehouse

155

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
The average daily hospital 

patient load in Indian Health 

Service and Tribal direct and 

contract general hospitals has 

decreased 66.4 percent since 

FY 1970. In FY 2013, the average 

daily patient load was 790.

Chart 5.6 Average Daily Hospital Patient Load

IHS and Tribal Direct and Contract General Hospitals

 

156

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.6 Average Daily Hospital Patient Load

IHS and Tribal Direct and Contract General Hospitals, Fiscal Years 1955-2013

Total IHS and 

Tribal Admissions

Indian Health Service Tribal

Fiscal Year Total Direct Contract Total Direct Contract

2013 790 371 226 145 419 325 94

2012 789 367 229 138 422 326 96

2011 784 361 236 125 423 323 100

2010 802 382 262 120 420 324 96

2009 762 371 260 111 391 320 71

2008 790 386 283 103 404 330 74

2007 832 419 321 98 413 353 60

2006 856 533 379 154 323 224 99

2005 888 554 394 160 334 221 113

2004 890 567 398 169 323 223 100

2003 895 592 410 182 303 220 83

2002 876 603 427 176 273 214 59

2001 894 639 449 190 255 198 57

2000 883 624 474 150 259 230 29

1999 954 691 520 171 263 221 42

1998 973 811 619 192 162 119 43

1997 1,009 836 623 213 173 129 44

1996 1,002 826 636 190 176 121 55

1995 1,066 874 672 202 192 127 65

1990 1,209 1,053 825 228 156 90 66

1985 1,410 1,286 1,052 234 124 47 771

1980 1,594 1,576 1,178 398 18 18

1975 1,768 1,768 1,330 438

1970 2,353 2,353 1,729 624

1965 3,127 3,127 2,244 883

1960 3,142 3,142 2,232 910

1955 3,711 3,711 2,531 1,180

1

 Tribal contract data not available prior to FY 1985.

SOURCE: IHS National Data Warehouse

157

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 77.4 percent of all 

discharges for patients under 

1 year of age from Indian Health 

Service and Tribal direct and 

contract general hospitals 

pertained to supplementary 

classification, followed by 

respiratory system diseases 

at 9.4 percent.

Chart 5.7 Leading Causes of Hospitalization: Ages Under 1 Year

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.7 Ten Leading Causes of Hospitalization for GM&S* Patients Under 1 Year of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 11,227 5,932 5,295 100.0 52.8 47.2

Supplementary classification 8,687 4,478 4,209 77.4 75.5 79.5

Respiratory system diseases 1,060 592 468 9.4 10.0 8.8

Perinatal period conditions 718 432 286 6.4 7.3 5.4

Symptoms, signs, & ill-defined conditions 341 197 144 3.0 3.3 2.7

Endocrine, nutritional, & metabolic diseases 85 47 38 0.8 0.8 0.7

Congenital anomalies 62 37 25 0.6 0.6 0.5

Infectious & parasitic diseases 57 29 28 0.5 0.5 0.5

Genitourinary system diseases 54 25 29 0.5 0.4 0.5

Digestive system diseases 49 36 13 0.4 0.6 0.2

Skin & subcutaneous tissue diseases 48 21 27 0.4 0.4 0.5

All other 66 38 28 0.6 0.6 0.5

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

158

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 58.1 percent of all 

discharges for patients 1 to 4 years 

of age from Indian Health Service 

and Tribal direct and contract 

general hospitals pertained to 

respiratory system diseases, 

followed by symptoms, signs, 

and ill-defined conditions at 

8.5 percent.

Chart 5.8 Leading Causes of Hospitalization: Ages 1 to 4 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.8 Ten Leading Causes of Hospitalization for GM&S* Patients 1 to 4 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 1,757 925 832 100.0 52.6 47.4

Respiratory system diseases 1,021 559 462 58.1 60.4 55.5

Symptoms, signs, & ill-defined conditions 149 70 79 8.5 7.6 9.5

Skin & subcutaneous tissue diseases 122 62 60 6.9 6.7 7.2

Endocrine, nutritional, & metabolic disorders 93 41 52 5.3 4.4 6.3

Injury & poisoning 77 45 32 4.4 4.9 3.8

Digestive system diseases 76 45 31 4.3 4.9 3.7

Infectious & parasitic diseases 55 27 28 3.1 2.9 3.4

Genitourinary system diseases 47 7 40 2.7 0.8 4.8

Nervous system & sense organ diseases 41 24 17 2.3 2.6 2.0

Musculoskeletal system & connective 

tissue diseases 24 11 13 1.4 1.2 1.6

All other 52 34 18 3.0 3.7 2.2

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

159

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 20.6 percent of 

all discharges for patients 5 

to 14 years of age from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to respiratory system 

diseases, followed by digestive 

system diseases at 17.8 percent.

Chart 5.9 Leading Causes of Hospitalization: Ages 5 to 14 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.9 Ten Leading Causes of Hospitalization for GM&S* Patients 5 to 14 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 1,525 795 730 100.0 52.1 47.9

Respiratory system diseases 314 170 144 20.6 21.4 19.7

Digestive system diseases 271 176 95 17.8 22.1 13.0

Injury & poisoning 201 104 97 13.2 13.1 13.3

Symptoms, signs, & ill-defined conditions 137 67 70 9.0 8.4 9.6

Mental disorders 127 53 74 8.3 6.7 10.1

Skin & subcutaneous tissue diseases 121 76 45 7.9 9.6 6.2

Genitourinary system diseases 69 14 55 4.5 1.8 7.5

Endocrine, nutritional, & metabolic disorders 59 27 32 3.9 3.4 4.4

Nervous system & sense organ diseases 52 26 26 3.4 3.3 3.6

Infectious & parasitic diseases 35 19 16 2.3 2.4 2.2

All other 139 63 76 9.1 7.9 10.4

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

160

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 51.1 percent of all 

discharges for patients 15 to 

24 years of age from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to obstetric deliveries 

and complications of pregnancy 

and the puerperium, followed by 

mental disorders at 9.8 percent.

Chart 5.10 Leading Causes of Hospitalization: Ages 15 to 24 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.10 Ten Leading Causes of Hospitalization for GM&S* Patients 15 to 24 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 8,523 2,014 6,509 100.0 23.6 76.4

Obstetric deliveries & complications of 

pregnancy & puerperium 4,351 0 4,351 51.1 0.0 66.8

Mental disorders 831 452 379 9.8 22.4 5.8

Digestive system diseases 729 327 402 8.6 16.2 6.2

Injury & poisoning 712 473 239 8.4 23.5 3.7

Supplementary classification 337 69 268 4.0 3.4 4.1

Skin & subcutaneous tissue diseases 256 156 100 3.0 7.7 1.5

Respiratory system diseases 225 140 85 2.6 7.0 1.3

Genitourinary system diseases 220 21 199 2.6 1.0 3.1

Symptoms, signs, & ill-defined conditions 183 70 113 2.1 3.5 1.7

Endocrine, nutritional, & metabolic disorders 178 72 106 2.1 3.6 1.6

All other 501 234 267 5.9 11.6 4.1

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

161

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 29.4 percent of all 

discharges for patients 25 to 

44 years of age from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to obstetric deliveries 

and complications of pregnancy 

and the puerperium, followed 

by digestive system diseases 

at 13.1 percent.

Chart 5.11 Leading Causes of Hospitalization: Ages 25 to 44 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.11 Ten Leading Causes of Hospitalization for GM&S* Patients 25 to 44 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 18,401 6,645 11,756 100.0 36.1 63.9

Obstetric deliveries & complications of 

pregnancy & puerperium 5,406 0 5,406 29.4 0.0 46.0

Digestive system diseases 2,411 1,227 1,184 13.1 18.5 10.1

Injury & poisoning 1,606 1,018 588 8.7 15.3 5.0

Mental disorders 1,442 954 488 7.8 14.4 4.2

Skin & subcutaneous tissue diseases 1,094 672 422 5.9 10.1 3.6

Genitourinary system diseases 1,038 207 831 5.6 3.1 7.1

Endocrine, nutritional, & metabolic disorders 916 553 363 5.0 8.3 3.1

Symptoms, signs, & ill-defined conditions 797 324 473 4.3 4.9 4.0

Respiratory system diseases 747 357 390 4.1 5.4 3.3

Supplementary classification 652 205 447 3.5 3.1 3.8

All other 2,292 1,128 1,164 12.5 17.0 9.9

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

162

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 17.0 percent of all 

discharges for patients 45 to 

54 years of age from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to digestive system 

diseases, followed by injury 

and poisoning at 8.8 percent.

Chart 5.12 Leading Causes of Hospitalization: Ages 45 to 54 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.12 Ten Leading Causes of Hospitalization for GM&S* Patients 45 to 54 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 9,096 4,693 4,403 100.0 51.6 48.4

Digestive system diseases 1,547 774 773 17.0 16.5 17.6

Injury & poisoning 798 469 329 8.8 10.0 7.5

Respiratory system diseases 761 360 401 8.4 7.7 9.1

Circulatory system diseases 722 447 275 7.9 9.5 6.2

Skin & subcutaneous tissue diseases 718 418 300 7.9 8.9 6.8

Endocrine, nutritional, & metabolic disorders 688 404 284 7.6 8.6 6.5

Symptoms, signs, & ill-defined conditions 685 310 375 7.5 6.6 8.5

Genitourinary system diseases 590 177 413 6.5 3.8 9.4

Musculoskeletal system & 

connective tissue diseases 573 315 258 6.3 6.7 5.9

Mental disorders 561 384 177 6.2 8.2 4.0

All other 1,453 635 818 16.0 13.5 18.6

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

163

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 14.4 percent of all 

discharges for patients 55 to 

64 years of age from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to digestive system 

diseases, followed by circulatory 

system diseases at 12.8 percent.

Chart 5.13 Leading Causes of Hospitalization: Ages 55 to 64 Years

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.13 Ten Leading Causes of Hospitalization for GM&S* Patients 55 to 64 Years of Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 8,129 4,019 4,110 100.0 49.4 50.6

Digestive system diseases 1,174 526 648 14.4 13.1 15.8

Circulatory system diseases 1,044 624 420 12.8 15.5 10.2

Respiratory system diseases 988 420 568 12.2 10.5 13.8

Symptoms, signs, & ill-defined conditions 633 304 329 7.8 7.6 8.0

Injury & poisoning 591 302 289 7.3 7.5 7.0

Endocrine, nutritional, & metabolic disorders 568 308 260 7.0 7.7 6.3

Genitourinary system diseases 548 206 342 6.7 5.1 8.3

Skin & subcutaneous tissue diseases 524 296 228 6.4 7.4 5.5

Musculoskeletal system & 

connective tissue diseases 519 253 266 6.4 6.3 6.5

Infectious & parasitic diseases 394 194 200 4.8 4.8 4.9

All other 1,146 586 560 14.1 14.6 13.6

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

164

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 20.0 percent of 

all discharges for patients 

65 years and older from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to respiratory system 

diseases, followed by circulatory 

system diseases at 15.6 percent.

Chart 5.14 Leading Causes of Hospitalization: 65 Years of Age and Older

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.14 Ten Leading Causes of Hospitalization for GM&S* Patients 65 Years of Age and Older

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 12,055 5,222 6,833 100.0 43.3 56.7

Respiratory system diseases 2,412 1,039 1,373 20.0 19.9 20.1

Circulatory system diseases 1,883 946 937 15.6 18.1 13.7

Digestive system diseases 1,328 532 796 11.0 10.2 11.6

Symptoms, signs, & ill-defined conditions 1,021 430 591 8.5 8.2 8.6

Genitourinary system diseases 985 347 638 8.2 6.6 9.3

Injury & poisoning 813 298 515 6.7 5.7 7.5

Endocrine, nutritional, & metabolic disorders 788 328 460 6.5 6.3 6.7

Infectious & parasitic diseases 551 264 287 4.6 5.1 4.2

Musculoskeletal system & 

connective tissue diseases 527 233 294 4.4 4.5 4.3

Skin & subcutaneous tissue diseases 515 253 262 4.3 4.8 3.8

All other 1,232 552 680 10.2 10.6 10.0

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

165

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, 14.8 percent of all 

discharges from Indian Health 

Service and Tribal direct and 

contract general hospitals 

pertained to supplementary 

classification, followed by obstetric 

deliveries and complications of 

pregnancy and the puerperium 

(13.8 percent).

Chart 5.15 Leading Causes of Hospitalization for GM&S Patients by Sex

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

Table 5.15 Ten Leading Causes of Hospitalization for GM&S* Patients by Sex

Indian Health Service and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Number of Discharges Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 70,713 30,245 40,468 100.0 42.8 57.2

Supplementary classification 10,495 5,128 5,367 14.8 17.0 13.3

Obstetric deliveries & complications 

of pregnancy & puerperium 9,792 3 9,789 13.8 0.0 24.2

Digestive system diseases 7,585 3,643 3,942 10.7 12.0 9.7

Respiratory system diseases 7,528 3,637 3,891 10.6 12.0 9.6

Injury & poisoning 4,816 2,717 2,099 6.8 9.0 5.2

Circulatory system diseases 4,224 2,336 1,888 6.0 7.7 4.7

Symptoms, signs, & ill-defined conditions 3,946 1,772 2,174 5.6 5.9 5.4

Genitourinary system diseases 3,551 1,004 2,547 5.0 3.3 6.3

Skin & subcutaneous tissue diseases 3,398 1,954 1,444 4.8 6.5 3.6

Endocrine, nutritional, & metabolic disorders 3,375 1,780 1,595 4.8 5.9 3.9

All other 12,003 6,271 5,732 17.0 20.7 14.2

* General Medical and Surgical

SOURCE: IHS National Data Warehouse

166

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
For males, 17.0 percent of all 

discharges (FY 2013) from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to supplementary 

classification, followed by 

digestive system diseases and 

respiratory system diseases 

both at 12.0 percent.

Chart 5.16 Leading Causes of Hospitalization for Males

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

For females, 24.2 percent of all 

discharges (FY 2013) from Indian 

Health Service and Tribal direct 

and contract general hospitals 

pertained to obstetric deliveries 

and complications of pregnancy 

and the puerperium, followed 

by supplementary classification 

(13.3 percent) and digestive 

system diseases (9.7 percent).

Chart 5.17 Leading Causes of Hospitalization for Females

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

 

167

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.16 Ten Leading Causes of Hospitalization by Sex

Indian Health Service and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Diagnostic Category

Number of 

Discharges

Percent 

of Total

MALE

All categories 30,245 83.0

Supplementary classification 5,128 17.0

Digestive system diseases 3,643 12.0

Respiratory system diseases 3,637 12.0

Injury & poisoning 2,717 9.0

Circulatory system diseases 2,336 7.7

Mental disorders 2,054 6.8

Skin & subcutaneous tissue diseases 1,954 6.5

Endocrine, nutritional, & metabolic disorders 1,780 5.9

Symptoms, signs, & ill-defined conditions 1,772 5.9

Musculoskeletal system & connective tissue diseases 1,228 4.1

All other 3,996 13.2

FEMALE

All categories 40,468 100.0

Obstetric deliveries & complications of pregnancy & puerperium 9,789 24.2

Supplementary classification 5,367 13.3

Digestive system diseases 3,942 9.7

Respiratory system diseases 3,891 9.6

Genitourinary system diseases 2,547 6.3

Symptoms, signs, & ill-defined conditions 2,174 5.4

Injury & poisoning 2,099 5.2

Circulatory system diseases 1,888 4.7

Endocrine, nutritional, & metabolic disorders 1,595 3.9

Skin & subcutaneous tissue diseases 1,444 3.6

All other 5,732 14.2

SOURCES: IHS National Data Warehouse

168

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
For Indian Health Service (FY 2013) 

and U.S. (CY 2010), discharge rates 

were highest for the age groups 

under 1 year and over 65 years. 

The U.S. rate was higher than 

the AI/AN rate for all age groups 

except for those under 1 year.

Chart 5.18 Hospital Discharge Rates by Age

 

Table 5.18 Comparison of IHS and U.S. Hospital Discharge Rates by Age

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

U.S. General Short-Stay Hospitals, Calendar Year 2010

Discharges per 1,000 Population

Age of Admission

IHS 

FY 2013

U.S. 

CY 2010

Percent Difference IHS 

(FY 2013) Rate to U.S. Rate

All Ages 40.0 114.0 -64.9

Under 1 year 230.9 153.4 -50.5

1-4 years 23.9 34.6 -30.9

5-14 years 5.2 18.1 -71.3

15-19 years 12.3 50.6 -65.8

20-24 years 37.8 81.1 -53.4

25-34 years 42.2 96.6 -56.3

35-44 years 41.9 78.8 -46.8

45-54 years 49.9 97.7 -48.9

55-64 years 58.6 143.0 -59.0

65 years and over 97.6 335.3 -70.9

NOTE: IHS discharge rates were calculated using the IHS FY 2013 user populations; excludes newborn infants.

SOURCE: IHS National Data Warehouse

 U.S.: National Hospital Discharge Survey: 2010

 National Center for Health Statistics, http://1.usa.gov/1k06F9L

169

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Eighty-three (83.4) percent of 

Indian Health Service hospitals 

(FY 2013) had fewer than 50 beds, 

as compared to 33 percent of U.S. 

short-stay hospitals (CY 2012).

Chart 5.19 Beds per Hospital

IHS (Fiscal Year 2013) versus U.S. Short Stay (Calendar Year 2012)

 

Table 5.19 Comparison of IHS and U.S. Hospitals by Bed Size

Indian Health Service and Tribal Hospitals, Fiscal Year 2013 and 

U.S. General Short-Stay Hospitals, Calendar Year 2012

Number of Hospitals Percent of Total

Bed Size IHS1 U.S. IHS U.S.

All 48 4,999 99.9 100.0

6 - 24 25 462 52.1 9.2

25 - 49 15 1,192 31.3 23.8

50 - 99 7 954 14.6 19.1

100 - 199 1 1,012 2.0 20.2

200+ — 1,379 — 27.6

1

 Operated by IHS or the Tribes on September 30, 2013.

SOURCES: IHS: National Data Warehouse, FY 2013.

 U.S.: Hospital Statistics, 2014 Edition, American Hospital Association, Table 3

170

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Ambulatory medical visits to Indian 

Health Service and Tribal direct and 

contract facilities have increased 

660 percent since FY 1970. 

In FY 2013, there were nearly 

13.6 million visits.

Chart 5.20 Number of Ambulatory Medical Visits

IHS and Tribal Direct and Contract Facilities

 

171

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.20 Number of Ambulatory Medical Visits

Indian Health Service and Tribal Direct and Contract Facilities, Fiscal Years 1955-2013

Indian Health Service Tribal

Fiscal Year Grand Total Total Hospitals

Health Centers and 

Other Field Clinics Contract Total Direct Contract

2013 13,587,102 5,222,060 3,225,596 1,814,418 182,046 8,365,042 8,101,434 263,608

2012 13,394,845 5,007,160 3,049,700 1,769,473 187,987 8,387,685 8,127,428 260,257

2011 13,042,306 4,773,364 2,945,006 1,741,496 86,862 8,268,942 8,030,095 238,847

2010 12,815,328 4,754,182 2,918,101 1,743,170 92,911 8,061,146 7,825,364 235,782

2009 11,796,166 4,495,543 2,779,711 1,643,783 72,049 7,300,623 7,091,289 209,334

2008 10,997,555 4,259,297 2,660,735 1,528,150 70,412 6,738,258 6,540,869 197,389

2007 10,671,931 4,055,559 2,553,770 1,433,774 68,015 6,616,372 6,431,492 184,880

2006 10,508,097 4,874,819 3,224,719 1,488,432 161,668 5,633,278 5,435,752 197,526

2005 10,298,430 4,779,516 3,193,129 1,440,580 145,807 5,518,914 5,295,197 223,717

2004 9,975,652 4,765,963 3,224,989 1,365,152 175,822 5,209,689 4,962,001 247,688

2003 9,361,538 4,621,264 3,103,727 1,327,293 190,244 4,740,274 4,491,946 248,328

2002 8,731,122 4,625,020 3,094,136 1,333,830 197,054 4,106,102 3,907,309 198,793

2001 8,244,706 4,483,854 2,976,906 1,303,563 203,385 3,760,852 3,577,666 183,186

2000 8,143,356 4,497,610 2,891,425 1,475,098 131,087 3,645,746 3,485,514 160,232

1999 8,097,227 4,572,332 2,965,256 1,481,157 125,919 3,524,895 3,342,755 182,140

1998 7,610,976 4,687,117 3,120,298 1,443,753 123,066 2,923,859 2,806,170 117,689

1997 7,062,360 4,466,763 2,923,409 1,417,478 125,876 2,595,597 2,520,412 75,185

1996 7,050,151 4,264,885 2,734,825 1,392,678 137,382 2,785,266 2,438,351 346,915

1995 6,546,028 4,306,109 2,750,617 1,405,529 149,963 2,239,919 1,975,136 264,783

1990 5,031,262 3,790,953 2,363,459 1,266,493 161,001 1,240,309 1,084,923 155,386

1985 4,432,054 3,665,075 2,088,973 1,300,645 275,457 766,979 667,651 99,3282

1980 3,869,936 3,469,936 1,795,607 1,399,329 275,0001 400,000 400,0001

1975 2,501,050 2,501,050 1,465,816 1,035,234

1970 1,786,920 1,786,920 1,068,820 718,100

1965 1,325,400 1,325,400 757,700 567,700

1960 989,500 989,500 585,100 404,400

1955 455,000 455,000 355,000 100,000

1

 Estimate; comparable data not available prior to FY 1980.

2

 Comparable Tribal contract health services data not available prior to FY 1985.

SOURCE: IHS National Data Warehouse

172

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

under 1 year was supplementary 

classification conditions, followed 

by respiratory system diseases.

Chart 5.21 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages Under 1 Year

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.21 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients Under 1 Year of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 230,813 121,649 109,164 100.0 52.7 47.3

Supplementary classification 113,902 58,848 55,054 49.3 48.4 50.4

Respiratory system diseases 37,779 20,802 16,977 16.4 17.1 15.6

Symptoms, signs, & ill-defined conditions 20,539 11,055 9,484 8.9 9.1 8.7

Nervous system & sense organ diseases 20,078 10,822 9,256 8.7 8.9 8.5

Infectious & parasitic diseases 9,160 4,691 4,469 4.0 3.9 4.1

Skin & subcutaneous tissue diseases 7,627 3,935 3,692 3.3 3.2 3.4

Digestive system diseases 7,126 3,685 3,441 3.1 3.0 3.2

Perinatal period conditions 6,663 3,640 3,023 2.9 3.0 2.8

Injury & poisoning 2,367 1,269 1,098 1.0 1.0 1.0

Congenital anomalies 1,574 851 723 0.7 0.7 0.7

All other 3,998 2,051 1,947 1.7 1.7 1.8

SOURCE: IHS National Data Warehouse

173

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

1 to 4 years was supplementary 

classification conditions, followed 

by respiratory system diseases.

Chart 5.22 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 1 to 4 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.22 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 1 to 4 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 501,780 260,248 241,532 100.0 51.9 48.1

Supplementary classification 190,358 98,589 91,769 37.9 37.9 38.0

Respiratory system diseases 96,437 50,772 45,665 19.2 19.5 18.9

Nervous system & sense organ diseases 62,609 33,026 29,583 12.5 12.7 12.2

Symptoms, signs, & ill-defined conditions 40,282 20,500 19,782 8.0 7.9 8.2

Skin & subcutaneous tissue diseases 25,287 12,561 12,726 5.0 4.8 5.3

Infectious & parasitic diseases 24,927 11,894 13,033 5.0 4.6 5.4

Injury & poisoning 21,936 12,247 9,689 4.4 4.7 4.0

Digestive system diseases 14,195 7,187 7,008 2.8 2.8 2.9

Mental disorders 8,678 5,616 3,062 1.7 2.2 1.3

Genitourinary system diseases 4,951 1,457 3,494 1.0 0.6 1.4

All other 12,120 6,399 5,721 2.4 2.5 2.4

SOURCE: IHS National Data Warehouse

174

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

5 to 14 years was supplementary 

classification conditions, followed 

by respiratory system diseases.

Chart 5.23 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 5 to 14 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.23 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 5 to 14 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 1,026,181 523,080 503,101 100.0 51.0 49.0

Supplementary classification 360,515 185,389 175,126 35.1 35.4 34.8

Respiratory system diseases 157,425 79,071 78,354 15.3 15.1 15.6

Mental disorders 109,318 68,170 41,148 10.7 13.0 8.2

Nervous system & sense organ diseases 99,735 47,263 52,472 9.7 9.0 10.4

Symptoms, signs, & ill-defined conditions 67,765 32,955 34,810 6.6 6.3 6.9

Injury & poisoning 61,186 33,388 27,798 6.0 6.4 5.5

Infectious & parasitic diseases 48,676 21,229 27,447 4.7 4.1 5.5

Skin & subcutaneous tissue diseases 42,480 20,829 21,651 4.1 4.0 4.3

Musculoskeletal system & connective tissue diseases 25,623 12,068 13,555 2.5 2.3 2.7

Digestive system diseases 20,255 9,712 10,543 2.0 1.9 2.1

All other 33,203 13,006 20,197 3.2 2.5 4.0

SOURCE: IHS National Data Warehouse

175

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

15 to 24 years was supplementary 

classification conditions, followed 

by mental disorders.

Chart 5.24 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 15 to 24 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.24 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 15 to 24 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 1,359,001 454,245 904,756 100.0 33.4 66.6

Supplementary classification 550,352 146,651 403,701 40.5 32.3 44.6

Mental disorders 141,581 67,396 74,185 10.4 14.8 8.2

Respiratory system diseases 99,241 38,291 60,950 7.3 8.4 6.7

Symptoms, signs, & ill-defined conditions 91,657 30,120 61,537 6.7 6.6 6.8

Injury & poisoning 76,925 43,292 33,633 5.7 9.5 3.7

Nervous system & sense organ diseases 75,751 29,378 46,373 5.6 6.5 5.1

Musculoskeletal system & connective tissue diseases 71,234 29,516 41,718 5.2 6.5 4.6

Skin & subcutaneous tissue diseases 48,495 22,729 25,766 3.6 5.0 2.8

Genitourinary system diseases 45,673 3,460 42,213 3.4 0.8 4.7

Obstetric deliveries & complications of pregnancy 

& puerperium 43,503 1 43,502 3.2 0.0 4.8

All other 114,589 43,411 71,178 8.4 9.6 7.9

SOURCE: IHS National Data Warehouse

176

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

25 to 44 years was supplementary 

classification conditions, followed 

by mental disorders.

Chart 5.25 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 25 to 44 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.25 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 25 to 44 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 3,360,083 1,177,004 2,183,079 100.0 35.0 65.0

Supplementary classification 1,260,155 387,727 872,428 37.5 32.9 40.0

Mental disorders 324,719 134,682 190,037 9.7 11.4 8.7

Musculoskeletal system & connective tissue diseases 288,438 110,747 177,691 8.6 9.4 8.1

Symptoms, signs, & ill-defined conditions 224,663 75,470 149,193 6.7 6.4 6.8

Endocrine, nutritional, & metabolic disorders 219,888 94,492 125,396 6.5 8.0 5.7

Respiratory system diseases 187,899 61,349 126,550 5.6 5.2 5.8

Nervous system & sense organ diseases 168,774 61,298 107,476 5.0 5.2 4.9

Injury & poisoning 133,089 68,161 64,928 4.0 5.8 3.0

Circulatory system diseases 108,067 61,738 46,329 3.2 5.2 2.1

Genitourinary system diseases 104,829 13,016 91,813 3.1 1.1 4.2

All other 339,562 108,324 231,238 10.1 9.2 10.6

SOURCE: IHS National Data Warehouse

177

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 

45 to 54 years was supplementary 

classification conditions, followed 

by endocrine, nutritional, and 

metabolic disorders.

Chart 5.26 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 45 to 54 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.26 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 45 to 54 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 2,379,845 929,239 1,450,606 100.0 39.0 61.0

Supplementary classification 905,630 341,217 564,413 38.1 36.7 38.9

Endocrine, nutritional, & metabolic disorders 269,550 122,186 147,364 11.3 13.1 10.2

Musculoskeletal system & connective tissue diseases 232,416 85,507 146,909 9.8 9.2 10.1

Symptoms, signs, & ill-defined conditions 152,746 54,604 98,142 6.4 5.9 6.8

Mental disorders 146,818 54,791 92,027 6.2 5.9 6.3

Circulatory system diseases 142,979 75,779 67,200 6.0 8.2 4.6

Nervous system & sense organ diseases 117,251 44,767 72,484 4.9 4.8 5.0

Respiratory system diseases 111,812 34,724 77,088 4.7 3.7 5.3

Injury & poisoning 66,073 30,930 35,143 2.8 3.3 2.4

Digestive system diseases 57,494 23,814 33,680 2.4 2.6 2.3

All other 177,076 60,920 116,156 7.4 6.6 8.0

SOURCE: IHS National Data Warehouse

178

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 55 

to 64 years was supplementary 

classification conditions, followed 

by endocrine, nutritional, and 

metabolic disorders.

Chart 5.27 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

Ages 55 to 64 Years

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.27 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 55 to 64 Years of Age

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 2,267,570 905,611 1,361,959 100.0 39.9 60.1

Supplementary classification 911,474 360,828 550,646 40.2 39.8 40.4

Endocrine, nutritional, & metabolic disorders 312,405 134,246 178,159 13.8 14.8 13.1

Musculoskeletal system & connective tissue diseases 191,754 67,748 124,006 8.5 7.5 9.1

Circulatory system diseases 176,458 89,791 86,667 7.8 9.9 6.4

Symptoms, signs, & ill-defined conditions 131,815 49,848 81,967 5.8 5.5 6.0

Nervous system & sense organ diseases 110,718 42,794 67,924 4.9 4.7 5.0

Respiratory system diseases 94,545 30,669 63,876 4.2 3.4 4.7

Mental disorders 83,579 28,732 54,847 3.7 3.2 4.0

Injury & poisoning 50,710 21,308 29,402 2.2 2.4 2.2

Genitourinary system diseases 49,973 15,934 34,039 2.2 1.8 2.5

All other 154,139 63,713 90,426 6.8 7.0 6.6

SOURCE: IHS National Data Warehouse

179

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities for ages 65 

years and over was supplementary 

classification conditions, followed 

by endocrine, nutritional, and 

metabolic disorders.

Chart 5.28 Leading Causes of Ambulatory Medical Clinical Impressions Visits: 

65 Years of Age and Older

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.28 Ten Leading Causes of Ambulatory Medical Clinical Impressions for Patients 65 Years of Age and Older

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 2,305,766 926,228 1,379,538 100.0 40.2 59.8

Supplementary classification 946,842 380,842 566,000 41.1 41.1 41.0

Endocrine, nutritional, & metabolic disorders 317,387 134,460 182,927 13.8 14.5 13.3

Circulatory system diseases 236,042 107,385 128,657 10.2 11.6 9.3

Musculoskeletal system & connective tissue diseases 146,266 46,164 100,102 6.3 5.0 7.3

Symptoms, signs, & ill-defined conditions 136,773 51,114 85,659 5.9 5.5 6.2

Nervous system & sense organ diseases 126,852 51,675 75,177 5.5 5.6 5.4

Respiratory system diseases 93,028 36,070 56,958 4.0 3.9 4.1

Genitourinary system diseases 61,208 22,567 38,641 2.7 2.4 2.8

Injury & poisoning 45,431 17,718 27,713 2.0 1.9 2.0

Digestive system diseases 42,342 15,801 26,541 1.8 1.7 1.9

All other 153,595 62,432 91,163 6.7 6.7 6.6

SOURCE: IHS National Data Warehouse

180

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
In FY 2013, the leading cause 

of ambulatory medical clinical 

impressions visits in Indian 

Health Service and Tribal direct 

and contract facilities was 

supplementary classification 

conditions, followed by 

endocrine, nutritional, and 

metabolic disorders.

Chart 5.29 Leading Causes of Ambulatory Medical Clinical Impressions Visits

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

Table 5.29 Ten Leading Causes of Ambulatory Medical Visits for All Sexes

Indian Health Service and Tribal Direct and Contract Facilities, Fiscal Year 2013

Number of Clinical Impressions Percent Distribution

Diagnostic Category Combined Male Female Combined Male Female

All categories 13,431,073 5,297,329 8,133,744 100.0 39.4 60.6

Supplementary classification 5,239,246 1,960,104 3,279,142 39.0 37.0 40.3

Endocrine, nutritional, & metabolic disorders 1,157,986 500,718 657,268 8.6 9.5 8.1

Musculoskeletal system & connective tissue diseases 959,390 353,666 605,724 7.1 6.7 7.4

Respiratory system diseases 878,169 351,751 526,418 6.5 6.6 6.5

Symptoms, signs, & ill-defined conditions 866,245 325,669 540,576 6.4 6.1 6.6

Mental disorders 851,330 371,103 480,227 6.3 7.0 5.9

Nervous system & sense organ diseases 781,769 321,024 460,745 5.8 6.1 5.7

Circulatory system diseases 674,078 340,767 333,311 5.0 6.4 4.1

Injury & poisoning 457,717 228,313 229,404 3.4 4.3 2.8

Skin & subcutaneous tissue diseases 352,154 162,128 190,026 2.6 3.1 2.3

All other 1,212,989 382,086 830,903 9.0 7.2 10.2

SOURCE: IHS National Data Warehouse

181

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
For AI/AN males, the leading cause 

of ambulatory medical clinical 

impressions visits (FY 2013) in 

Indian Health Service and Tribal 

direct and contract facilities was 

supplementary classification 

conditions, followed by endocrine, 

nutritional, and metabolic 

disorders.

Chart 5.30 Leading Causes of Ambulatory Medical Clinical Impressions Visits for Males

IHS and Tribal Direct and Contract Facilities, Fiscal Year 2013

 

For AI/AN females, the leading

cause of ambulatory medical 

clinical impressions visits 

(FY 2013) in Indian Health 

Service and Tribal direct 

and contract facilities was 

supplementary classification 

conditions, followed by endocrine, 

nutritional, and metabolic 

disorders.

Chart 5.31 Leading Causes of Ambulatory Medical Clinical Impressions Visits for Females

IHS and Tribal Direct and Contract General Facilities, Fiscal Year 2013

 

182

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.30 Ten Leading Causes of Ambulatory Medical Visits by Sex

Indian Health Service and Tribal Direct and Contract General Hospitals, Fiscal Year 2013

Diagnostic Category

Number of 

Clinical Impressions

Percent 

of Total

MALE

All categories 5,297,329 100.0

Supplementary classification 1,960,104 37.0

Endocrine, nutritional, & metabolic disorders 500,718 9.5

Mental disorders 371,103 7.0

Musculoskeletal system & connective tissue diseases 353,666 6.7

Respiratory system diseases 351,751 6.6

Circulatory system diseases 340,767 6.4

Symptoms, signs, & ill-defined conditions 325,669 6.1

Nervous system & sense organ diseases 321,024 6.1

Injury & poisoning 228,313 4.3

Skin & subcutaneous tissue diseases 162,128 3.1

All other 382,086 7.2

FEMALE

All categories 8,133,744 100.0

Supplementary classification 3,279,142 40.3

Endocrine, nutritional, & metabolic disorders 657,268 8.1

Musculoskeletal system & connective tissue diseases 605,724 7.4

Symptoms, signs, & ill-defined conditions 540,576 6.6

Respiratory system diseases 526,418 6.5

Mental disorders 480,227 5.9

Nervous system & sense organ diseases 460,745 5.7

Circulatory system diseases 333,311 4.1

Genitourinary system diseases 263,250 3.2

Injury & poisoning 229,404 2.8

All other 757,679 9.3

SOURCES: IHS National Data Warehouse

183

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
AI/AN children under 1 year of age 

comprise 1.2 percent of the Indian 

Health Service user population 

but have 1.7 percent of the 

ambulatory medical clinical 

impressions, 6.4 percent of the 

inpatient discharges, and 4.3 

percent of the inpatient days. 

Chart 5.32 Percent Distribution for Population and Patient Care Workloads, 

Ages Under 25, Fiscal Year 2013

 

184

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Indian adults over age 64 use 

IHS services more than any 

other age group over 25 years. 

They comprised 7.9 percent of 

the Indian Health Service user 

population, but have 17.2 percent 

of the ambulatory medical clinical 

impressions, 19.0 percent of the 

inpatient discharges, and 22.0 

percent of the inpatient days.

Chart 5.33 Percent Distribution for Population and Patient Care Workloads, 

Ages 25 and Over, Fiscal Year 2013

 

Table 5.32 Percent Distributions for Estimated Population, Ambulatory Medical Clinical Impressions, and 

Inpatient Discharges and Days, Fiscal Year 2013

AGE

Distribution

All 

Ages

Under 

1 year

1-4 

years

5-14 

years

15-24 

years

25-44 

years

45-54 

years

55-64 

years

65 years 

& over

Estimated user population 100.0 1.2 7.0 18.2 17.9 27.6 11.5 8.7 7.9

Ambulatory medical clinical impressions 100.0 1.7 3.7 7.6 10.1 25.0 17.7 16.9 17.2

Inpatient discharges* 100.0 6.4 2.7 2.4 13.2 29.0 14.4 12.8 19.0

Inpatient days* 100.0 4.3 1.6 2.3 10.8 26.5 17.1 15.4 22.0

* Newborns not included.

SOURCE: IHS National Data Warehouse

185

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Patients were seen by a pharmacist 

for 32 percent of ambulatory 

medical visits to Indian Health 

Service and Tribal facilities in 

FY 2013. For 12 percent of 

patient visits, the primary 

provider was a physician.

Chart 5.34 Percent Distributions of Ambulatory Medical Visits by Type of Provider

IHS and Tribal Direct Facilities, Fiscal Year 2013

 

Table 5.34 Number of Ambulatory Medical Visits by Type of Provider

Indian Health Service and Tribal Direct Facilities, Fiscal Year 2013

Type of Provider Number of Ambulatory Medical Visits Percent of Total

Total, All Providers 13,012,622 100.0

Primary Care Providers 6,287,278 48.3

 Physician 1,514,224 11.6

 Nurse Practitioner 1,003,185 7.7

 Physician Assistant 935,148 7.2

 Family Practice 743,958 5.7

 Pediatrician 282,011 1.7

 Internal Medicine 226,420 2.2

 All Other 1,582,332 12.2

Other Providers 6,725,344 51.7

 Pharmacist 4,139,744 31.8

 Clinic R.N. 384,952 3.0

 Optometrist 348,359 2.7

 Pharmacy technician 254,985 2.0

 Physical Therapist 185,308 1.4

 Licensed Practical Nurse 127,975 1.0

 All Other 1,284,021 9.9

SOURCE: IHS National Data Warehouse

186

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
IHS services shifted away from 

inpatient care as demonstrated 

by the decline of 77 percent in 

average daily patient load (ADPL) 

between 1980 and 2013. 

However, the Tribal total ADPL 

increased 2,228 percent during 

this time period.

Chart 5.35 Trend in Average Daily Patient Load

IHS and Tribal Direct and Contract Hospitals

 

While inpatient services declined, 

ambulatory medical services 

increased 206 percent between 

1985 and 2013. Also, the Tribal 

total ambulatory medical visits 

increased 991 percent during 

that time period.

Chart 5.36 Trend in Number of Ambulatory Medical Visits

IHS and Tribal Direct and Contract Facilities

 

187

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
IHS services related to preventive 

care have increased 436 percent 

since 1980. In 2013, the largest 

single category of preventive 

clinical impressions was other 

preventive health services (81 

percent), followed by well child 

care at six percent of the preventive 

total. These are conservative 

estimates since preventive 

activities also occur during visits 

reported for other causes.

Chart 5.37 Trend in Preventive Ambulatory Medical Clinical Impressions Visits

IHS and Tribal Direct and Contract Facilities

 

The number of direct and contract 

dental services provided by Indian 

Health Service, Tribal, and Urban 

Programs, as reported to the IHS 

central database, has increased 

405 percent since FY 1970. In 

FY 2013, over 3.7 million dental 

services were provided.

Chart 5.38 Dental Services Provided

 

188

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
The number of dental services 

provided by Tribal and Urban 

Programs, as reported to the IHS 

central database, has increased 

132 percent since FY 1979. 

In FY 2013, they comprised 

62 percent of the total dental 

services provided, as compared 

to 10 percent in FY 1979.

Chart 5.39 Dental Services Provided by Tribal/Urban Programs

 

189

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
Table 5.38 Number of Dental Services Provided

IHS, Contract, Tribal and Urban Programs, FY 1955-2013

Number of Services Provided Percent 

Contract 

of Total

Percent Tribal 

& Urban 

of Total

Percent Increase 

of Total 

since 1955

IHS

Fiscal Year Total Direct Contract Tribal & Urban 1

2013 3,722,297 1,404,486 5,304 2,312,507 0.1 62.1 1,967.9

2012 3,689,107 1,502,999 8,624 2,177,484 0.2 59.0 1,949.5

2011 3,532,748 1,483,406 4,151 2,045,191 0.1 57.9 1,862.6

2010 3,518,567 1,523,163 4,857 1,990,547 0.1 56.6 1,854.8

2009 3,489,189 1,573,729 4,189 1,911,271 0.1 54.8 1,838.4

2008 3,236,654 1,516,866 4,274 1,715,514 0.1 53.0 1,698.1

2007 3,145,668 1,518,367 5,095 1,622,206 0.2 51.6 1,647.6

2006 3,226,509 1,546,657 6,429 1,673,423 0.2 51.9 1,692.5

2005 3,239,491 1,620,142 8,497 1,610,852 0.3 49.7 1,699.7

2004 3,133,000 1,611,049 10,791 1,511,160 0.3 48.2 1,640.6

2003 2,984,887 1,531,988 11,160 1,441,739 0.4 48.3 1,558.3

2002 2,911,348 1,537,016 13,562 1,360,770 0.5 46.7 1,517.4

2001 2,777,184 1,493,739 15,229 1,268,216 0.5 45.7 1,442.9

2000 2,710,806 1,441,173 23,910 1,245,723 0.9 46.0 1,406.0

1999 2,331,398 1,251,038 23,899 1,056,461 1.0 45.3 1,195.2

1998 2,123,895 1,382,583 15,773 725,539 0.7 34.2 1,079.9

1997 2,052,076 1,451,797 26,134 574,145 1.3 28.0 1,040.0

1996 2,400,646 1,383,870 36,171 980,605 1.5 40.8 1,233.7

1995 2,058,032 1,261,787 49,827 746,418 2.4 36.3 1,043.4

1994 2,643,757 1,686,892 64,483 892,382 2.4 33.8 1,368.8

1993 2,675,525 1,742,936 97,897 834,692 3.7 31.2 1,386.4

1992 2,458,811 1,618,679 92,447 747,685 3.8 30.4 1,266.0

1991 2,369,484 1,516,233 133,253 719,998 5.6 30.4 1,216.4

1990 2,362,228 1,563,934 139,425 658,869 5.9 27.9 1,212.3

1989 2,207,082 1,466,812 132,918 607,352 6.0 27.5 1,126.2

1988 2,106,741 1,415,815 194,784 496,142 9.2 23.6 1,070.4

1987 2,130,690 1,397,262 191,639 541,789 9.0 25.4 1,083.7

1986 1,984,522 1,322,794 155,939 505,789 7.9 25.5 1,002.5

1985 1,914,820 1,276,623 210,508 427,689 11.0 22.3 963.8

1984 2,011,326 1,348,599 224,918 437,809 11.2 21.8 1,017.4

1983 1,907,336 1,325,187 149,741 432,408 7.9 22.7 959.6

1982 1,666,793 1,202,422 153,030 311,341 9.2 18.7 826.0

1981 1,801,982 1,319,913 182,880 299,189 10.1 16.6 901.1

1980 1,833,206 1,357,809 216,574 258,823 11.8 14.1 918.4

19792 1,618,383 1,239,108 215,997 163,278 13.3 10.1 799.1

19782 1,099,019 885,019 214,000 19.5 510.6

1977 1,037,640 823,328 214,312 20.7 476.5

1976 975,647 798,709 176,938 18.1 442.0

1975 946,722 745,831 200,891 21.2 426.0

1974 927,701 775,747 151,954 16.4 415.4

1973 863,057 728,909 134,148 15.5 379.5

1972 844,724 718,176 126,548 15.0 369.3

1971 776,168 684,612 91,556 11.8 331.2

1970 737,206 646,580 90,626 12.3 309.6

1969 703,232 634,479 68,753 9.8 290.7

1968 681,745 613,084 68,661 10.1 278.7

1967 626,458 545,509 80,949 12.9 248.0

19662 570,779 502,710 60,069 10.5 217.1

1965 572,079 495,006 77,073 13.5 217.8

1964 525,010 462,981 62,029 11.8 191.7

1963 453,906 398,452 55,454 12.2 152.2

1962 421,597 364,988 56,609 13.4 134.2

1961 403,528 348,776 54,752 13.6 124.2

19602 364,423 307,248 57,175 15.7 102.5

1959 328,613 283,206 45,407 13.8 82.6

1958 282,372 282,372 — — 56.9

1957 249,048 249,048 — — 38.4

1956 219,353 219,353 — — 21.9

1955 180,000 180,000 — — —

1

 Beginning with FY 1979, this category excludes contract services purchased from the private sector by Tribes.

2

 Data systems were modified in 1960, 1966, and 1978. In 1978 the IHS began to use the dental services coding list adopted by the American Dental Association (ADA). The ADA list identifies individual 

clinical services. Previously the IHS had reported specified clinical services combined into major dental service groupings. Excluded from the 1978 count are diagnostic and adjunctive services. 

Excluded from the clinical counts since 1979 are diagnostic services other than examinations, revisits and non-clinical adjunctive services.

SOURCE: IHS HQ/OCPS/Division of Oral Health

190

trends in indian health 2014 edition: patient care statistics

indian health service, u.s. department of health and human services
191

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The age-adjusted AI/AN drugrelated death rate is 4.1 deaths 

per 100,000 population for the 

three-year period 1979-1981, 

as compared to the AI/AN death 

rate of 22.7 in 2007-2009. This is 

an increase of 454 percent since 

drug-related death rates were first 

introduced for AI/AN in 1979. The 

2007-2009 AI/AN rate is 1.8 times 

greater than the U.S. all races rate 

of 12.6 for 2008. These AI/AN rates 

have been adjusted to compensate 

for misreporting of AI/AN race on 

state death certificates.

Chart 6.1 Age-Adjusted Drug-Related Death Rates

 
192

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.1 Drug-Related Deaths and Death Rates

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1980-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

Calendar Year(s) Unadjusted Adjusted All Races U.S. White 1 Unadjusted Adjusted1

 (2009) 349 447

2007-2009 (2008) 332 420 17.9 22.7 12.6 14.0 1.8 1.6

2006-2008 (2007) 269 346 17.1 21.5 12.6 13.8 1.7 1.6

2005-2007 (2006) 288 357 15.9 19.9 12.8 13.6 1.6 1.5

2004-2006 (2005) 248 311 16.0 19.6 11.3 12.0 1.7 1.6

2003-2005 (2004) 250 301 14.4 17.4 10.5 11.2 1.7 1.6

2002-2004 (2003) 201 237 12.7 15.0 9.9 10.5 1.5 1.4

2001-2003 (2002) 158 184 10.5 12.2 9.1 9.5 1.3 1.3

2000-2002 (2001) 126 147 8.6 9.9 7.6 7.8 1.3 1.3

1999-2001 (2000) 105 115 7.9 9.2 7.0 7.1 1.3 1.3

1998-2000 (1999) 113 140 7.6 8.7 6.8 6.8 1.3 1.3

1997-1999 (1998) 107 124 7.9 9.3 6.1 6.0 1.5 1.6

1996-1998 (1997) 105 126 8.0 9.6 5.9 5.7 1.6 1.7

1995-1997 (1996) 110 141 7.2 8.7 5.5 5.3 1.6 1.6

1994-1996 (1995) 69 80 7.0 8.4 5.3 5.0 1.6 1.7

1993-1995 (1994) 75 85 5.4 6.2 5.3 4.9 1.2 1.3

1992-1994 (1993) 52 62 5.2 6.0 5.1 4.8 1.2 1.3

1991-1993 (1992) 57 67 4.6 5.4 4.6 4.3 1.2 1.3

1990-1992 (1991) 50 59 4.9 5.6 4.4 3.8 1.3 1.5

1989-1991 (1990) 48 55 4.3 5.0 3.8 3.6 1.3 1.4

1988-1990 (1989) 45 52 4.0 4.6 4.3 4.0 1.1 1.2

1987-1989 (1988) 36 43 4.0 4.7 4.5 4.0 1.0 1.2

1986-1988 (1987) 45 52 3.9 4.6 4.0 3.6 1.2 1.3

1985-1987 (1986) 39 46 3.9 4.5 4.1 3.8 1.1 1.2

1984-1986 (1985) 34 38 3.6 4.0 3.6 3.4 1.1 1.2

1983-1985 (1984) 27 31 4.1 4.8 3.4 3.1 1.4 1.5

1982-1984 (1983) 40 49 4.3 5.0 3.3 3.1 1.5 1.6

1981-1983 (1982) 30 32 4.6 5.3 3.2 3.0 1.7 1.8

1980-1982 (1981) 28 33 3.8 4.2 3.2 3.0 1.3 1.4

1979-1981 (1980) 25 26 3.7 4.1 3.1 3.0 1.3 1.4

 (1979) 27 32

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 and forward are drawn from specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified and age-adjusted to the 2000 

standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
193

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The age-specific drug-related 

death rate (51.8) for AI/AN males 

peaked for age group 35 to 44 

years. The highest age-specific 

rate (44.0) for AI/AN females 

occurred in the 45-54 years age 

group. However, the peak male 

rate (51.8) was 17.7 percent 

greater than the peak female 

rate. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 6.2 Drug-Related Death Rates by Age and Sex

American Indians and Alaska Natives (2007-2009)

 
194

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.2 Drug-Related Death Rates by Age and Sex

American Indians and Alaska Natives, IHS Service Area, 2007-2009 

U.S. All Races and White Populations, 2008 (Rate per 100,000 Population)

American Indian and Alaska Native

Both Sexes Male Female

Age Group Unadjusted Adjusted1 Unadjusted Adjusted1 Unadjusted Adjusted1

Under 1 year 2.8 1.9 1.8 1.8 3.7 1.8

1-4 years 0.5 0.9 —* —* 0.9 1.8

5-14 years 0.3 0.3 0.2 0.2 0.4 0.4

15-24 years 11.8 16.1 16.7 21.5 6.7 10.4

25-34 years 25.3 35.3 30.7 40.6 19.3 29.0

35-44 years 35.6 45.5 40.7 51.8 31.4 40.4

45-54 years 34.3 40.8 35.7 41.3 36.3 44.0

55-64 years 20.2 24.1 21.6 25.8 21.2 25.3

65-74 years 4.1 4.1 6.3 6.3 2.7 2.7

75-84 years 3.3 3.3 5.9 5.9 2.0 2.0

85 years + 6.7 6.7 —* —* 20.1 20.1

U.S. All Races U.S. White

Age Group Both Sexes Male Female Both Sexes Male Female

Under 1 year 0.7 —* —* 0.6 0.6 —*

1-4 years 0.4 0.4 0.4 0.3 0.3 —*

5-14 years 0.2 0.2 0.1 0.2 0.2 —*

15-24 years 9.1 13.4 4.6 11.0 16.2 5.4

25-34 years 20.1 28.1 12.0 23.3 32.4 13.9

35-44 years 32.2 40.1 24.4 34.9 43.0 26.7

45-54 years 69.6 88.5 51.2 71.7 89.9 53.8

55-64 years 124.8 167.3 85.2 128.1 168.2 89.2

65-74 years 277.3 359.8 206.1 292.2 371.8 222.6

75-84 years 491.9 356.9 682.0 517.8 706.9 381.4

85 years + 588.4 401.1 967.3 615.1 999.9 432.4

—* Represents zero.

1

 Adjusted to compensate for misreporting of AI/AN race on state death certificates.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
195

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

In FY 2013, the total alcohol-related 

discharge rate (first diagnosis) for 

IHS and Tribal direct and contract 

general hospitals was 11.6 per 

10,000 user population aged 

15 years and older. This is 

82 percent lower than the 

CY 2013 rate of 14.1 for U.S. 

Short-Stay hospitals.

Chart 6.3 Alcohol-Related Discharge Rates (First-Listed Diagnosis)

IHS and Tribal Direct and Contract General Hospitals, FY 2013 and 

U.S. Federal Short-Stay Hospitals, CY 2010

 

Table 6.3 Number and Rate for Discharges with a First-Listed Alcohol-Related 

Diagnosis for Persons 15 Years Old and Older

IHS and Tribal Direct and Contract General Hospitals, Fiscal Year 2013 

U.S. General Short-Stay Hospitals, Calendar Year 2010

IHS and 

Tribal Hospitals

U.S. Non-Federal 

Short-Stay Hospitals

First Listed Diagnosis Number Rate

Number 

(thousands) Rate

Total 1,821 11.6 348 14.1

Alcoholic psychosis (ICD-9-CM 291) 813 7.0 158 6.4

Alcoholism (ICD-9-CM 303, 305.0) 647 5.6 120 4.9

Chronic liver disease and cirrhosis, specified 

as alcoholic (ICD-9-CM 571.0-571.3) 361 3.1 70 2.8

NOTE: Rate is number of discharges per 10,000 user population aged 15 years and older. CY 2010

U.S. Non-Federal Short Stay hospital data was used because CY 2013 was not available at time of going to press.

SOURCES: IHS and Tribal Hospitals: IHS National Data Warehouse

 U.S.: Non-Federal Short-Stay Hospitals, National Hospital Discharge Survey, NCHS, 2010
196

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Since FY 2010, the number 

of discharges for injuries and 

poisonings from IHS and 

Tribal direct and contract 

general hospitals decreased 

17 percent. In FY 2013, there 

were 4,816 discharges.

Chart 6.4 Hospitalizations for Injuries and Poisonings

IHS and Tribal Direct and Contract General Hospitals, FY 2010-2013

 

The age-adjusted motor vehicle 

death rate for AI/AN males has 

decreased 71 percent since the 

three-year period 1972-1974. The 

2007-2009 rate (51.4 deaths per 

100,000 population) is 2.7 times 

the U.S. all races rate (18.9) for 

2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 6.5 Age-Adjusted Motor Vehicle Death Rates for Males

 
197

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.5 Motor Vehicle Deaths and Death Rates for Males

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

Calendar Year(s) Unadjusted Adjusted All Races U.S. White 1 Unadjusted Adjusted1

 (2009) 379 447

2007-2009 (2008) 394 420 42.8 51.4 18.9 19.6 2.7 2.6

2006-2008 (2007) 417 346 47.5 56.6 21.1 21.6 2.7 2.6

2005-2007 (2006) 488 357 50.7 60.1 21.6 22.2 2.8 2.7

2004-2006 (2005) 462 311 52.8 61.9 21.9 22.5 2.8 2.8

2003-2005 (2004) 423 301 53.1 62.0 21.6 22.1 2.9 2.8

2002-2004 (2003) 475 237 56.2 65.8 21.8 22.2 3.0 3.0

2001-2003 (2002) 491 184 56.7 65.9 22.3 22.7 3.0 2.9

2000-2002 (2001) 424 147 57.0 65.9 21.9 22.1 3.0 3.0

1999-2001 (2000) 424 115 56.2 64.2 21.8 21.8 2.9 2.9

1998-2000 (1999) 410 140 54.1 62.0 21.4 21.4 2.9 2.9

1997-1999 (1998) 396 124 51.7 59.1 21.9 21.8 2.7 2.7

1996-1998 (1997) 407 126 49.6 56.4 22.0 21.9 2.6 2.6

1995-1997 (1996) 417 141 50.5 57.1 22.5 22.4 2.5 2.5

1994-1996 (1995) 396 80 52.5 59.5 22.8 22.6 2.6 2.6

1993-1995 (1994) 373 85 59.9 68.0 22.6 22.6 3.0 3.0

1992-1994 (1993) 367 62 53.2 60.3 22.8 22.7 2.6 2.7

1991-1993 (1992) 382 67 56.7 64.1 22.5 22.4 2.8 2.9

1990-1992 (1991) 393 59 59.9 66.2 24.3 24.2 2.7 2.7

1989-1991 (1990) 399 55 60.0 67.0 26.5 26.3 2.5 2.5

1988-1990 (1989) 381 52 62.2 69.6 26.9 26.7 2.6 2.6

1987-1989 (1988) 410 43 65.1 73.4 28.2 28.1 2.6 2.6

1986-1988 (1987) 423 52 67.8 76.6 27.9 28.0 2.7 2.7

1985-1987 (1986) 395 46 65.6 74.4 28.1 28.0 2.6 2.7

1984-1986 (1985) 354 38 65.9 74.9 27.2 27.2 2.8 2.8

1983-1985 (1984) 351 31 68.1 78.0 27.7 27.9 2.8 2.8

1982-1984 (1983) 358 49 73.3 83.5 27.1 27.3 3.1 3.1

1981-1983 (1982) 362 32 78.4 89.0 28.3 28.6 3.1 3.1

1980-1982 (1981) 405 33 86.0 97.1 32.2 32.6 3.0 3.0

1979-1981 (1980) 429 26 93.3 104.5 33.6 33.8 3.1 3.1

 (1979) 448 32

1972-1974 (1973) 1,199 1,330 157.7 175.5 39.3 38.4 4.5 4.6

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 and forward are drawn from specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified and age-adjusted to the 2000 

standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
198

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The age-adjusted motor vehicle 

death rate for AI/AN females has 

decreased 55 percent since the 

three year period 1972 1974. 

The 2007-2009 rate (29.0 deaths 

per 100,000 population) is 4.0 

times the U.S. all races rate (7.2) 

for 2008. These AI/AN rates have 

been adjusted to compensate 

for misreporting of AI/AN race 

on state death certificates.

Chart 6.6 Age-Adjusted Motor Vehicle Death Rates for Females

 
199

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.6 Motor Vehicle Deaths and Death Rates for Females

American Indians and Alaska Natives, IHS Service Area, and U.S. All Races and White Populations, 1973-2008 

(Age-Adjusted Rate per 100,000 Population)

American Indian and Alaska Native

U.S. 

All Races

U.S. 

White

Ratio of American Indian 

and Alaska Native1 to:

Number Rate

Rate Rate

U.S. 

Calendar Year(s) Unadjusted Adjusted All Races U.S. White 1 Unadjusted Adjusted1

 (2009) 198 264

2007-2009 (2008) 208 278 22.8 29.0 7.2 7.6 4.0 3.8

2006-2008 (2007) 220 282 23.5 30.1 8.2 8.6 3.7 3.5

2005-2007 (2006) 240 318 23.7 30.2 8.9 9.2 3.4 3.3

2004-2006 (2005) 207 271 25.2 31.9 9.0 9.3 3.5 3.4

2003-2005 (2004) 235 299 26.8 33.9 9.3 9.6 3.6 3.5

2002-2004 (2003) 252 330 29.3 37.1 9.4 9.6 3.9 3.9

2001-2003 (2002) 252 327 28.4 36.2 9.6 9.9 3.8 3.7

2000-2002 (2001) 200 261 28.0 35.2 9.4 9.5 3.7 3.7

1999-2001 (2000) 233 294 27.1 34.1 9.6 9.8 3.6 3.5

1998-2000 (1999) 206 273 29.3 34.2 9.6 9.7 3.6 3.5

1997-1999 (1998) 223 278 26.2 32.3 10.1 10.3 3.2 3.1

1996-1998 (1997) 204 253 25.5 30.9 10.4 10.5 3.0 2.9

1995-1997 (1996) 208 257 24.3 29.8 10.4 10.6 2.9 2.8

1994-1996 (1995) 194 247 24.0 29.6 10.3 10.4 2.9 2.8

1993-1995 (1994) 179 218 23.7 29.0 10.2 10.2 2.8 2.8

1992-1994 (1993) 201 249 23.8 28.7 9.8 10.0 2.9 2.9

1991-1993 (1992) 156 197 24.2 29.8 9.7 9.8 3.1 3.0

1990-1992 (1991) 165 218 22.4 27.8 10.3 10.5 2.7 2.6

1989-1991 (1990) 149 186 22.4 27.5 11.0 11.2 2.5 2.5

1988-1990 (1989) 155 186 21.9 26.4 11.4 11.7 2.3 2.3

1987-1989 (1988) 155 188 23.2 27.5 11.5 11.7 2.4 2.4

1986-1988 (1987) 151 185 24.5 29.3 11.2 11.5 2.6 2.5

1985-1987 (1986) 171 202 25.4 30.1 10.7 11.0 2.8 2.7

1984-1986 (1985) 154 184 24.8 29.5 10.7 11.0 2.8 2.7

1983-1985 (1984) 134 166 24.2 29.2 10.6 11.0 2.8 2.7

1982-1984 (1983) 140 175 26.6 32.2 10.1 10.4 3.2 3.1

1981-1983 (1982) 168 204 29.4 35.1 10.2 10.5 3.4 3.3

1980-1982 (1981) 165 193 34.0 39.9 11.2 11.7 3.6 3.4

1979-1981 (1980) 193 230 35.4 40.6 11.8 12.2 3.4 3.3

 (1979) 168 192

1972-1974 (1973) 480 533 58.5 64.1 14.5 14.5 4.4 4.4

1

 Adjusted – specifies a number, rate, or ratio of rates adjusted to compensate for misreporting of AI/AN race on state death certificates.

NOTE: Data from 1972 and forward are drawn from specific counties in the IHS service area. The AI/AN death rate columns present data for the three-year period specified and age-adjusted to the 2000 

standard population; the U.S. all races and U.S. white columns present data for a one-year period. The number columns indicate total AI/AN deaths for the one-year period specified.

SOURCE: Rates for U.S. All Races and U.S. White: Centers for Disease Control and Prevention. CDC Wonder. http://wonder.cdc.gov/
200

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

There were 390,859 public 

health nursing visits recorded 

in the Headquarters reports for 

FY 2013. The most frequent 

program areas dealt with 

during these visits were health 

promotion/disease prevention 

(37 percent of the visits) and 

morbidity (12 percent). A 

significant workload (42 percent 

of the visits) dealt with a general/

other category which includes such 

activity as administrative, posthospitalization, and a vast array of 

aftercare and medical follow up.

Chart 6.7 IHS Public Health Nursing, Percent of Visits by Program Area

Fiscal Year 2013

 

Table 6.7 IHS Public Health Nursing Visits by Program Area, Fiscal Year 2013

Program Area Number of Visits Percent Distribution

Total Visits 390,859 100.0

Health Promotion/Disease Prevention 143,052 36.6

Morbidity 48,211 12.3

Maternal Health 14,003 3.6

Communicable Disease 12,575 3.2

Mental Health 6,055 1.5

School Health 4,100 1.0

Accidents/Trauma 1,864 0.5

Child Health 69 0.0

General 157,632 40.3

Unspecified 3,298 0.8

SOURCE: IHS National Data Warehouse

IHS HQ/OCPS/Division of Nursing Services
201

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Seventeen (17) percent of public 

health nursing time in FY 2013 

was devoted to patient service 

in the home, while seventy-eight 

(78) percent was spent on 

patient service outside the 

home. Five (5) percent of time 

in FY 2013, the public health 

nurse did not locate the patient 

at the home visit. 

Chart 6.8 IHS Public Health Nursing, Percent of PHN Visits by Type of Activity

Fiscal Year 2013

 

Table 6.8 IHS Public Health Nursing Visits Worked by Type of Activity, Fiscal Year 2013

Type of Activity Number of Visits Percent Distribution

Total Visits 390,859 100.0

Patient Service-Other1 306,972 78.5

Patient Service-Home2 65,249 16.7

Not Found 18,638 4.8

1

 The nurse provided health care service to a patient in a location other than in the patient’s home (such as: School, Office visit, chart review, 

telephone, case management, or group event).

2

 The nurse provided health care service to a patient in the patient’s home.

SOURCE: IHS National Data Warehouse

IHS HQ/OCPS/Division of Nursing Services
202

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

For the public health nursing 

program in FY 2013 female 

visits outnumbered male 

visits by 60 percent. Nearly 

24 percent of all visits pertained 

to males under 5 years of age 

and 15 percent pertained to 

males aged 65 and over. The 

corresponding percentages for 

females were nearly 15 percent 

and over 17 percent, respectively.

Chart 6.9 IHS Public Health Nursing Percent Visits by Age and Sex, Fiscal Year 2013

 

Table 6.9 IHS Public Health Nursing Visits by Age and Sex of Patients, Fiscal Year 2013

Age Group

Number of Visits1

Percent Distribution 

of All Visits Ratio 

Female 

Male Female Male Female to Male

All Ages 155,263 235,596 39.7 60.3 1.5

Under 5 years 36,938 35,146 23.8 14.9 0.6

5 to 9 years 14,355 15,232 9.2 6.5 0.7

10 to 14 years 14,858 15,777 9.6 6.7 0.7

15 to 19 years 9,604 17,379 6.2 7.4 1.2

20 to 24 years 5,995 19,894 3.9 8.4 2.2

25 to 34 years 10,825 29,223 7.0 12.4 1.8

35 to 44 years 10,187 17,949 6.6 7.6 1.2

45 to 64 years 29,259 43,987 18.8 18.7 1.0

65 years + 23,242 41,009 15.0 17.4 1.2

Unspecified Age 0 0 0.0 0.0 0.0

1

 Visits are determined as those visits that have a PHN to provide health care service. There is only one patient per encounter, never multiple. 

If two patients were seen, it would be documented as two separate encounters with one patient per visit.

SOURCE: IHS National Data Warehouse

IHS HQ/OCPS/Division of Nursing Services
203

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

In FY 2013, 18.4 percent of 

public health nursing visits 

pertained to children under 

5 years of age and 16.4 percent 

pertained to adults over the 

age of 64. Based on the 2000 

census bridged race, these 

two age groups comprised 

much smaller proportions of the 

AI/AN population 9.7 percent 

and 5.6 percent, respectively.

Chart 6.10 IHS Public Health Nursing Visits by Age, Fiscal Year 2013 versus 2000 Census

 

Table 6.10 IHS Public Health Nursing Visits by Age of Patients

Fiscal Year 2013 Visits Compared with 2000 Census Data

Age Group

PHN Visits

2000 Census 

Percent Distribution2

Ratio PHN Visit 

Distribution to 

Number 2000 Census 1

Percent 

Distribution

All Ages 390,859 100.0 100.0

Under 5 years 72,084 18.4 9.7 2.1

5 to 9 years 29,587 7.6 10.7 0.7

10 to 14 years 30,635 7.8 10.9 0.6

15 to 19 years 26,983 6.9 10.0 0.7

20 to 24 years 25,889 6.6 7.8 0.8

25 to 34 years 40,048 10.2 14.0 0.6

35 to 44 years 28,136 7.2 14.7 0.5

45 to 64 years 73,246 18.7 16.6 1.0

65 years + 64,251 16.4 5.6 3.4

Unspecified Age 0 0.0 —* —*

—* Represents zero.

1

 Visits are determined as those visits that have a PHN to provide health care service. e.g., there is only one patient per encounter, never multiple. 

If two patients were seen, it would be documented as two separate encounters with one patient per visit.

2

 Based on 2000 census bridged-race file developed by the Census Bureau and the National Center for Health Statistics, Centers for Disease Control 

and Prevention.

SOURCE: IHS National Data Warehouse

IHS HQ/OCPS/Division of Nursing Services
204

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The community health 

representatives (CHR) program 

reported approximately 5.7 million 

client contacts in October 1, 2007 

to September 30, 2013. Most of 

these contacts took place in the 

home (37 percent), followed by 

community (27 percent). 

Chart 6.11 Distribution of CHR Client Contacts by Setting 

October 1, 2007 to September 30, 2013

 

Table 6.11 Community Health Representative Client Contacts by Setting 

October 1, 2007 to September 30, 2013

Activity Location

Number 

of Services

Percent 

Distribution

Service 

Hours

Percent 

Distribution

Number of 

Client Contacts1

Percent 

Distribution

Total Client Contacts 3,603,9682 100.0 1,337,993.042 100.0 5,684,3372 100.0

Home 2,093,138 58.1 513,387.37 38.4 2,104,212 37.0

Community 769,805 21.4 373,817.45 27.9 1,535,783 27.0

CHR Office 248,554 6.9 126,730.13 9.5 998,076 17.6

Hospitals and Clinics 346,243 9.6 287,004.70 21.5 478,184 8.4

Radio/Telephone 129,385 3.6 30,897.32 2.3 460,835 8.1

School 16,251 0.5 5,567.62 0.4 106,577 1.9

1

 Actual data based on CHR Client Contacts during these timeframes.

2

 Total includes 592 number of services; 588.45 service hours; and 670 number of client contacts which were not specified.

SOURCE: IHS HQ/OCPS/Community Health Representative
205

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The three leading detailed 

activities for CHR contacts in 

October 1, 2007 to September 30, 

2013 were case management 

(23 percent), health education 

(15 percent) and patient care 

(15 percent). 

Chart 6.12 CHR Client Contacts by Leading Detailed Activities

October 1, 2007 to September 30, 2013

 

Table 6.12 Community Health Representative Client Contacts for Leading Detailed Activities 

October 1, 2007 to September 30, 2013

Detailed Activity

Number of 

Services Percent Service Hours Percent Travel Hours Percent

Number of 

Client Contacts1 Percent

Total Client Contacts 3,603,9682,3 100.0 1,337,9932 100.0 946,8812 100.0 5,684,3372 100.0

Case Management 471,419 13.1 176,438 13.2 92,657 9.8 1,297,367 22.8

Health Education 453,797 12.6 139,730 10.4 87,275 9.2 866,705 15.2

Provide Patient Care 753,607 20.9 211,562 15.8 201,810 21.3 851,071 15.0

Case Finding and Screening 559,820 15.5 89,828 6.7 80,504 8.5 735,266 12.9

Monitor Patient 435,835 12.1 96,332 7.2 121,308 12.8 473,892 8.3

Provide Other Patient Services 201,040 5.6 108,050 8.1 50,865 5.4 443,635 7.8

Transport Patient 385,372 10.7 390,480 29.2 231,214 24.4 437,752 7.7

Community Development 26,435 0.7 46,511 3.5 7,030 0.7 256,900 4.5

Provide Environmental Services 75,062 2.1 24,329 1.8 16,650 1.8 121,595 2.1

Interpret/Translate for Patient 80,424 2.2 15,272 1.1 19,151 2.0 97,967 1.7

Not Found 121,303 3.4 14,645 1.1 27,025 2.9 45,407 0.8

Provide Homemaker Services 35,663 1.0 20,411 1.5 10,044 1.1 43,553 0.8

Provide Emergency Care 4,160 0.1 4,328 0.3 1,314 0.1 13,191 0.2

1

 Actual data based on CHR Client Contacts during these timeframes.

2

 Total includes 31 number of services, 75.27 service hours, 34.41 travel hours and 36 number of client contacts which were not specified.

3

 Data represents top 10 CHR health problems and number of client services from data exports to RPMS CHR PCC. 

SOURCE: IHSHQ/OCPS/Community Health Representative
206

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The top leading health problems 

for CHR contacts in October 1, 

2007 to September 30, 2013 were 

diabetes mellitus (15 percent), 

hypertension (10 percent), 

other health promotion/disease 

prevention (10 percent), heart 

(5 percent), nutrition (4 percent), 

and dialysis (4 percent). The 

remaining 52 percent include 

all other health problems.

Chart 6.13 Leading Health Problems for CHR Client Contacts

October 1, 2007 to September 30, 2013

 

Table 6.13 Community Health Representative Client Contacts for Top Leading Health Problems 

October 1, 2007 to September 30, 2013

Health Problems

Number 

of Services

Percent 

Distribution

Service 

Hours

Percent 

Distribution

Number of 

Client Contacts1

Percent 

Distribution

Total Service 3,603,9682 100.0 1,337,993.032 100.0 5,681,3372 100.0

Diabetes Mellitus 690,725 19.2 187,948.43 14.0 827,427 14.6

Hypertension 528,414 14.7 91,432.82 6.8 579,141 10.2

Other Health Promotion/Disease Prevention 275,086 7.6 153,973.63 11.5 568,753 10.0

Heart 212,660 5.9 42,741.35 3.2 280,919 4.9

Nutrition 168,771 4.7 45,839.13 3.4 247,944 4.4

Dialysis 157,188 4.4 130,888.35 9.8 200,283 3.5

Other Respiratory 126,203 3.5 15,812.18 1.2 138,306 2.4

Socio-Economic Assistance 94,556 2.6 33,261.63 2.5 138,162 2.4

Injury Control 84,759 2.4 29,671.88 2.2 134,510 2.4

Fitness 76,389 2.1 44,355.08 3.3 124,744 2.2

1

 Actual data based on CHR Client Contacts during these timeframes.

2

 Total includes 1,189,217 number of services (33 percent); 562,068.55 service hours (42 percent), and 2,444,148 number of client contacts (43 percent) were not specified.

Data represents top 10 CHR health problems and number of client services from data exports to RPMS CHR PCC. 

SOURCE: IHS HQ/OCPS/Community Health Representative
207

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Data reflect the top six health 

problems by percentages of age 

for which CHRs provide services. 

It is clear that patients over 60 

are primary recipients. 

Chart 6.14 Leading Health Problems for CHR Client Contacts by Age 

October 1, 2007 to September 30, 2013

 

Table 6.14 Community Health Representative Client Contacts for Leading Health Problems by Age 

October 1, 2007 to September 30, 2013

Health Problem

Ages

0-9 10-19 20-29 30-39 40-49 50-59 60 + Unknown

Other Health Promotion/Disease Prevention 3.5 3.6 7.1 7.5 12.4 15.5 35.5 15.0

Nutrition 5.0 1.7 4.9 4.5 7.0 12.8 52.4 11.6

Heart 0.6 1.8 3.3 3.6 7.6 13.5 64.7 4.8

Hypertension 0.6 1.4 2.6 3.4 7.6 13.9 65.8 4.7

Diabetes Mellitus 0.5 1.1 2.0 3.7 8.9 17.8 60.7 5.2

Dialysis 0.0 0.1 2.4 5.4 13.2 26.0 47.0 5.8

SOURCE: IHSHQ/OCPS/Community Health Representative
208

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The CHR program reported 

receiving 1,789,240 referrals 

in FY 2007-2013. Family/Self/

Community referrals comprised 

24 percent of the total, while 

8 percent came from medical 

referrals. Incoming referrals 

were for individual patient 

services. No code was reported 

for 54 percent, but reporting 

incoming referrals was not a 

required field for CHRs to complete 

in CHR PCC during this timeframe.

Chart 6.15 Leading Types of CHR, Incoming Client Referrals, Fiscal Years 2007-2013

 

The CHR program reported 

making 1,789,240 referrals in 

FY 2007-2013. Family/self/

community made up 10 percent 

of outgoing CHR referrals, while 

medical referrals were 6 percent 

and CHRs was 4 percent. Outgoing 

referrals were for individual patient 

services. No code was reported for 

75 percent, but reporting outgoing 

referrals was not a required field 

for CHRs to complete in CHR PCC 

during this timeframe. 

Chart 6.16 Leading Types of CHR, Outgoing Client Referrals, Fiscal Years 2007-2013

 
209

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Since 1960, Indian Health 

Service has funded the provision 

of sanitation facilities for over 

302,000 Indian homes.

Chart 6.17 Types of Indian Homes, Provided with Sanitation Facilities by IHS 

through 2013

 
210

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.17 Indian Homes Provided with Sanitation Facilities by IHS, Fiscal Years 1960-2013

Fiscal Year

Total 

First Service

First Service 

& Upgrade

Existing 

First Service

HUD 

First Service

HIP 

First Service

Tribal 

& Other

Total 

Upgrade

Total 302,801 714,541 130,397 61,897 23,456 87,052 411,740

2013 3,223 19,042 2,541 5 40 637 15,819

2012 2,883 19,417 1,692 9 38 1,144 16,534

2011 3,913 21,984 2,604 21 40 1,249 18,071

2010 4,136 18,638 2,203 203 125 1,605 14,502

2009 7,703 45,325 6,276 96 138 1,193 37,622

2008 4,033 21,811 1,807 30 135 2,061 17,778

2007 3,698 25,517 2,079 41 86 1,492 21,819

2006 3,177 24,090 1,766 79 30 1,302 20,913

2005 4,424 24,072 2,029 23 123 2,249 19,648

2004 4,939 24,928 2,391 5 112 2,431 19,989

2003 6,460 22,750 2,689 422 334 3,015 16,290

2002 4,985 21,996 1,232 186 212 3,355 17,011

2001 5,862 18,978 1,670 503 217 3,472 13,116

2000 5,748 17,296 1,674 331 201 3,542 11,548

1999 5,471 18,003 1,740 497 244 2,990 12,532

1998 6,987 17,479 2,815 643 232 3,297 10,492

1997 6,919 19,912 2,306 1,109 397 3,107 12,993

1996 6,779 15,151 2,565 1,161 435 2,618 8,372

1995 5,915 12,041 1,847 920 457 2,691 6,126

1994 6,457 15,612 1,564 1,867 307 2,719 9,155

1993 6,434 14,084 1,663 1,247 415 3,109 7,650

1992 5,506 15,116 1,911 910 394 2,291 9,610

1991 7,600 13,300 2,099 1,668 645 3,188 5,700

1990 4,572 7,407 524 1,679 468 1,901 2,835

1980-1989 60,491 100,853 16,473 19,225 7,003 17,790 40,362

1970-1979 69,607 91,078 24,874 24,168 9,247 11,318 21,471

1960-1969 44,879 48,661 37,363 4,849 1,381 1,286 3,782

NOTE: Data for the later years represent estimates of services to be provided.

SOURCE: IHSHQ/OEHE/Sanitation Facilities Construction Program
211

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Contributions to Indian Health 

Service sanitation facilities 

projects are received from 

numerous sources. In FY 2013, 

42 percent of the contributions 

were attributed to the US 

Department of Agriculture 

and 42 percent by the US 

Environmental Protection 

Agency. Tribes contributed 

fifteen percent of the funds 

for these cooperative projects, 

followed by State Government 

with one percent.

Chart 6.18 Contributions to IHS, Sanitation Facilities Projects, Fiscal Year 2013

 

Table 6.18 P.L. 86-121 Program—Summary of Cash 

Contributions Received in Fiscal Year 2013 by Contributor

Contributor Contributions Percent

Total $112,105,722 16.4

US Department of Agriculture $47,071,817 42.0

US Environmental Protection Agency $46,704,318 42.0

Tribes1 $16,811,087 15.0

State Government $1,129,500 1.0

Department of Housing and Urban

 Development (DHUD) Infrastructure $389,000 0.3

1

 Includes EPA and DHUD Community Development Block Grant funds that were contributed by Tribes.

SOURCE: IHSHQ/OEHE/Sanitation Facilities Construction Program
212

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

The FY 2013 sanitation deficiency 

of $1,717 million to serve existing 

AI/AN homes and communities 

represents the cost to provide 

first service sanitation facilities, 

to upgrade existing facilities, to 

provide solid waste facilities, and 

to provide assistance to operation 

and maintenance organizations.

Chart 6.19 Sanitation Facilities Deficiencies, FY 2013—Costs

 

The sanitation facility deficiency 

for AI/AN homes and communities 

is categorized into requirements 

for water, sewer, assistance to 

establish and equip organizations 

to operate and maintain the 

facilities, and solid waste 

disposal systems. Units are 

the total number of homes.

Chart 6.20 Sanitation Facilities Deficiencies, FY 2013—Units

 
213

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.19 Sanitation Facilities Deficiency Summary, Fiscal Year 2013

Total

Units Cost (thousands)

Total Eligible Deficiency: $1,717,083,5901

Water 176,656 $872,629

Sewer 129,836 $669,213

Solid Waste 160,576 $171,117

Operation and Maintenance 0 $4,124

Units are the total number of homes

1

 Cost estimates are for projects in current IHS funding plan. Additional projects totaling approximately $1,368 million, mostly for the provision of 

piped water and sewer to 2-5 percent of existing American Indian and Alaska Native homes and communities, are not considered economically 

feasible at the this time.

SOURCE: IHSHQ/OEHE/Sanitation Facilities Construction Program
214

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

In FY 2013, 4,800,312 patient 

education topics were provided 

to patients through a diverse 

range of health care disciplines. 

Pharmacists documented 25 

percent of the patient education 

provided to patients, followed 

by clinical nurses (23 percent), 

physicians (12 percent), LPNs 

(9 percent), nursing assistants 

(7 percent), public health 

nurses and nurse practitioners 

(5 percent). Other disciplines 

individually provided less than 

5 percent and are grouped 

together in the other category, 

which altogether provided 

14 percent of patient education.

Chart 6.21 IHS Clinicians Documenting Patient Education, Fiscal Year 2013

 

Table 6.21 IHS Clinicians Documenting Patient Education, Fiscal Year 2013

Provider

Number of Education 

Codes Documented Percent Distribution

Total Education Codes 4,800,312 100.0

Pharmacy 1,180,714 24.6

Clinical RN 1,104,721 23.0

MD 558,700 11.6

LPN 453,478 9.4

Nurse Assistant 353,731 7.4

Public Health Nurse 229,407 4.8

Nurse Practitioner 217,029 4.5

Family Practice 187,535 3.9

Physician Assistant 160,888 3.4

Pediatrics 142,124 3.0

Internal Medicine 86,311 1.8

Dentist 43,515 0.9

Contract Physician 42,917 0.9

Emergency Room Physicians 39,242 0.8

SOURCE: IHS National Data Warehouse

Office of Clinical and Preventive Services, Health Promotion/Disease Prevention and Health Education Program
215

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

In FY 2013, patient education was 

provided to 3,695,117 patients. 

Areas documenting the highest 

levels of patient education are: 

Oklahoma City (28 percent), 

Navajo (17 percent), and 

Phoenix (16 percent). 

Chart 6.22 IHS Clients Served by IHS Areas, Fiscal Year 2013

 

Most patient education is provided 

in the hospital (51 percent) or 

health center (42 percent) location. 

Health locations, health stations, 

and village clinics, account for 

approximately 7 percent of health 

education provided and the 

remaining 1 percent of health 

education is provided in other 

health care related settings.

Chart 6.23 IHS Patient Education, Percent of Clients Served by Location, Fiscal Year 2013

 
216

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

Table 6.22 IHS Clients Served by Location, Fiscal Year 2013

Area Total Hospital Health Center

Health 

Location

Health 

Station Village Clinic School Other1

Total Clients 3,695,1172 1,849,521 1,519,983 113,472 100,946 21,842 2,885 35,515

Alaska 74,740 26,139 24,705 1,594 265 21,842 186 9

Albuquerque 265,589 129,344 116,583 6,191 13,397 0 0 74

Bemidji 178,769 61,296 96,710 11,179 9,579 0 0 5

Billings 96,020 26,852 54,309 297 14,324 0 0 238

California 146,640 0 131,867 10,984 3,716 0 0 73

Great Plains 359,602 204,582 129,185 3,069 2,823 0 0 19,943

Nashville 117,756 71,656 29,044 235 5,708 0 0 11,113

Navajo 634,139 422,577 140,674 32,603 38,187 0 94 4

Oklahoma 1,011,450 441,061 533,043 36,715 0 0 348 283

Phoenix 567,236 442,282 112,556 5,261 3,180 0 2,257 1,700

Portland 133,492 0 121,338 2,387 9,767 0 0 0

Tucson 58,731 23,732 29,969 2,957 0 0 0 2,073

1

 “Other” includes facility types categorized as other, home, office, dental clinic, adminstration, standalone urgent care facility, behavioral health facility, psychiatric inpatient, extended/elder care, or 

alcohol/substance abuse treatment facility.

2

 Total includes 50,953 unspecified.

SOURCE: IHS National Data Warehouse

Office of Clinical and Preventive Services, Health Promotion/Disease Prevention and Health Education Program 
217

trends in indian health 2014 edition: community health statistics

indian health service, u.s. department of health and human services

In FY 2013, the top 2 patient 

education codes comprised 

81 percent of all patient education 

codes provided (4,596,740 codes 

out of a total 5,643,613). The top 

25 education codes are grouped 

in six categories. The most 

education was provided on 

medications (60 percent), followed 

by immunizations (22 percent), 

tobacco (8 percent), Health 

Promotion and Disease Prevention 

(6 percent), diabetes (3 percent), 

and flu (1 percent).

Chart 6.24 Top 25 IHS Patient and Family Education, Code Documented 

by All IHS Areas, Fiscal Year 2013

 

Table 6.24 Top 25 IHS Patient and Family Education Code Documented

by All IHS Areas, Fiscal Year 2013

Patient and Family Education Code Documented Frequency Count

Total Documented 5,643,613

Medication, Reconciliation (M-MR) 1,754,826

Medication, Information (M-I) 960,372

Immunization, Information (IM-I) 441,693

Medications, Patient Information Literature (M-L) 414,636

Immunization, Patient Information Literature (IM-L) 377,041

HPDP, Exercise (HPDP-Ex) 161,412

Medication, Dispensation to Proxy (M-PRX) 154,164

Immunization, Schedule (IM-SCH) 152,974

Tobacco, Quit (TO-QT) 142,301

TO-Second-hand/Third-hand smoke (TO-SHS) 104,232

Immunization, Prevention (IM-P) 96,454

Immunization, Follow Up (IM-FU) 91,425

TO-Prevention (TO-P) 82,490

HPDP-Screening (HPDP-SCR) 81,479

Medication, Follow Up (M-FU) 80,103

IM-Deficiency (IM-DEF) 73,052

Flu-Literature (FLU-L) 59,635

Diabetes Mellitus, Exercise (DM-EX) 57,775

HPDP-Lifestyle Adaptations (HPDP-LA) 56,209

TO-Complications (TO-C) 55,624

HPDP-Literature (HPDP-L) 55,234

DM-Footcare and Examinations (DM-FTC) 53,534

TO-Literature (TO-L) 47,160

Diabetes Mellitus, Follow Up (DM-FU) 46,169

TO-Lifestyle Adaptations (TO-LA) 43,619

SOURCE: IHS National Data Warehouse

Office of Clinical and Preventive Services, Health Promotion/Disease Prevention and Health Education Program

indian health service, u.s. department of health and human services 219

trends in indian health 2014 edition

glossary of icd-10 codes

List of 113 Causes of Death (1999-present)

Cause of Death ICD-10 Codes

Salmonella infections A01-A02

Shigellosis and amebiasis A03, A06

Certain other intestinal infections A04, A07-A09

Tuberculosis A16-A19

Respiratory Tuberculosis A16

Other Tuberculosis A17-A19

Whooping cough A37

Scarlet fever and erysipelas A38, A46

Meningococcal infection A39

Septicemia A40-A41

Syphilis A50-A53

Acute poliomyelitis A80

Arthropod-borne viral encephalitis A83-A84, A85.2

Measles B05

Viral Hepatitis B15-B19

Human immunodeficiency virus (HIV) disease B20-B24

Malaria B50-B54

Other and unspecified infections and parasitic diseases and their sequelae A00, A05, A20-A36,

 A42-A44, A48-A49, A54-A79, A81-A82, A85.0-A85.1, 

A85.8, A86-B04, B06-B09, B25-B49, B55-B99

Malignant neoplasm C00-C97

Malignant neoplasm of lip, oral cavity and pharynx C00-C14

Malignant neoplasm of esophagus C15

Malignant neoplasm of stomach C16

Malignant neoplasm of colon, rectum, anus C18-C21

Malignant neoplasm of liver and intrahepatic bile ducts C22

Malignant neoplasm of pancreas C25

Malignant neoplasm of larynx C32

Malignant neoplasm of trachea, bronchus and lung C33-C34

Malignant melanoma of skin C43

Malignant neoplasm of breast C50

Malignant neoplasm of cervix uteri C53

Malignant neoplasm of corpus uteri and uterus, part unspecified C54-C55

Malignant neoplasm of ovary C56

Malignant neoplasm of prostate C61

Malignant neoplasm of kidney and renal pelvis C64-C65
220

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Cause of Death ICD-10 Codes

Malignant neoplasm of bladder C67

Malignant neoplasm of meninges, brain, and other parts of central nervous system C70-C72

Malignant neoplasm of lymphoid, hematopoietic and related tissue C81-C96

Hodgkin’s disease C81

Non-Hodgkin’s lymphoma C82-C85

Leukemia C91-C95

Multiple myeloma and immunoproliferative neoplasm C88, C90

Other and unspecified malignant neoplasm of lymphoid, hematopoietic and related tissue C96

All other unspecified malignant neoplasm C17, C23-C24, C26-C31, C37-C41, C44-C49, 

C51-C52, C57-C60, C62-C63, C66, C68-C69, C73-C80, C97

In situ neoplasm, benign neoplasm and neoplasm of uncertain or unknown behavior D00-D48

Anemia D50-D64

Diabetes mellitus E10-E14

Nutritional deficiencies E40-E64

Malnutrition E40-E46

Other nutritional deficiencies E50-E64

Meningitis G00, G03

Parkinson’s disease G20-G21

Alzheimer’s disease G30

Major cardiovascular diseases I00-I78

Diseases of heart I00-I09, I11, I13, I20-I51

Acute rheumatic fever and chronic rheumatic heart diseases I00-I09

Hypertensive heart disease I11

Hypertensive and renal disease I13

Ischemic heart disease I20-I25

Acute myocardial infraction I21-I22

Other acute ischemic heart diseases I24

Other forms of chronic ischemic heart disease I20-I25

Atherosclerotic cardiovascular disease, so described I25.0

All other forms of chronic ischemic heart disease I20, I25.1-I25.9

Other heart diseases I26-I51

Acute and subacute endocarditis I33

Diseases of pericardium and acute myocarditis I30-I31, I40

Heart failure I50

All other forms of heart disease I26-I28, I34-I38, I42-I49, I51

Essential (primary) hypertension and hypertensive renal disease I10, I12, I15

Cerebrovascular disease I60-I69
indian health service, u.s. department of health and human services 221

trends in indian health 2014 edition

Cause of Death ICD-10 Codes

Atherosclerosis I70

Other diseases of circulatory system I71-I78

Aortic aneurysm and dissection I71

Other diseases of arteries, arterioles and capillaries I72-I78

Other disorders of circulatory system I80-I99

Influenza and pneumonia J10-J18

Influenza J10-J11

Pneumonia J12-J18

Other acute lower respiratory infections J20-J22, UO4

Acute bronchitis and bronchiolitis J20-J21

Unspecified acute lower respiratory infection J22, U04

Chronic lower respiratory diseases J40-J47

Bronchitis chronic and unspecified J44, J47

Emphysema J43

Asthma J45-J46

Other chronic lower respiratory diseases J44, J47

Pneumoconioses and chemical effects J60-J66, J68

Pneumonitis due to solids and liquids J69

Other diseases of respiratory system J00-J06, J30-J39, J67, J70-J98

Peptic ulcer K25-K28

Diseases of appendix K35-K38

Hernia K40-K46

Chronic liver disease and cirrhosis K70, K73-K74

Alcoholic liver disease K70

Other chronic liver disease and cirrhosis K73-K74

Cholelithiasis and other disorders of gall bladder K80-K82

Nephritis, nephritic syndrome and nephrosis N00-N07, N17-N19, N25-N27

Acute and rapidly progressive nephritic and nephritic syndrome N00-N01, N04

Chronic glomerulonephritis, nephritis and nephropathy not specified 

as acute or chronic, and renal sclerosis unspecified N02-N03, N05-N07, N26

 Renal failure N17-N19

Other disorders of kidney N25, N27

Infections of kidney N10-N12, N13.6, N15.1

Hyperplasia of prostate N40

Inflammatory diseases of female pelvic organs N70-N76

Pregnancy, childbirth and the puerperium O00-O99

Pregnancy with abortive outcome O00-O07
222

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Cause of Death ICD-10 Codes

Other complications of pregnancy, childbirth and the puerperium O10-O99

Certain conditions originating in the perinatal period P00-P96

Congenital malformations, deformations and chromosomal abnormalities Q00-Q99

Symptoms, signs, and abnormal clinical and laboratory findings not elsewhere classified R00-R99

All other diseases Residual

Accidents (unintentional injuries) V01-X59, Y85-Y86

Transport accidents V01-V99, Y85

Motor vehicle accidents V02-V04, V09.0-V09.2, V12-V14, V19.0-V19.2, V19.4-V19.6, 

V20-V79, V80.3-V80.5, V81.0-V81.1, V82.0-V82.1, V83-V86, 

V87.0-V87.8, V88.0-V88.8, V89.0, V89.2

 Other land transport accidents V01, V05-V06, V09.1, V09.3-V09.9, V10-V11, V15-V18, 

V19.3, V19.8-V19.9, V80.0-V80.2, V80.6-V80.9, V81.2-V81.9, 

V82.2-V82.9, V87.9, V88.9, V89.1, V89.3, V89.9

Water, air and space and other and unspecified transport accidents 

and their sequelae V90-V99, Y85

Nontransport accidents W00-X59, Y86

Falls W00-W19

Accidental discharge of firearms W32-W34

Accidental drowning and submersion W65-W74

Accidental exposure to smoke, fire and flames X00-X09

Accidental poisoning and exposure to noxious substances X40-X49

Other and unspecified nontransport accidents and their sequelae W20-W31, W35-W64, 

W75-W99, X10-X39, X50-X59, Y86

Intentional self-harm (suicide) U03, X60-X84, Y87.0

Intentional self-harm (suicide) by discharge of firearms X72-X74

Intentional self-harm (suicide) by other and unspecified means and their sequelae U03, 

X60-X71, X75-X84, Y87.0

Assault (homicide) U01-U02, X85-Y09, Y87.1

Assault (homicide) by discharge of firearms U01.4, X93-X95

Assault (homicide) by other and unspecified means and their sequelae U01.0-U01.3, 

U01.5-U01.9, U02, X85-X92, X96-Y09, Y87.1

Legal intervention Y35, Y89.0

Events of undetermined intent Y10-Y34, Y87.2, Y89.9

Discharge of firearms, undetermined intent Y22-Y24

Other and unspecified events of undetermined intent and their sequelae Y10-Y21, Y25-Y34, 

Y87.2, Y89.9

Operations of war and their sequelae Y36, Y89.1

Complications of medical and surgical care Y40-Y84, Y88
indian health service, u.s. department of health and human services 223

trends in indian health 2014 edition

List of 130 Causes of infant Death (1999-present)

Cause of Death ICD-10 Codes

Certain infections and parasitic diseases A00-B99

Certain intestinal infectious diseases A00-A08

Diarrhea and gastroenteritis of infectious origin A09

Tuberculosis A16-A19

Tetanus A33, A35

Diphtheria A36

Whooping cough A37

Meningococcal infection A39

Septicemia A40-A41

Congenital syphilis A50

Gonococcal infection A54

Viral diseases A80-B34

Acute poliomyelitis A80

Varicella (chickenpox) B01

Measles B05

Human immunodeficiency virus (HIV) disease B20-B24

Mumps B26

Other and unspecified viral diseases A81-B00, B02-B04, B06-B19, B25, B27-B34

Candidiasis B37

Malaria B50-B54

Pneumocystosis B59

All other and unspecified infectious and parasitic diseases A20-A32, A38, A42-A49, A51-A53, 

A55-A79, B35-B36, B38-B49, B55-B58, B60-B99

Neoplasm C00-D48

Malignant neoplasm C00-C97

Hodgkin’s disease and non-Hodgkin’s lymphomas C81-C85

Leukemia C91-C95

Other and unspecified malignant neoplasm C00-C80, C88-C90, C96-C97

In situ neoplasm, benign, neoplasm and neoplasm of uncertain or unknown behavior D00-D48

Diseases of the blood and blood forming organs and certain disorders involving 

the immune mechanism D50-D89

Anemias D50-D64

Other diseases of blood and blood forming organs D65-D76

Certain disorders involving the immune mechanism D80-D89

Endocrine, nutritional and metabolic diseases E00-E88

Short stature, not elsewhere classified E34.3
224

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Cause of Death ICD-10 Codes

Malnutrition and other nutritional deficiencies E40-E64

Cystic fibrosis E84

Volume depletion, disorders of fluid, electrolyte and acid-base balance E86-E87

All other endocrine, nutritional and metabolic diseases E00-E32, E34.0-E34.2, 

E34.4-E34.9, E65-E83, E85, E88

Diseases of the nervous system G00-G98

Meningitis G00, G03

Infantile spinal muscular atrophy, type I (Werdnig-Hoffman) G12.0

Infantile cerebral palsy G80

Anoxic brain damage, not elsewhere classified G93.1

Other diseases of nervous system G04, G06-G11, G12.1-G12.9, G20-G72, 

G81-G92, G93.0, G93.2-G93.9, G95-G98

Diseases of the ear and mastoid process H60-H93

Diseases of the circulatory system I00-I99

Pulmonary heart disease and diseases of pulmonary circulation I26-I28

Pericarditis, endocardititis and myocarditis I30, I33, I40

Cardiomyopathy I42

Cardiac arrest I46

Cerebrovascular disease I60-I69

All other diseases of the circulatory system I00-I25, I31, I34-I38, I44-I45, I47-I51, I70-I99

Diseases of the respiratory system J00-J98

Acute upper respiratory infections J00-J06

Influenza and pneumonia J10-J18

Influenza J10-J11

Pneumonia J12-J18

Acute bronchitis and acute bronchiolitis J20-J21

Bronchitis, chronic and unspecified J40-J42

Asthma J45-J46

Pneumonitis due to solids and liquids J69

Other and unspecified diseases of the respiratory system J22, J30-J39, J43-J44, J47-J68, J70-J98

Diseases of the digestive system K00-K92

Gastritis, duodenitis, and noninfective enteritis and colitis K29, K50-K55

Hernia of abdominal cavity and intestinal obstruction without hernia K40-K46, K56

All other and unspecified diseases of the digestive system K00-K28, K30-K38, K57-K92

Diseases of the genitourinary system N00-N95

Renal failure and other diseases of the kidney N17-N19, N25, N27

Other and unspecified diseases of the genitourinary system N00-N15, N20-N23, N26, N28-N95
indian health service, u.s. department of health and human services 225

trends in indian health 2014 edition

Cause of Death ICD-10 Codes

Certain conditions originating in the prenatal period P00-P96

Newborn affected by maternal factors and by complications of pregnancy, 

labor and delivery P00-P04

Newborn affected by maternal hypertensive disorders P00.0

Newborn affected by other maternal conditions which may be unrelated 

to present pregnancy P00.1- P00.9

Newborn affected by maternal complications of pregnancy P01

Newborn affected by incompetent cervix P01.0

Newborn affected by premature rupture of membranes P01.1

Newborn affected by multiple pregnancy P01.5

Newborn affected by other maternal complications of pregnancy P01.2-P01.4, P01.6-P01.9

Newborn affected by complications of placenta, cord, and membranes P02

Newborn affected by complications involving placenta P02.0-P02.3

Newborn affected by complications involving cord P02.4-P02.6

Newborn affected by chorioamnionitis P02.7

Newborn affected by other and unspecified abnormalities of membranes P02.8-P02.9

Newborn affected by other complications of labor and delivery P03

Newborn affected by noxious influences transmitted via placenta or breast milk P04

Disorders related to length of gestation and fetal malnutrition P05-P08

Slow fetal growth and fetal malnutrition P05

Disorders related to short gestation and low birth weight not elsewhere classified P07

Extremely low birth weight or extreme immaturity P07.0-P07.2

Other low birth weight or preterm P07.1, P07.3

Disorders related to long gestation and high birth weight P08

Birth trauma P10-P15

Intrauterine hypoxia and birth asphyxia P20-P21

Intrauterine hypoxia P20

Birth asphyxia P21

Respiratory distress of newborn P22

Other respiratory conditions originating in the perinatal period P23-P28

Congenital pneumonia P23

Neonatal aspiration syndromes P24

Interstitial emphysema and related conditions originating in the perinatal period P25

Pulmonary hemorrhage originating in the perinatal period P26

Chronic respiratory disease originating in the perinatal period P27

Atelectasis P28.0-P28.1

All other respiratory conditions originating in the perinatal period P28.2-P28.9
226

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Cause of Death ICD-10 Codes

Infections specific to the perinatal period P35-P39

Bacterial sepsis of newborn P36

Omphalitis of newborn with or without mild hemorrhage P38

All other infections specific to the perinatal period P35, P37, P39

Hemorrhagic and hematological disorders of newborn P50-P61

Neonatal hemorrhage P50-P52, P54

Hemorrhagic disease of newborn P53

Hemolytic disease of newborn due to isoimmunization and other perinatal jaundice P55-P59

Hematological disorders P60-P61

Syndrome of infant of a diabetic mother and neonatal diabetes mellitus P70.0-P70.2

Necrotizing enterocolitis of newborn P77

Hydrops fetalis not due to hemolytic disease P83.2

Other perinatal conditions P29, P70.3-P76, P78-P81, P83.0-P83.1, P83.3-P83.9, P90-P96

Congenital malformations, deformations and chromosomal abnormalities Q00-Q99

Anencephaly and similar malformations. Q00

Congenital hydrocephalus Q03

Spina bifida Q05

 Other congenital malformations of the nervous system Q01-Q02, Q04, Q06-Q07

Congenital malformations of heart Q20-Q24

Other congenital malformations of circulatory system Q25-Q28

Congenital malformations of respiratory system Q30-Q34

Congenital malformations of digestive system Q35-Q45

Congenital malformations genitourinary system Q50-Q64

Congenital malformations and deformations of musculoskeletal system, 

limbs and integument Q65-Q85

Down’s syndrome Q90

Edwards syndrome Q91.0-Q91.3

Patau syndrome Q91.4-Q91.7

Other congenital malformations and deformations Q10-Q18, Q86-Q89

Other chromosomal abnormalities, not elsewhere classified Q92-Q99

Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified R00-R99

Sudden infant death syndrome R95

Other symptoms, signs and abnormal clinical and laboratory findings, 

not elsewhere classified R00-R53, R55-R59.4, R96-R99

All other diseases F01-F99, H00-H57, L00-M99
indian health service, u.s. department of health and human services 227

trends in indian health 2014 edition

Cause of Death ICD-10 Codes

External causes of mortality U01, V01-Y84

Accidents (unintentional injuries) V01-X59

Transport accident V01-V99

Motor vehicle accidents V02-V04, V09.0, V09.2, V12-V14, V19.0-V19.2, V19.4-V19.6, 

V20-V79, V80.3,-V80.2, V80.6-V80.5, V81.0-V81.1, V82.0-V82.1, 

V83-V86, V87.0-V87.8, V88.0-V88.8, V89.0, V89.2

Other unspecified transport accidents V01, V05-V06, V09.1, V09.3-V09.9, V10-V11, 

V15-V18, V19.3, V19.8, V19.9, V80.0-V80.2, V80.6-V80.9, 

V81.2-V81.9, V82.2-V82.9, V87.9, V88.9, V89.1, V89.3, V89.9, V90-V99

Falls W00-W19

Accidental discharge of firearms W32-W34

Accidental drowning and submersion W65-W74

Accidental suffocation and strangulation in bed W75

Other accidental suffocation and strangulation W76-W77, W81-W84

Accidental inhalation and ingestion of food or other objects causing 

obstruction of respiratory tract W78-W80

Accidents caused by exposure to smoke, fire and flames X00-X09

Accidental poisoning and exposure to noxious substances X40-X49

Other and unspecified accidents W20-W31, W35-W64, W85-W99, X10-X39, X50-X59

Assault (homicide) X85-Y09

Assault (homicide) by hanging, strangulation and suffocation X91

Assault (homicide) by discharge of firearms X93-X95

Neglect, abandonment and other maltreatment syndromes Y06-Y07

Assault (homicide) by other and unspecified means U01.0-U01.3, X85-X90, X92, 

X96-X99, Y00-Y05, Y08-Y09

Complications of medical and surgical care Y40-Y84

Other external causes X60-X84, Y10-Y36
228

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

aDDitionaL Causes of Death anD their CorresponDing iCD-10 CoDes (1999-present)

(These categories are not included as part of the 113 cause of death or 130 causes of infant death 

lists. They are independent of these two lists but are valid cause of death codes to use for the 

causes indicated.) 

Cause of Death ICD-10 Codes

Alcohol-related deaths F10, G31.2, G62.1, I42.6, K29.2, K70, R78.0, X45, X65, Y15

Breast cancer (females) C50

Cervical cancer C53

Colon-rectal-cancer C18-C21

Drug-related deaths F11-F11.5, F11.7-F11.9, F12-F12.5, F12.7-F12.9, F13-F13.5, 

F13.7-F13.9, F14-F14.5, F14.7-F14.9, F15-F15.5, F15.7-F15.9, F16-F16.5, 

F16.7-F16.9, F17.0, F17.3-F17.5, F17.7-F17.9, F18-F18.5, F18.7-F18.9, 

F19-F19.5, F19.7-F19.9, X40-X44, X60-X64, X85, Y10-Y14

Enterocolitis due to Clostridium Difficile (C. difficile) A04.7

Firearm deaths W32-W34, X72-X74, X93-X95, Y22-Y24, Y35.0, U01.4 

Human Immunodeficiency virus (HIV) infection B24

Lung cáncer C33-C34 

Maternal death A34, O00-O95, O98-O99

Prostate cancer C61, D29
indian health service, u.s. department of health and human services 229

trends in indian health 2014 edition

List of iCD-9-CM CoDes useD in patient Care Charts anD tabLes

 ICD-9-CM

Condition Codes 

Infectious and parasitic diseases 001-139

Neoplasms 140-239

Endocrine, nutritional, and metabolic diseases and immunity disorders 240-279

Diseases of the blood and blood-forming organs 280-289

Mental disorders 290-319

Diseases of the nervous system and sense organs 320-389

Diseases of the circulatory system 390-459

Diseases of the respiratory system 460-519

Diseases of the digestive system 520-579

Diseases of the genitourinary system 580-629

Complications of pregnancy, childbirth, and the puerperium 630-679

Diseases of the skin and subcutaneous tissue 680-709

Diseases of the musculoskeletal system and connective tissue 710-739

Congenital anomalies 740-759

Certain conditions originating in the perinatal period 760-779

Symptoms, signs, and ill-defined conditions 780-799

Injury and poisoning 800-999

Supplementary classification (classification of factors influencing health status 

and contact with health service) V01-V89
230

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

methods used to rank leading sites 

of cancer deaths

 ICD-10

Site of Cancer Death Codes

Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues C00-C97

Malignant neoplasms of lip, oral cavity, and pharynx C00-C14

Malignant neoplasms of esophagus C15

Malignant neoplasms of stomach C16

Malignant neoplasms of colon, rectum and anus C18-C21

Malignant neoplasms of liver /intraehepatic bile ducts C22.0, C22.2-C22.4, C22.7, C22.9

Malignant neoplasms of gallbladder C23

Malignant neoplasms of pancreas C25

Malignant neoplasms of larynx C32

Malignant neoplasms of lung and bronchus C33-C34 

Malignant neoplasms of bones and joints C40-C41

Malignant neoplasms of skin C43

Malignant mesothelioma** C45

Malignant kaposi sarcoma** C46

Malignant neoplasms of soft tissue including heart** C47, C49, C38.0, C45.2

Malignant neoplasms of breast C50

Malignant neoplasms of vulva C51

Malignant neoplasms of cervic uteri C53

Malignant neoplasms of corpus uteri and uterus, part unspecified C54, C55

Malignant neoplasms of ovary C56

Malignant neoplasms of prostate C61

Malignant neoplasms of testis C62

Malignant neoplasms of kidney and renal pelvis C64-C65

Malignant neoplasms of urinary bladder C67

Malignant neoplasms eye and orbit C69

Malignant neoplasms of meninges, brain and other parts of central nervous system C70-C72

Malignant neoplasms of thyroid C73
indian health service, u.s. department of health and human services 231

trends in indian health 2014 edition

 ICD-10

Site of Cancer Death Codes

Malignant neoplasms of lymphoid, hematopoietic, and related tissue C81-C96

Hodgkin’s lymphoma C81

Non-Hodgkin’s lymphoma C82-C85, C96.3

Multiple myeloma C90.0, C90.2

Leukemia C90.1, C91-C95

Lymphocytic leukemia C91

Acute lymphocytic leukemia C91.0

Chronic lymphocytic leukemia C91.1

Myeloid and monocytic leukemia C92-C93

Acute myeloid leukemia C92.0, C92.4-C92.5, C94.0, C94.2

Acute monocytic leukemia C93.0

Chronic myeloic leukemia C92.1

Other and unspecified malignant neoplasms of lymphoid, 

Hematopoietic, and related tissue C96

All other and unspecified malignant neoplasms C17, C24,C26-C31,C36-C39, C44, C48, C52, 

C57-C60, C63, C66, C68, C74-C80, C97

**These variables can be created with or without Mesothelioma (C45) and Kaposi Sarcoma (C46) as separated 

groupings. The list above documents both possibilities. Note that this is only possible with ICD10.
232

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

index to charts and tables

(Numbers refer to chart and table numbers)

Chart Table

A

Accidents (Unintentional Injuries), all causes 4.19,4.20 4.19,4.20

Accidents (Unintentional Injuries), motor vehicle 6.5,6.6 4.19,6.5,6.6

Accidents (Unintentional Injuries), firearms 4.25,4.26 4.25,4.26

Accomplishments, program 4.61,4.62 4.61

Accreditation 1.7,1.8 1.7,1.8

Acquired immune deficiency syndrome (see HIV)

Alcoholism 4.27,4.28,6.3 4.27,4.28,6.3

Alzheimer’s Disease 4.50,4.51 4.50,4.51

Ambulatory medical visits 5.20-5.31, 5.36 5.20-5.31

Ambulatory medical visits, leading causes 5.21-5.31 5.21-5.30

Ambulatory medical visits, by patient age 5.32,5.33 5.32

Ambulatory medical visits, preventive 5.37

Ambulatory medical visits, by type of provider 5.34 5.34

Area Offices 2.2

Asthma 4.56 4.56

B

Births 3.1-3.6 3.1-3.4

Budget, IHS 1.6 1.6

C

Cancer (Malignant Neoplasms) 4.31-4.40 4.31-4.39

Cancer, lung 4.33,4.34 4.33,4.34

Cancer, leading sites 4.35-4.40 4.35-4.39

Cerebrovascular diseases 4.48,4.49 4.48,4.49

Chronic liver disease and cirrhosis 4.29,4.30 4.29,4.30

Community health nursing 6.7-6.10 6.7-6.10

Community health representatives 6.11-6.16 6.11-6.14

Compact and contract awards, Tribal health 5.1,5.2,5.3 5.1,5.2

D

Dental services 5.38,5.39 5.38

Diabetes 4.44,4.45 4.44,4.45

Drug abuse 6.1,6.2 6.1,6.2
indian health service, u.s. department of health and human services 233

trends in indian health 2014 edition

Chart Table

E

Educational attainment 2.5 2.5

Education, patient 6.21-6.24 6.21-6.24

Employment 2.6 2.5

Environmental health 6.17-6.20 6.17-6.19

Enterocolitis due to Clostridium difficile 4.53 4.53

F

Facilities, inpatient and ambulatory 1.5

Facilities, sanitation 6.17-6.20 6.17-6.19

Firearm injuries 4.25,4.26 4.25,4.26

G

Grant awards, Tribal Health 5.1,5.2,5.3 5.1,5.2

H

Heart Disease 4.46,4.47 4.46,4.47

Homicide, all causes 4.23,4.24 4.23,4.24

Hospital admissions 5.5 5.5

Hospital average daily patient load 5.6,5.35 5.6

Hospital beds 5.19 5.19

Hospital discharges, injuries and poisonings 6.4

Hospital discharge rates 5.18 5.18

Hospital discharge rates, alcohol-related 6.3 6.3

Hospitalization, leading causes 5.7-5.17 5.7-5.16

Hospital workload, by patient age 5.32,5.33 5.32

Human immunodeficiency virus (HIV) 4.54,4.55 4.54,4.55

I

Income 2.7 2.5

Infant mortality, rates 3.8,3.9 3.8,3.9

Infant mortality, leading causes 3.10-3.12 3.10

Inpatient admissions 5.5 5.5

Inpatient average daily patient load 5.6,5.35 5.6

Inpatient beds 5.19 5.19

Inpatient discharges, injuries and poisonings 6.4

Inpatient discharge rates 5.18 5.18

Inpatient discharge rates, alcohol-related 6.3 6.3
234

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

Chart Table

Inpatient, leading causes 5.7-5.17 5.7-5.16

Inpatient workload, by patient age 5.32,5.33 5.32

L

Laboratory services 1.8 1.8

Life expectancy at birth 4.58 4.58

M

Malignant neoplasms (see cancer)

Map of Area Offices 2.2

Maternal deaths 3.7 3.7

Mortality rates, age-specific 4.12-4.16 4.12,4.14

Mortality rates, all causes 4.57,4.60 4.57,4.60

Mortality rates, selected causes 4.11 4.11

Mortality rates, specific causes (see cause name)

Mortality, leading causes 4.1-4.10 4.1-4.9

N

Neonatal mortality 3.9 3.9

Neonatal mortality, leading causes 3.11 3.10

Nursing, community/public 6.7-6.10 6.7-6.10

O

Organizational structure 1.1-1.4

Outpatient visits 5.20, 5.36 5.20

Outpatient visits, leading causes 5.21-5.31 5.21-5.30

Outpatient visits, by patient age 5.21-5.28,5.32-5.33 5.21-5.28,5.32

Outpatient visits, preventive 5.37

Outpatient visits, by type of provider 5.34 5.34
indian health service, u.s. department of health and human services 235

trends in indian health 2014 edition

Chart Table

P

Patient education 6.21-6.24 6.21-6.24

Parkinson’s disease 4.52 4.52

Pneumonia and influenza 4.41,4.42 4.41,4.42

Poisoning 4.17, 4.18 4.17,4.18

Population, service 2.1,2.2 2.1

Population, by age and sex 2.3 2.3

Population, by age 2.4 2.4

Postneonatal mortality 3.9 3.9

Postneonatal mortality, leading causes 3.12 3.10

Poverty level (see Income)

Public health nursing 6.7-6.10 6.7-6.10

S

Sanitation facilities 6.17-6.20 6.17-6.19

Socio-economic factors 2.5-2.7 2.5

Suicide, all causes 4.21, 4.22 4.21, 4.22

T

Tuberculosis 4.43 4.43

U

Unemployment (see employment)

Urban programs 1.4,2.8,5.1-5.4 2.8,5.2-5.4

Y

Years of Potential Life Lost 4.59 4.58
236

trends in indian health 2014 edition

indian health service, u.s. department of health and human services

-

U.S. Depar tment of Health and Human Ser vices 

Indian Health Ser vice 

Trends in Indian Health 2014 Edition 

Released March 2015 

ISSN 1095 2896