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Health Issues Facing American Indians in North Carolina

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Title: Health Issues Facing American Indians in North Carolina


1
Health Issues Facing American Indians in North
Carolina
  • Ronny A. Bell, PhD, MS (Lumbee)
  • Associate Professor
  • Wake Forest University School of Medicine
  • Winston-Salem, North Carolina

2
North Carolina American Indians
  • NC has 7th largest American Indian population
    among all U.S. states and the largest population
    east of the Mississippi River
  • 4 of all U.S. American Indians live in North
    Carolina

3
American Indian Population in Eastern U.S. States
State Approximate AI Population (2003 Census)
North Carolina 108,000
New York 105,000
Florida 69,000
Georgia 27,000
Louisiana 26,000
4
Native American Tribes in North Carolina
Guilford Native American Association
Triangle Native American Society
MEHERRIN
SAPPONY
HALIWA-SAPONI
OCHANEECHI
CHEROKEE
COHARIE
WACCAMAW-SIOUAN
LUMBEE
Metrolina Native American Association
Cumberland County Association of Indian Persons
a
5
North Carolina Counties with at Least 1,000
Native Americans
Columbus, Cumberland, Guilford Halifax, Hoke,
Jackson, Mecklenburg Robeson, Scotland, Swain,
Wake


a
6
Why Are Native Americans at High Risk for
Diabetes?
  • Diabetes has been referred to as being epidemic
    in some American Indian communities
  • Dramatic changes in diet and physical activity in
    the 20th century led to declining efficiency in
    managing calories
  • All populations in the US have experienced
    increased rates of diabetes, but not to the
    extent as Native Americans

7
Prevalence of Diabetes Among Strong Heart
Participants
with Diabetes, 45-74 Years of Age, By Sex and
Center
From Welty, et al. Cardiovascular Disease Risk
Factors among American Indians The Strong
Heart Study. American Journal of Epidemiology
1995142269-287
8
Prevalence of Overweight Among Strong Heart
Participants
Overweight, 45-74 Years of Age, by Sex and
Center
From Welty, et al. Cardiovascular Disease Risk
Factors among American Indians The Strong
Heart Study. American Journal of Epidemiology
1995142269-287
9
Leading Causes of DeathAmerican Indians, North
Carolina, 2002
10
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11
Are Native Americans in North Carolina at
Increased Risk for Diabetes?
  • Ten counties with highest diabetes death rates
  • Bertie Graham
  • Robeson Hertford
  • Vance Hyde
  • Swain Martin
  • Scotland Wayne

12
Diabetes Among the Eastern Band Cherokee Indians
  • In a report published in 1993
  • Prevalence of diabetes in the Eastern Band
    Cherokee Indians was four times higher than the
    US rate
  • In 2001 2002
  • Prevalence of diabetes in the EBCI was 20.5
    among men and 26.8 among adult women, compared
    to 6.7 and 6.8 for the state, respectively

13
Age-Adjusted Rates for Diabetes Among Lumbee and
Catawba Indians
Percent

Levin et al, Ethnicity and Health, 2002

14
Diabetes Complications among Eastern Band of
Cherokee Indians
  • Prevalence of lower extremity amputations was
    three times higher than the US rate
  • The rate of new cases of end-stage renal disease
    was six times higher than the rate for US whites

15
Prevalence of Diabetes among American Indian
Youth, 2004
MMWR, November 10, 2006, 551201-3
16
Age-Adjusted Cancer Incidence and Death Rates By
Race and Ethnicity and Cause of Death, North
Carolina Resident Deaths, 1999-2002
17
Age-Adjusted Prostate Cancer Death and Incidence
Rates by Race and Ethnicity, North Carolina, 1997
- 2000
18
Age-Adjusted Breast Cancer Death and Incidence
Rates by Race and Ethnicity, North Carolina 1997
- 2000
19
Age-Adjusted Cervical Cancer Incidence Rates by
Race and Ethnicity, North Carolina 1997 - 2000
20
North Carolina American Indian Survey
  • NC BRFSS 2002-2003 data
  • 16,203 total respondents 434 American Indian,
    12,050 White, 2,933 African American
  • Data weighted to be representative of NC adult
    population
  • Prevalence rates age-adjusted to the US 2000
    population

21
Racial and Ethnic Health Disparities in North
Carolina REPORT CARD 2006
Office of Minority Health and Health
Disparities And State Center for Health
Statistics North Carolina Department of Health
and Human Services
22
Racial and Ethnic Health Disparities in North
Carolina Report Card 2006
  • Tool designed to give a brief summary of major
    health indicators for racial/ethnic populations
    in North Carolina
  • First report published in 2003
  • Data come from a variety of sources, but some
    gaps exist where data are not available
  • Baseline 1997 2001 update 2000 - 2004

23
Racial and Ethnic Health Disparities in North
Carolina Report Card 2006
  • Disparity grades calculated by comparing
    rates/percentages to that of the Non-Hispanic
    White population
  • A 0 0.5
  • B 0.6 1.0
  • C 1.1 1.9
  • D 2.0 2.9
  • F gt 3.0

24
Access to Health Careby Race, NC BRFSS 2002-03
plt0.10, plt0.05, plt0.01 for American Indians
compared to Whites
25
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29
Quality of Lifeby Race, NC BRFSS 2002-03
plt0.10, plt0.05, plt0.01 for American Indians
compared to Whites
30
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32
Chronic Disease Health Behaviors for Lumbee
Indians

33
Prevalence of Chronic Health Risk Factorsby
Race, NC BRFSS 2002-03
plt0.10, plt0.05, plt0.01, plt0.005, plt0.001
compared to American Indians
34
Dietary Chronic Health Indicators Among Lumbee
Indian Women
Bell et al, Journal of the American Dietetic
Association, 1995
35
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40
Summary
  • Health indicators with passing grades (A or B)
  • -- Chronic lung disease -- Childhood obesity
  • -- Lung cancer -- High blood pressure
  • -- Colorectal cancer
  • -- Breast cancer
  • -- Suicide
  • Health indicators with failing grades (C or
    lower)
  • Everything else!

41
North Carolina American Indian Health Task Force
  • Jointly convened by the NC DHHS Secretary (Carmen
    Hooker Odom) and the Commission on Indian Affairs
    (Paul Brooks)
  • Task Force made of individuals from a variety of
    disciplines
  • Task Force began meeting in June 2004

42
North Carolina American Indian Health Task Force
  • Three subcommittees
  • Data, Information and Gaps
  • Sovereignty, Governance and Systems
  • Access to Prevention and Care Services
  • Final recommendations presented at North Carolina
    Indian Unity Conference
  • Recommendations to be implemented through
    legislation, systems change and advocacy

43
North Carolina American Indian Health Facts Sheet
Source North Carolina Office of Minority Health
and Health Disparities/State Center for Health
Statistics
44
Summary
  • Generally, many chronic diseases are more common
    and more devastating among American Indians in
    North Carolina compared to whites
  • Many chronic disease risk factors are much higher
    among American Indians compared to whites
  • Efforts are on-going to increase our
    understanding of the health issues in this
    population, but much more is needed
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