Health Issues Facing American Indians in North Carolina

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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

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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

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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
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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
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North Carolina Counties with at Least 1,000
Native Americans
Columbus, Cumberland, Guilford Halifax, Hoke,
Jackson, Mecklenburg Robeson, Scotland, Swain,
Wake


a
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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

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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
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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
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Leading Causes of DeathAmerican Indians, North
Carolina, 2002
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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

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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

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

Levin et al, Ethnicity and Health, 2002

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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

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Prevalence of Diabetes among American Indian
Youth, 2004
MMWR, November 10, 2006, 551201-3
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Age-Adjusted Cancer Incidence and Death Rates By
Race and Ethnicity and Cause of Death, North
Carolina Resident Deaths, 1999-2002
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Age-Adjusted Prostate Cancer Death and Incidence
Rates by Race and Ethnicity, North Carolina, 1997
- 2000
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Age-Adjusted Breast Cancer Death and Incidence
Rates by Race and Ethnicity, North Carolina 1997
- 2000
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Age-Adjusted Cervical Cancer Incidence Rates by
Race and Ethnicity, North Carolina 1997 - 2000
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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

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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
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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

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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

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

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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
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Dietary Chronic Health Indicators Among Lumbee
Indian Women
Bell et al, Journal of the American Dietetic
Association, 1995
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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!

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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

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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

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North Carolina American Indian Health Facts Sheet
Source North Carolina Office of Minority Health
and Health Disparities/State Center for Health
Statistics
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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