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Health Issues Facing American Indians in North Carolina

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. North Carolina American Indians.

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Health Issues Facing American Indians in North Carolina

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  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

  4. Native American Tribes in North Carolina Guilford Native American Association Triangle Native American Society SAPPONY MEHERRIN 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 1995;142:269-287

  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 1995;142:269-287

  9. Leading Causes of DeathAmerican Indians, North Carolina, 2002

  10. Prevalence of Diabetesby Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01 for American Indians compared to Whites

  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 timeshigher 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, 55:1201-3

  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 = > 3.0

  24. Access to Health Careby Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01 for American Indians compared to Whites

  25. Quality of Lifeby Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01 for American Indians compared to Whites

  26. Quality of Lifeby Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01 for American Indians compared to Whites

  27. Prevalence of Chronic Disease Risk Factors by Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01, †p<0.005, ††p<0.001; compared to American Indians Insufficient physical activity: no activity, or some activity, but does not meet recommended level of physical activity

  28. Chronic Disease Health Behaviors for Lumbee Indians

  29. Prevalence of Chronic Health Risk Factorsby Race, NC BRFSS 2002-03 §p<0.10, *p<0.05, **p<0.01, †p<0.005, ††p<0.001; compared to American Indians

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

  31. 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!

  32. 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

  33. 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

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

  35. 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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