American Indians in Utah: Selected Health Data

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2 American Indians in Utah: Selected Health Data The vital events analyzed in this report include asthma, cardiovascular diseases, diabetes, human immunodeficiency virus (HIV) infections, liver diseases, mental health, sexually transmitted diseases, substance abuse, mortality, cancer and population demographics of American Indians in Utah. The information was compiled from the U.S. Census Bureau (2000), the Utah Department of Health ( ), and the Indian Health Service Resource Patient Management System ( ). Additionally, national and statewide statistics were provided to allow for data comparisons including the following: the Centers for Disease Control and Prevention ( ), the National Cancer Institute (2002), and the Substance Abuse and Mental Health Services Administration (2004). Prepared 2010 ii Inter Tribal Council of Arizona, Inc.

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4 American Indians in Utah: Selected Health Data iv Inter Tribal Council of Arizona, Inc.

5 American Indians in Utah: Selected Health Data Prepared by: Tribal Epidemiology Center Inter Tribal Council of Arizona, Inc N. Central Ave., Suite 100 Phoenix, AZ Tel: Fax: Funded by: U.S. Department of Health and Human Services Indian Health Service Grant No. U1B /12

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7 American Indians in Utah: Selected Health Data Table of Contents Section 1. Introduction... 1 Section 2. Background... 7 Section 3. Summary of Findings Section 4. Data Sources Section 5. Federal Data U.S. Census Bureau Demographics Section 6. Federal Data Indian Health Service Asthma Cancer Cardiovascular Diseases (CVD) Diabetes Human Immunodeficiency Virus (HIV) Infections Chronic Liver Diseases/Cirrhosis Mental Health Sexually Transmitted Diseases (STD) Substance Abuse Section 7. State Data Utah Department of Health Mortality Appendix

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9 Section 1: Introduction

10 American Indians in Utah: Selected Health Data Purpose The health status of the United States population is described using data and statistics that represent an aggregate of most people living in this country. This information is often collected, analyzed and presented in a way that captures the differences and disparities that exist across geographic, ethnic, gender and socio-economic lines. However, the real health problems experienced by American Indians and Alaska Natives (AI/AN) are often not captured in the reports and results documented by state and federal agencies. Health information on AI/AN populations is scarce and scattered among various data sources. It takes special effort to compile information into one report or Community Health Profile for tribal, state and national agencies to use in budget projections, program planning and evaluation. As a part of its mission to empower the American Indian tribes in Arizona, Nevada, and Utah in the development of health services and systems, the Inter Tribal Council of Arizona Epidemiology Center (ITCA Tribal Epi Center) proposes to prepare health profiles that describe the health status of American Indians living in the three-state area. The main objective of the community health profiles project is to assist tribes in tracking trends in health outcomes that affect their community members and residents. These reports also can serve as a reference for grant writing and as a marketing tool for seeking additional resources for under-addressed areas of health. Through a collaborative process of data collection, analysis, report preparation and information dissemination, the community health profiles project can help tribal communities become engaged in defining and measuring their health status over time and in implementing activities to improve their communities health. This report was prepared to review the current health status of American Indians living in Utah, and to highlight important changes in their health status over the last five years. Our hope is that this report will assist tribal, state and federal agencies in identifying and addressing important health issues and health disparities, with the eventual goal of improving the overall health status of American Indians living in Utah. As a complementary activity of this profile, the ITCA Tribal Epi Center can offer training assistance in the use of the profile to support assessment, planning, and evaluation functions. Also, the Center can provide continuing technical assistance in epidemiology, and to share solutions found by other sites that use community health profiles. 2 Inter Tribal Council of Arizona, Inc.

11 Section 1: Introduction Data Sources The information presented in this profile was compiled from a number of data sources, including: the U.S. Census Bureau, the Utah Department of Health (UDOH), and the Indian Health Service (IHS). Detailed information on the data sources used, population denominators and the limitations associated with these data sources are presented in Section 4: Data Sources. Methods The indicators presented in this profile were selected based on: 1) health disparities and priorities identified by tribal, state and federal health programs; 2) national and regional goals outlined by Healthy People 2010 and the IHS Area Government Performance Results Act (GPRA); and 3) available data sources. Prevalence rates, age distributions and gender distributions are presented when possible. The information presented on clinical indicators was compiled from data downloaded from the IHS Resource Patient Management System (RPMS). The data were downloaded and categorized using International Classification of Disease (ICD-9) codes. All patient visits falling within the ICD-9 code range for each indicator were downloaded from the RPMS system (see Appendix Table A.1 for a detailed listing of ICD-9 codes for each indicator). SAS v. 8.2 was used for all analyses. In order to measure the burden of disease, the prevalence by person by year was calculated for each clinical indicator. The annual prevalence rates for the calendar years between 2000 and 2004 (inclusive) were calculated as follows: Prevalence = Number of patients with at least one visit for indicator that year Rate Active User Population Comparisons to a source population are made when available and appropriate. For demographic indicators, data on American Indians are compared to state and national data. For mortality indicators, data on American Indians are compared to state data. For clinical indicators, there were no data that were comparable to the rates presented. In these sections, only data on the IHS Phoenix Area patient population in Utah are presented. Tribal Epidemiology Center 3

12 American Indians in Utah: Selected Health Data Limitations This profile is intended to be a snapshot of the overall health status of American Indians in Utah. However, due to a number of limitations, the data presented in this profile may not accurately represent the true health status of this population. Most of these limitations are related to the availability and quality of health information, and variations between the data sources used for this profile. While every attempt was made to include indicators that would effectively capture the overall health status of American Indians in Utah, there are crucial gaps in this profile due to a lack of reliable and accurate data. Some of these gaps in information include injury data, oral health data, behavioral risk factors and preventive health measures. In addition, there is variability between data sources in the way American Indians are identified and counted. For demographic data from the U.S. Census Bureau, only individuals who identified as American Indian alone (and not in combination with other races) were included in the analysis. For mortality data from the Utah Department of Health, American Indians are identified by the race reported on death certificates. For the clinical data from the IHS, information on race and tribal affiliation is obtained and verified at the time the patient first registers for services at an IHS facility. There are a number of limitations specific to the clinical indicators presented in this profile (Section 6). For these clinical indicators, only data from IHS Service Units within the Phoenix Area were included. Therefore, data on American Indians who received health care from other IHS service areas in Utah were not included in this profile. The prevalence rates presented in these sections do not represent the true burden of disease among American Indians in Utah, but instead represent a patient prevalence rate in the IHS Phoenix Area patient population in Utah. This patient prevalence rate is an estimate of the rate of disease among patients in Utah who received care at IHS facilities within the Phoenix Area. Finally, some of the findings for the clinical indicators are limited by small numbers of cases. A small number of cases can result in instability in prevalence rates; this is because small fluctuations in the number of cases can result in apparently large fluctuations in the prevalence rate, even when there are no meaningful changes in the true prevalence of disease in the community. This limitation applies to many of the analyses presented in this profile. 4 Inter Tribal Council of Arizona, Inc.

13 Section 1: Introduction Despite the limitations in the data and analyses presented in this profile, we believe that this information can still provide valuable information on the overall health status of American Indians in Utah. The ITCA Tribal Epi Center will continue to work with tribal, state and federal health programs to improve and develop data systems that will address the current gaps in health information for tribal communities. Tribal Epidemiology Center 5

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15 Section 2: Background

16 American Indians in Utah: Selected Health Data American Indian Tribes in Utah The state of Utah was named for the Ute, one of the five major tribes with homelands within the state of Utah. The other major tribes are the Navajo, Paiute, Goshute and Shoshoni tribes. The history of American Indian tribes in Utah is characterized by armed conflicts with settlers, forced removal from ancestral land and resettlement on reservation lands. The Utes were removed from the Provo Valley in Utah to the Uintah Basin reservation in In 1881, the federal government forcibly resettled the White River Ute tribes from Colorado to the Uintah reservation, and in 1882 resettled the Uncompahgre band of Utes to the adjoining Ouray reservation. The Uintah, White River and Uncompahgre Ute bands eventually incorporated as the Northern Ute Tribe. The tribe (with a membership of approximately 3,300 members) continues to live on the Uintah-Ouray (U&O) Reservation in eastern Utah. The Northern Ute tribal government headquarters is located in Fort Duchesne, Utah. The Navajo homeland extends through northern New Mexico, northern Arizona and southern Utah. In response to settlers encroaching on their homelands in the mid-1850s, small groups of Navajo began to raid these settlements. There were a number of military campaigns against these raiders, which ultimately culminated in the forcible removal and incarceration of the majority of the Navajo population at Fort Sumner, New Mexico. This incarceration ended in 1868, and the Navajo eventually returned to their former lands. Approximately 7,000 members of Navajo Nation reside in Utah. The Navajo Nation headquarters is located in Window Rock, Arizona. The Goshute have remained fairly isolated through most of their history, in part because of the austere conditions of their desert homeland. However, incursions by Mormon settlers in the 1850s and interference from the U.S. military disrupted their traditional ways of life and subsistence. The federal government established two reservations in the Great Basin desert area in Utah, where the two bands of the Goshute tribe currently live. The Skull Valley Goshute Tribe has a tribal membership of approximately 127 members, while the Confederated Tribes of Goshute have a membership of approximately 412 members. The Paiute Indian Tribe of Utah is comprised of five bands: the Shivwits Band, the Indian Peaks Band, the Kanosh Band, the Koosharem Band and the Cedar Band. In the early part of the twentieth century, four of the five Paiute Bands received federal recognition and reservation lands. The termination of federal recognition and assistance in 1954 resulted in a drastic loss of income, health resources and approximately 15,000 acres of reservation lands; these losses resulted in a large number of deaths among the Paiute Indians. All five Paiute bands received federal recognition in 1980, though only 4,800 acres of reservation land were restored. The Paiute bands continue to live on separate reservations in southwestern Utah, and have a total membership of approximately 709 members. The central headquarters for the Paiute Indian Tribe of Utah is located in Cedar City, Utah. The Northwestern Band of Shoshoni Tribe received federal recognition in 1980 and currently live on a 187-acre reservation and on adjoining private lands in northwestern Utah. This land base is a fraction of their former homelands, which extended through northwestern Utah and southeastern Idaho. The Northwestern Band suffered a devastating blow during the 1863 Bear River Massacre, when the U.S. military killed 250 members of the Shoshoni tribe during an attack on a village in Idaho. The Band has approximately 431 members, and has its headquarters in Brigham City, Utah. 8 Inter Tribal Council of Arizona, Inc.

17 Section 2: Background Figure 1: Indian Tribal Lands in Utah, Map source: Utah Division of Indian Affairs. Accessed September 15, References: The Utah Division of Indian Affairs. Accessed September 15, Utah History to Go Website. Native Americans in Utah. utah_chapters/american_indians/nativeamericansinutah.html. Accessed September 15, Tribal Epidemiology Center 9

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19 Section 3: Summary of Findings

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21 Section 3: Summary of Findings Summary of Findings There are two different meanings of case in the below text and throughout the profile. When describing data from IHS, case is defined as a visit to a provider that generated an ICD-9 code relevant to this health condition. For example, the average prevalence of asthma in the IHS Phoenix Area in Utah was 6,870 cases per 100,000 patient population. Case here refers to a deduplicated visit to an IHS provider any time in a given year. When describing data from the Utah Department of Health, case means a death, and is required to be reported to health authorities in Utah. For example, for American Indians, 126 cases of death due to unnatural causes were reported to the Utah Department of Health, Office of Vital Records and Statistics during the five years analyzed. This means that 126 American Indians in Utah met the criteria for death due to an unnatural cause and represent the officially reported numbers for Utah. Demographics In the 0-4, 5-14, and age groups, the percentages of American Indian residents in Utah were higher than the percentages of all residents in Utah. In the 45-64, and 75 and older age groups, the percentages of American Indian residents in Utah were lower than the percentages of all residents in Utah. Approximately 40% of American Indians aged 25+ years had an educational attainment above high school, compared to 63% for all Utah residents of the same age. The median household income for American Indian households was $18,837 less than the median income for all Utah households. The percentage of American Indians below the poverty threshold was approximately 32% compared to 9% for all Utah residents. (This includes American Indians living on and off reservations.) Female-headed households were much more common for American Indians (approximately 23%) compared to all Utah residents (approximately 9%). Mortality Number of deaths per year remained fairly stable in 2000, 2001 and 2005 and were slightly higher in 2002 and Number of deaths was higher among males compared to females for all years except 2003 when there was the same number of deaths among American Indian males and females. The percentage of deaths among those aged was much higher among American Indians compared to all Utah residents for similar age groups. The percentage of deaths due to unnatural causes was higher among American Indians compared to all Utah residents in all five years. Asthma The average prevalence of asthma among IHS Phoenix Area patients in Utah was approximately 6,870 cases per 100,000 patient population between 2000 and More females (average of 57%) had asthma than males (average of 43%). Approximately 50% of those with asthma were aged 24 years or younger. Cancer Males accounted for a majority of the cancer cases for the five year period (approximately 54%). Approximately 29% of cancer cases occurred among those under 45 years of age. Kidney and renal pelvis cancer and colorectal cancer each accounted for approximately 8% of all cancer cases. Tribal Epidemiology Center 13

22 American Indians in Utah: Selected Health Data Cardiovascular Diseases The prevalence rate of cardiovascular disease among IHS Phoenix Area patients rose by 61% from 2000 to 2004, averaging 17,041 cases per 100,000 patient population. Cardiovascular disease was higher among females than males. Less than 5% of cardiovascular cases were aged 24 years or younger, with the majority of cases (approximately 74%) in the and age groups combined. Prevalence of hypertension rose steadily from 9,347 cases per 100,000 patient population in the year 2000, to 16,255 cases per 100,000 patient population in The average prevalence rate of stroke was 221 cases per 100,000 patient population. Type 2 Diabetes The prevalence rate of Type 2 diabetes rose from 9,875 cases per 100,000 patient population in 2000 to 13,722 cases per 100,000 patient population in More females had Type 2 diabetes (average of 59%) than males (average of 41%). Less than five percent of Type 2 diabetes cases were among those aged 0-24 years, with the majority of cases (approximately 79%) in the and age groups combined. HIV/AIDS Infections The average annual prevalence rate of HIV was 25 cases per 100,000 patient population during the five year time period. Liver Diseases The prevalence of liver diseases rose by approximately 74% from 359 cases per 100,000 patient population in 2000, to 623 cases per 100,000 patient population in More males had liver diseases (average of 58.5%) than females (average of 41.5%). The vast majority of cases occurred in the (approximately 38%) and (approximately 48%) age groups combined. The prevalence rate of alcohol-related liver diseases increased from 2000 to 2004, averaging 362 cases per 100,000 patient population for the five year time period. Mental Health The prevalence of depression/affective disorders rose steadily from 7,465 cases per 100,000 patient population in 2000, to 10,837 cases per 100,000 patient population in More females had depression/affective disorders (average of 68%) than males (average of 32%). Approximately 6% of depression diagnoses occurred in those aged 0-14 years, 22% occurred in those aged years, 41% occurred in those aged years, and 26% occurred in those aged years. The prevalence of anxiety rose from 3,108 cases per 100,000 patient population in 2000, to 4,339 cases per patient population in More females had anxiety (average of 74%) than males (average of 26%). Roughly 3% of anxiety diagnoses were among those aged 0-14 years, 15% occurred among those aged years, 47% occurred among those aged years, and 30% was among those aged years. 14 Inter Tribal Council of Arizona, Inc.

23 Section 3: Summary of Findings Sexually Transmitted Diseases On average, females accounted for 60.3% of annual cases, while males accounted for 39.7% of annual cases. The majority of STD cases were in the younger age groups, with approximately 46% of all cases between the ages of 15-24, and approximately 32% of all cases between the ages of Chlamydia, gonorrhea and syphilis prevalence rates varied widely from year to year, with a mean rate of 21 cases/100,000 population for chlamydia, 50 cases/100,000 population for gonorrhea, and 42 cases/100,000 for non-congenital syphilis. Substance Abuse The prevalence rate of overall substance abuse averaged 741 cases per 100,000 patient population during the five year time period. More males had a substance abuse diagnosis (average of 60%) than females (average of 40%). The highest percentage of cases occurred among those aged (46%), followed by those aged (approximately 28%). Males accounted for more alcohol (approximately 67%), cannabis (70%), and cocaine (57%) abuse diagnoses than females. Females accounted for more opioid (53%), and tobacco (56%) abuse diagnoses than males. The prevalence rate of alcohol abuse averaged approximately 3,838 cases per 100,000 patient population between 2000 and The prevalence rate of amphetamine abuse varied and averaged 125 cases per 100,000 patient population between 2000 and The prevalence rate of tobacco abuse rose by approximately 80% from 888 cases per 100,000 patient population in 2000, to 1,599 cases per 100,000 patient population in The prevalence rate of cannabis abuse varied and averaged approximately 309 cases per 100,000 patient population during the five year time period. The prevalence rate of cocaine abuse averaged 146 cases per 100,000 patient population between 2000 and The prevalence rate of opioid abuse varied, and averaged 63 cases per 100,000 patient population between 2000 and Tribal Epidemiology Center 15

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25 Section 4: Data Sources

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27 Section 4: Data Sources Data Sources Federal Data U.S. Census Bureau (2000) Data on Utah state residents from 2000 Long-Form Census, Summary Files 1 and 3. Data on American Indians in Utah from the American Indian/Alaska Native Summary File (sample data) Limitations: Detailed demographics data not available past Indian Health Service Resource Patient Management System (IHS RPMS) - Phoenix Area IHS in Utah ( ) Tribal affiliation and race verified at time of patient registration. Denominator* for Phoenix Area IHS in Utah. Active user population by year (all patients with at least one visit in the past 3 years) for the IHS service unit in Utah. Estimates for Active User Population for Phoenix Area IHS in Utah obtained from Phoenix Area IHS: Active Users by Tribal Community and Service Unit reports, Population Denominator* Active User Population for Phoenix Area IHS in Utah 4,729** 4,729 4,802 4,903 4,817 **Applied FY2001 user population counts to FY2000. Did not have a user population this year due to data integrity problems. Limitations: Reliability and validity of population estimates are unknown. The IHS Active User Population for the Phoenix Area IHS in Utah represents only a proportion of the American Indian population in Utah For example, the IHS active user population for 2000 was estimated at 4,729, while the 2000 U.S. Census Bureau estimated that 28,646 American Indians resided in Utah. State Data Utah Department of Health, Office of Vital Records ( ) Data obtained from death certificates. Population Denominator American Indians in Utah*** 31,363 31,452 31,959 32,428 32,537 All Utah Residents 2,243,136 2,287,736 2,336,673 2,378,696 2,420,708 ***Population denominators are based on Race Alone estimates obtained from the US Census Bureau Limitations: Detailed information on mortality among American Indians (e.g., leading causes of death) not available Tribal Epidemiology Center 19

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29 Section 5: Federal Data U.S. Census Bureau

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31 Section 5: Federal Data U.S. Census Bureau Demographics Tribal Epidemiology Center 23

32 American Indians in Utah: Selected Health Data Age Distribution Graph 1 and Table 1 show the age distributions of American Indians in Utah and all Utah residents in American Indians were younger than the general population of Utah. For instance, 84.0% of American Indians in Utah were aged 0-44 years and 74.6% of the Utah residents were aged 0-44 years. In the 5-14 age group, the percentage of American Indians in Utah was higher than the percentage of all Utah residents (21.1% compared to 17.3%). A higher percentage of American Indians were in the 5-14 age group (21.1% compared to 17.3% of the general population), the age group (21.1% compared to 19.8%) and the age group (32.3% compared to 28.1%). In contrast, a higher percentage of the general Utah population were in the age group (17.0% compared to 12.5% of American Indians), the age group (4.5% compared to 2.3%) and the 75+ age group (4.0% compared to 1.2%). Individuals between the ages of accounted for the largest percentage of both populations (32.3% of American Indians in Utah and 28.1% of all Utah residents). Graph 1: Age distributions of American Indians in Utah and all Utah residents, American Indians in Utah All Utah Residents Percent Age Group 1.2 *Comment: The age groups presented in Graph 1 and Table 1 are categorized, or divided, in order to represent different basic stages of life (i.e. infant and toddler, youth, teens and young adults). All of the age groups do not consist of the same number of years. For example, the year age group includes ten years, while the year age group includes 20 years. Therefore, the age groups should not be directly compared to each other and should be interpreted with caution. A suitable way to obtain information from the data is to compare the age group of American Indians in Utah to the same age group of Utah state residents. The narrative above provides examples. 24 Inter Tribal Council of Arizona, Inc.

33 Section 5: Federal Data U.S. Census Bureau Table 1: Age distributions of American Indians in Utah and all Utah residents, Age Group American Indians in Utah All Utah Residents N % N % 0 4 2, , , , , , , , , , , , Total 28, ,233, Note: Total percents may not add to due to rounding. Tribal Epidemiology Center 25

34 American Indians in Utah: Selected Health Data Age Distribution by Gender Graph 2a and Table 2 show the age distribution by gender of American Indians in Utah in American Indian males were slightly younger than American Indian females; 31.5% of all American Indian males were less than 15 years of age (9.9% in the 0-4 age group and 21.6% in the 5-14 age group). In contrast, 29.5% of all females were less than 15 years of age (9.0% in the 0-4 age group and 20.5% in the 5-14 age group). For American Indians in Utah ages 45 years and older, females accounted for a higher percentage of the population than males (16.9% for females compared to 15.2% for males). These findings are similar to the age distribution by gender of all Utah residents in 2000 (Graph 2b and Table 2). However, both the Utah male and female populations had higher percentages of residents 45 years or over compared to American Indian males and females in Utah for the same age range. (24.3% for Utah males and 26.7 for Utah females compared to 15.2% for American Indian males and 16.9% for American Indian females. Graph 2a: Age distribution by gender of American Indians in Utah, Percen t Median age of both genders (AI only): 23.2 years Males Females Age Group 1.4 Graph 2b: Age distribution by gender of all Utah residents, Median age of both genders (Utah): 27.1 years Males Females Percent Age Group 26 Inter Tribal Council of Arizona, Inc.

35 Section 5: Federal Data U.S. Census Bureau Table 2: Age distributions by gender of American Indians in Utah and all Utah residents, Age Group American Indian Males in Utah American Indian Females in Utah Utah Males Utah Females N % N % N % N % 0 4 1, , , , , , , , , , , , , , , , , , , , , , , , Total 14, , ,119, ,114, Note: Total percents may not add to due to rounding. Tribal Epidemiology Center 27

36 American Indians in Utah: Selected Health Data Educational Attainment Graph 3 and Table 3 show the educational attainment for American Indians in Utah and all Utah residents who were 25 years or older. In 2000, 40.2% of American Indians ages 25 years or older had an educational attainment higher than a high school degree (31.4% with an associate degree/some college, 6.4% with a bachelor s degree and 2.4% with a graduate/ professional degree). A larger percentage of all Utah residents (63.2%) had an educational attainment higher than a high school degree (37.0% with an associate degree/some college, 17.9% with a bachelor s degree and 8.3% with a graduate/professional degree). The largest differences in educational attainment between the two populations were for individuals with less than a high school degree (31.4% of American Indians compared to 12.3% of all Utah residents) and for individuals with graduate/professional degrees (2.4% of American Indians compared to 8.3% of all Utah residents). Graph 3: Educational attainment of persons 25 years and older for American Indians in Utah and all Utah residents, American Indians in Utah All Utah Residents Percent Less than High school graduate High school graduate Associate Degree/Some College Bachelor's Degree Graduate/Professional Degree Educational Attainment 28 Inter Tribal Council of Arizona, Inc.

37 Section 5: Federal Data U.S. Census Bureau Table 3: Educational attainment of persons 25 years and older for American Indians in Utah and all Utah residents, Educational Attainment American Indians in Utah All Utah residents N % N % Less than High school graduate 4, , High school graduate 3, , Associate Degree/Some College 4, , Bachelor s degree , Graduate or professional degree , Total persons 25 years and older 13, ,197, Note: Total percents may not add to due to rounding. Tribal Epidemiology Center 29

38 American Indians in Utah: Selected Health Data Household Income Graph 4 and Table 4 compare the household income distributions for American Indians in Utah and all Utah residents in The median household income for American Indians living in Utah was $18,837 less than the median income for all Utah residents ($26,889 for American Indians compared to $45,726 for all Utah residents). The largest differences in household income between the two populations were in households with incomes less than $10,000 (18.9% of American Indian households compared to 6.0% of all Utah households) and in households with incomes greater than $75,000 (10.1% of American Indian households compared to 22.5% of all Utah households). Graph 4: Household income for American Indians in Utah and all Utah residents, American Indians in Utah 32.3 All Utah Residents Percent <$10,000 $10,000-$24,999 $25,000-$49,999 $50,000-$74,999 >$75,000 Household Income 30 Inter Tribal Council of Arizona, Inc.

39 Section 5: Federal Data U.S. Census Bureau Table 4: Household income for American Indians in Utah and all Utah residents, Household Income American Indians in Utah All Utah residents N % N % < $10,000 1, , $10,000 - $24,999 2, , $25,000 - $49,999 2, , $50,000 - $74,999 1, , >$75, , Total number of households 7, , Median Household Income $26,889 $45,726 Note: Total percents may not add to due to rounding. Tribal Epidemiology Center 31

40 American Indians in Utah: Selected Health Data Poverty Status Graph 5 and Table 5 compare the population below poverty level for American Indians in Utah, all Utah residents and the United States population in A higher percentage of the American Indian population in Utah fell below the poverty level (31.8%) compared to the percentage of the Utah population below the poverty level (9.2%) and the percentage of the United States population below the poverty level (12.4%). The percentage of American Indians in Utah living below the poverty includes those living on and off reservations. This may underestimate the percentage of the American Indian population living below poverty level on reservations. The U.S. Census calculates poverty status using the poverty thresholds located in Appendix B. Graph 5: Population below poverty level for American Indians in Utah, all Utah residents and the United States population, Percent of population American Indians in Utah All Utah Residents United States Population 32 Inter Tribal Council of Arizona, Inc.

41 Section 5: Federal Data U.S. Census Bureau Table 5: Population below poverty level for American Indians in Utah, all Utah residents and the United States population, Population Population below poverty level Total population* N % N % American Indians in Utah 9, , All Utah Residents 206, ,233, United States 33,899, ,882, Note: Total percents may not add to due to rounding. *Total population for which poverty status was determined. Tribal Epidemiology Center 33

42 American Indians in Utah: Selected Health Data Household characteristics Graph 6 and Table 6 compare the household characteristics of American Indians in Utah and all Utah residents in Married couple families accounted for a lower percentage of American Indian households in Utah compared to all Utah households (46.1% compared to 63.2%). Female headed households accounted for a higher percentage of American Indian households in Utah compared to all Utah households (23.1% compared to 9.4%). Graph 6: Household characteristics of American Indians in Utah and all Utah residents, Percent of all households American Indians in Utah All Utah Residents Married Couple Family Female Householder, no husband present Non-family households Household Type 34 Inter Tribal Council of Arizona, Inc.

43 Section 5: Federal Data U.S. Census Bureau Table 6: Household characteristics of American Indians in Utah and all Utah residents, Household Characteristics American Indians in Utah All Utah residents N % N % Married Couple family 3, , Female householder, no husband present 1, , Non-family households 1, , Total households* 7, , *Total percent does not add up to because other household types are included in the Total Households count but not included in this table. Tribal Epidemiology Center 35

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45 Section 6: Federal Data Indian Health Service Resource Patient Management System (IHS RPMS) - Phoenix Area IHS in Utah

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47 Section 6: Federal Data Indian Health Service Asthma Definition: Asthma is a chronic lung disease that is characterized by the narrowing of air passages to the lungs, which causes difficulty in breathing. Asthma can be divided into two categories: allergic asthma and non-allergic asthma. Allergic asthma, the most common form of asthma, is triggered by exposure to allergens such as dust, pollen, dander and mold. Non-allergic asthma is triggered by factors such as smoke, cold or dry air, exercise, anxiety or stress. The underlying cause of asthma is unknown, though there is strong evidence that is has a genetic basis. While there is no cure for asthma, asthma symptoms can be prevented and treated. Symptoms and Complications: When a person with asthma is exposed to an asthma trigger, the air passages to the lungs become inflamed and swollen. This constriction is often accompanied by a build-up of mucus in the passages. These episodes (or asthma attacks ) result in difficulty in breathing, chest tightness, wheezing and coughing. The triggers that cause an asthma attack, and the severity of the attack, vary from person to person. Asthma can restrict a person s everyday activities, and severe attacks can result in hospitalization and even death. Impact: Data from the 2004 National Health Interview Survey indicated that 21.3 million adults (9.9 %) and 8.9 million children (12.2%) had ever been diagnosed with asthma. An estimated 4.0 million children (5.4%) had an asthma attack in There were 3,780 deaths due to asthma in 2004, resulting in a mortality rate of 1.3 deaths/100,000 population. Females, minorities and children have higher prevalence rates of asthma. The table below summarizes the age-adjusted rates (cases per 100 population) of current asthma and lifetime diagnosis of asthma for American Indians/Alaska Natives (AI/AN) alone, Whites and all races. AI/AN Alone White All Races Current Asthma Lifetime Asthma Diagnosis *Data source: 2002 National Health Interview Survey, National Center for Health Statistics, CDC. Risk Factors: A family history of asthma is an important risk factor for developing asthma. The risk of developing asthma is three to six times higher among individuals who have a parent with asthma compared to individuals whose parents do not have asthma. Asthma-related morbidity and mortality are higher among minorities, children living in inner cities and low-income populations. Prevention and Treatment: While there is no cure for asthma, asthma patients can manage their symptoms through prevention and treatment. It is important for asthma patients to know and avoid the things that trigger their asthma attacks. Patients should monitor their symptoms in order to catch an asthma attack in its early stages. Asthma symptoms are often treated using a combination of medications. Long-term controller medications work to prevent inflammation and keep airways open over longer periods of time; these medications are usually taken daily. Quick-relief medications work to rapidly stop the wheezing, coughing and chest-tightness that occur during an asthma attack. These medicines are often administered by an inhaler, and are taken at the time of an asthma attack. References: Asthma and Allergy Foundation of America. Asthma. Accessed 12/18/2006. Centers for Disease Control and Prevention. Asthma. Accessed 12/18/2006. Tribal Epidemiology Center 39

48 American Indians in Utah: Selected Health Data Prevalence Rates of Asthma Graph 1 and Table 1 show the prevalence rate of asthma in the IHS Phoenix Area patient population in Utah between 2000 and The rate of asthma in this patient population increased by 10.6% overall during the five-year period, from 6,323 cases/100,000 in 2000 to 6,996 cases/100,000 in The rate peaked at 7,567 cases/100,000 in Graph 1: Prevalence rate of Asthma in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 40 Inter Tribal Council of Arizona, Inc.

49 Section 6: Federal Data Indian Health Service Table 1: Prevalence rates (cases/100,000 patient population) of Asthma in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 6,323 6,407 7,060 7,567 6,996 6,870 Tribal Epidemiology Center 41

50 American Indians in Utah: Selected Health Data Gender and Asthma Graph 2 and Table 2 show the gender distribution of asthma cases among IHS Phoenix Area patients in Utah for the years Females accounted for the majority of asthma cases in this patient population during the five-year period. On average, females accounted for 56.6% of annual asthma cases, while males accounted for 43.4% of asthma cases. Graph 2: Gender distribution of Asthma cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 42 Inter Tribal Council of Arizona, Inc.

51 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Asthma cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent Males IHS Phoenix Area Asthma Cases in Utah Females All Tribal Epidemiology Center 43

52 American Indians in Utah: Selected Health Data Age and Asthma Graph 3 and Table 3 show the age distribution of asthma cases among IHS Phoenix Area patients in Utah for the years combined. The majority of asthma cases in this patient population were between the ages of (25.4%). The second largest age group was the 5-14 age group (21.8%). Graph 3: Age distribution of Asthma cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 44 Inter Tribal Council of Arizona, Inc.

53 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Asthma cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area Asthma Cases in Utah % % % % % % % Tribal Epidemiology Center 45

54 American Indians in Utah: Selected Health Data Seasonal Distribution of Asthma Cases Graph 4 and Table 4 show the seasonal distribution of asthma cases among IHS Phoenix Area patients in Utah for the years combined. There appeared to be a seasonal pattern of asthma cases, with the majority of cases occurring during the fall and winter months. The most cases occurred in December (21.7%), followed by November (11.7%), October and September (8.7% for both months). Graph 4: Distribution of Asthma cases by month of visit among IHS Phoenix Area patients in Utah, combined Percent of all Cases January February March April May June July August September October November December Month 46 Inter Tribal Council of Arizona, Inc.

55 Section 6: Federal Data Indian Health Service Table 4: Distribution of Asthma cases by month of visit among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Month IHS Phoenix Area Asthma Cases in Utah January 5.9% February 6.1% March 5.8% April 6.2% May 5.9% June 5.8% July 5.5% August 7.9% September 8.7% October 8.7% November 11.7% December 21.7% Tribal Epidemiology Center 47

56 American Indians in Utah: Selected Health Data 48 Inter Tribal Council of Arizona, Inc.

57 Section 6: Federal Data Indian Health Service Cancer Definition: Cancer refers to the uncontrolled growth of organ or tissue cells due to damage to cellular DNA. As cancer cells grow, they can form tumors in the affected organ or tissues, and can spread to other parts of the body. As cancer progresses, it prevents vital organs from functioning properly and eventually leads to death if not treated. Some forms of cancer can be successfully treated if diagnosed early; depending on the cancer site and the progression of disease, this treatment may include surgery, radiation therapy and chemotherapy. However, some forms of cancer are not treatable and have a high fatality rate. Cancer is the second leading cause of death in the United States, and also the second leading cause of death for American Indians/Alaska Natives. There are regional variations in the incidence and prevalence rates of cancer sites. The table below shows the incidence rates in the general population of Arizona and the United States in 2002 for selected major cancer sites. Cancer Site Arizona Incidence Rate United States Incidence Rate All Sites cases/100, cases/100,000 Breast cases/100, cases/100,000 Cervical 7.2 cases/100, cases/100,000 Colorectal 42.2 cases/100, cases/100,000 Kidney/Renal Pelvis 13.4 cases/100, cases/100,000 Lung 56.1 cases/100, cases/100,000 Prostate cases/100, cases/100,000 Risk Factors: Each type of cancer has its own associated risk factors; however, there are a number of factors that are associated with increased risk for more than one type of cancer. Some of these factors include: smoking and tobacco use, lack of physical activity, poor diet, age, family history of cancer, racial/ethnic background, certain infectious diseases and exposure to chemicals or radiation. Prevention: In general, minimizing exposure to the environmental factors that are known to cause cancer can reduce the risk of developing cancer. Some general ways to reduce this risk include stopping tobacco use, getting screened for common cancers on a regular basis, maintaining a healthy diet and increasing physical activity. References: American Cancer Society. Accessed July 25 th, Intercultural Cancer Council. American Indians/Alaska Natives and Cancer. Accessed July 25 th, National Cancer Institute. State Cancer Profiles. Accessed July 25 th, Tribal Epidemiology Center 49

58 American Indians in Utah: Selected Health Data Prevalence Rate of Cancer Graph 1 and Table 1 show the prevalence rate of cancer in the IHS Phoenix Area patient population in Utah between 2000 and The prevalence rate increased from 592 cases/100,000 in 2000 to 708 cases/100,000 in The rate then decreased to 602 cases/100,000 in The rate has increased slightly overall by 1.7% over the five-year period. Graph 1: Prevalence rate of Cancer in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 50 Inter Tribal Council of Arizona, Inc.

59 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of Cancer in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 51

60 American Indians in Utah: Selected Health Data Gender and Cancer Graph 2 and Table 2 show the gender distribution of cancer cases among IHS Phoenix Area patients in Utah for the years On average, males accounted for the majority of all annual cases during this time period (53.9%). However, females accounted for an increasing percentage of all annual cases over time. Females accounted for 46.1% of annual cases on average; the percentage of cancer cases who were female rose from 42.9% in 2000 to 51.7% in Graph 2: Gender distribution of Cancer cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 52 Inter Tribal Council of Arizona, Inc.

61 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Cancer cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent Males IHS Phoenix Area Cancer Cases in Utah Females All Tribal Epidemiology Center 53

62 American Indians in Utah: Selected Health Data Age and Cancer Graph 3 and Table 3 show the age distribution of cancer cases among IHS Phoenix Area patients in Utah for the years combined. The majority of cancer cases were between the ages of (38.3% of all cases). Cases between the ages of accounted for the second highest percentage of all cancer cases (20.8%). Graph 3: Age distribution of Cancer cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 54 Inter Tribal Council of Arizona, Inc.

63 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Cancer cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area Cancer Cases in Utah % % % % % % % Tribal Epidemiology Center 55

64 American Indians in Utah: Selected Health Data Distribution by Major Cancer Site Chart 1 and Table 4 show the distribution of prevalent cancer cases by cancer site among IHS Phoenix Area patients in Utah for the years combined. Of the major cancer sites, cancers of the kidney and renal pelvis accounted for the highest percentage of all cancer cases (8.4%). Colorectal cancer was the second most common cancer site (7.8%), followed by prostate cancer (5.2%). Chart 1: Distribution of prevalent cancer cases by cancer site among IHS Phoenix Area patients in Utah, combined. Breast 2.6% Cervical 1.3% Colorectal 7.8% Kidney/Renal Pelvis 8.4% Lung 2.6% Prostate 5.2% Other 72.1% 56 Inter Tribal Council of Arizona, Inc.

65 Section 6: Federal Data Indian Health Service Table 4: Distribution of prevalent cancer cases among IHS Phoenix Area patients in Utah, combined. Distribution (Percent of All Cases) Cancer Site IHS Phoenix Area Cancer Cases in Utah Breast 2.6% Cervical 1.3% Colorectal 7.8% Kidney/ Renal Pelvis 8.4% Lung 2.6% Prostate 5.2% Other 72.1% Tribal Epidemiology Center 57

66 American Indians in Utah: Selected Health Data 58 Inter Tribal Council of Arizona, Inc.

67 Section 6: Federal Data Indian Health Service Cardiovascular Diseases (CVD) Definition: Cardiovascular diseases are characterized by reduced blood and oxygen supply to the heart, brain and other organs. These diseases are often caused by narrowing of the arteries by fatty deposits or plaque, or by clots that block blood flow to the organs. The table below summarizes the most common forms of cardiovascular disease, along with the burden of these diseases in the general population and among American Indians/Alaska Natives. Condition Description Burden Coronary heart disease (CHD) Plaque buildup in the arteries results in reduced blood and oxygen supply to the heart muscle Can lead to heart attacks, angina (chest pain) and heart failure Most common form of heart disease Estimated 13.2 million persons affected by CHD in 2006 Estimated 8.2% of AI/AN individuals age 18 years or older have CHD Stroke High blood pressure (Hypertension) Heart failure (Congestive heart disease) Blood supply to brain is disrupted by a blockage or a hemorrhage, resulting in brain damage Can result in disabilities such as paralysis and speech impairments; can also result in death Pressure in arteries (the force of blood pushing against blood vessel walls) is above the normal range (120/80 for most adults) Often has no symptoms Increases risk of CHD and stroke Heart is unable to deliver a sufficient blood/oxygen supply to muscles and organs Caused by coronary artery disease, hypertension and diabetes No cure; treatment options include medications and heart transplants Third leading cause of death in U.S. Approximately 700,000 strokes occur each year 160,000 deaths occur due to stroke each year 3.6% of AI/AN individuals age 18 or older have had a stroke; highest of all ethnicities Estimated one in three U.S. adults have hypertension Estimated 23.9% of AI/AN individuals age 18 years or older have hypertension Estimated 5 million persons had heart failure in 2006 Risk Factors: The major risk factors associated with an increased risk of developing cardiovascular diseases include underlying health conditions and lifestyle factors. The following health conditions are associated with an increased risk of developing CVD: high blood cholesterol levels, obesity, diabetes and hypertension. Lifestyle factors include tobacco use, diet, physical inactivity and excessive alcohol consumption. A family history of cardiovascular disease might also increase the risk of developing CVD. Prevention: The risk of cardiovascular diseases can be reduced by a number of lifestyle changes. These changes can include losing weight, eating a healthy diet, increasing physical activity and stopping tobacco use. These lifestyle changes can help in controlling and preventing high blood cholesterol levels, hypertension and diabetes, which are the major risk factors for developing cardiovascular diseases. References: American Heart Association. Accessed July 25 th, Centers for Disease Control and Prevention. Division of Heart Disease and Stroke Prevention. Accessed July 25 th, Tribal Epidemiology Center 59

68 American Indians in Utah: Selected Health Data Prevalence Rate of Cardiovascular Diseases Graph 1 and Table 1 show the prevalence rate of cardiovascular diseases (CVD) in the IHS Phoenix Area patient population in Utah between 2000 and The prevalence rate of CVD has steadily increased from 12,645 cases/100,000 in 2000 to 20,386 cases/100,000 in This represents an overall increase of 61.2% during the five-year period. Graph 1: Prevalence rate of CVD in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 60 Inter Tribal Council of Arizona, Inc.

69 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of CVD in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 12,645 15,860 17,389 18,927 20,386 17,041 Tribal Epidemiology Center 61

70 American Indians in Utah: Selected Health Data Gender and CVD Graph 2 and Table 2 show the gender distribution of CVD cases among IHS Phoenix Area patients in Utah for the years Overall, females accounted for a larger percentage of all CVD cases compared to males. On average, females accounted for 51.4% of annual cases while males accounted for 48.6% of annual cases. Graph 2: Gender distribution of CVD cases among IHS Phoenix Area patients in Utah by year, Male 49.8 Female 50.2 Percent of Annual Cases Year 62 Inter Tribal Council of Arizona, Inc.

71 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of CVD cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent IHS Phoenix Area CVD Cases in Utah Males Females All Tribal Epidemiology Center 63

72 American Indians in Utah: Selected Health Data Age and CVD Graph 3 and Table 3 show the age distribution of CVD cases among IHS Phoenix Area patients in Utah for the years combined. The majority of Utah CVD cases were between the ages of years of age; 73.9% of all cases fell into this age group, with 27.7% of all cases in the age group and 46.2% of all cases in the age group. Graph 3: Age distribution of CVD cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 64 Inter Tribal Council of Arizona, Inc.

73 Section 6: Federal Data Indian Health Service Table 3: Age distribution of CVD cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area CVD Cases in Utah % % % % % % % Tribal Epidemiology Center 65

74 American Indians in Utah: Selected Health Data Coronary Heart Disease Graph 4 and Table 4 show the prevalence rate of coronary heart disease in the IHS Phoenix Area patient population in Utah. The prevalence rate steadily increased between 2000 and 2002, dropped slightly in 2003 and then increased to 1,329 cases/100,000 patient population in The prevalence rate increased by 23.3% overall during this five-year period. Graph 4: Prevalence rate of Coronary Heart Disease in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 66 Inter Tribal Council of Arizona, Inc.

75 Section 6: Federal Data Indian Health Service Table 4: Prevalence rate (cases/100,000 patient population) of Coronary Heart Disease in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 1,078 1,205 1,270 1,122 1,329 1,201 Tribal Epidemiology Center 67

76 American Indians in Utah: Selected Health Data Heart Failure Graph 5 and Table 5 show the prevalence rate of heart failure in the IHS Phoenix Area patient population in Utah. The rate of heart failure in this patient population decreased by 14.9% overall, from 952 cases/100,000 in 2000 to 810 cases/100,000 in Graph 5: Prevalence rate of Heart Failure in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 68 Inter Tribal Council of Arizona, Inc.

77 Section 6: Federal Data Indian Health Service Table 5: Prevalence rate (cases/100,000 patient population) of Heart Failure in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 69

78 American Indians in Utah: Selected Health Data Hypertension Graph 6 and Table 6 show the prevalence rate of hypertension in the IHS Phoenix Area patient population in Utah. The prevalence rate of hypertension increased by 73.9% overall, from 9,347 cases/100,000 in 2000 to 16,255 cases/100,000 in Graph 6: Prevalence rate of Hypertension in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 70 Inter Tribal Council of Arizona, Inc.

79 Section 6: Federal Data Indian Health Service Table 6: Prevalence rate (cases/100,000 patient population) of Hypertension in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 9,347 12,222 13,140 15,174 16,255 13,228 Tribal Epidemiology Center 71

80 American Indians in Utah: Selected Health Data Stroke Graph 7 and Table 7 show the prevalence rate of stroke in the IHS Phoenix Area patient population in Utah. The prevalence rate increased between 2000 and 2002, decreased in 2003 and then sharply increased to 353 cases/100,000 in The prevalence rate of stroke in this patient population apparently increased by 138.5% overall between 2000 and However, this finding should be interpreted with caution, since it is based on a small number of cases. Graph 7: Prevalence rate of Stroke in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 72 Inter Tribal Council of Arizona, Inc.

81 Section 6: Federal Data Indian Health Service Table 7: Prevalence rate (cases/100,000 patient population) of Stroke in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 73

82 American Indians in Utah: Selected Health Data 74 Inter Tribal Council of Arizona, Inc.

83 Section 6: Federal Data Indian Health Service Diabetes Definition: Diabetes is a disorder characterized by high levels of sugar (glucose) in the blood. Normally, a hormone called insulin controls blood glucose levels by delivering glucose into the cells of the body for energy. Diabetes occurs when the body either does not produce enough insulin, or when cells do not respond to insulin. There are two common forms of diabetes. Type 1 diabetes is usually diagnosed in childhood and accounts for approximately 5-10% of all diabetes cases. Type 1 diabetes occurs when the cells that produce insulin are destroyed by the immune system, and the body is unable to produce any insulin. Type 2 diabetes, which is the most common form of diabetes, occurs when cells in the body stop responding normally to insulin. The body initially increases insulin production in an attempt to normalize blood glucose levels, but eventually loses the ability to produce insulin. Symptoms and Complications: Some common symptoms of diabetes include: increased thirst, increased urination, increased appetite, weight loss, fatigue, blurred vision, slow healing wounds and changes in vision. Complications associated with diabetes include: heart disease, stroke, blindness, kidney disease, nerve damage, foot problems, amputation and depression. These complications may develop over time due to poor diabetes management. Impact: In 2005, an estimated 20.8 million people in the United States were living with diabetes. AI/AN are 2.2 times as likely to have diabetes than non-hispanic whites. It is estimated that 15.1% of American Indians/Alaska Natives ages 20 years or older have diabetes. Diabetes is the fourth leading cause of death for American Indians/Alaska Natives. Risk Factors: The following factors are associated with increased risk of diabetes: being overweight or obese, high blood pressure, high cholesterol, low levels of physical activity, tobacco use and diet. Characteristics such as gender, age and racial/ethnic background also affect the risk of developing diabetes. Prevention: While Type 1 diabetes cannot be prevented, there are a number of lifestyle and behavioral changes that can help prevent Type 2 diabetes. Early detection of pre-diabetes, or high blood glucose levels before any long-term damage to the body occurs, can help in prevention. The most important lifestyle changes include losing weight, eating a healthy diet and increasing physical activity. These changes can also help in managing diabetes after diagnosis. References: American Diabetes Association. Accessed July 25 th, Centers for Disease Control and Prevention. Diabetes Public Health Resource. Accessed July 25 th, Tribal Epidemiology Center 75

84 American Indians in Utah: Selected Health Data Prevalence Rate of Type 2 Diabetes Graph 1 and Table 1 show the prevalence rate of Type 2 diabetes in the IHS Phoenix Area patient population in Utah. The prevalence rate increased from 9,875 cases/100,000 in 2000 to 13,722 cases/100,000 in 2004, representing an overall increase of 39.0% during the five-year period. The rate of Type 2 diabetes in this patient population rapidly increased between 2000 and 2002, but has shown signs of leveling off in more recent years. Graph 1: Prevalence rate of Type 2 Diabetes in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 76 Inter Tribal Council of Arizona, Inc.

85 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of Type 2 Diabetes in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 9,875 11,736 12,870 13,461 13,722 12,333 Tribal Epidemiology Center 77

86 American Indians in Utah: Selected Health Data Gender and Type 2 Diabetes Graph 2 and Table 2 show the gender distribution of Type 2 diabetes cases among IHS Phoenix Area patients in Utah. The majority of Type 2 diabetes cases were female. On average, females accounted for 58.9% of annual cases, while males accounted for 41.1% of annual cases. Graph 2: Gender distribution of Type 2 Diabetes cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 78 Inter Tribal Council of Arizona, Inc.

87 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Type 2 Diabetes cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent IHS Phoenix Area Type 2 Diabetes Cases in Utah Males Females All Tribal Epidemiology Center 79

88 American Indians in Utah: Selected Health Data Age and Type 2 Diabetes Graph 3 and Table 3 show the age distribution of Type 2 diabetes cases among IHS Phoenix Area patients in Utah for the years combined. The majority of Type 2 diabetes cases were between the ages of 45-64: 46.4% of all cases fell into this age group. Type 2 diabetes cases between the ages of accounted for 32.2% of all cases. Graph 3: Age distribution of Type 2 Diabetes cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 80 Inter Tribal Council of Arizona, Inc.

89 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Type 2 Diabetes cases among IHS Phoenix Area patients in Utah, combined. Age Group Age Distribution (Percent of All Cases) IHS Phoenix Area Type 2 Diabetes Cases in Utah % % % % % % % Tribal Epidemiology Center 81

90 American Indians in Utah: Selected Health Data 82 Inter Tribal Council of Arizona, Inc.

91 Section 6: Federal Data Indian Health Service Human Immunodeficiency Virus (HIV) Infections Definition: HIV infection is caused by the human immunodeficiency virus, which targets and destroys the immune system and impairs the body s ability to fight infections. Following infection with HIV, there is often a latent period during which there are no obvious signs or symptoms of infection. During this time, the virus progressively destroys critical components of the immune system. Eventually, persons infected with HIV develop Acquired Immune Deficiency Syndrome (AIDS), a condition in which the immune system is unable to fight off infections. There is no cure for HIV, though there are a number of treatments that can delay the onset of AIDS. Transmission: HIV is spread through the exchange of bodily fluids that contain the HIV virus. The most common forms of transmission are: Sexual contact: Oral, vaginal or anal sex Exchange of blood: Needle sharing or blood transfusions (rare) Mother-to-child: During pregnancy or through breastfeeding Symptoms and complications: HIV infection destroys the immune system and causes the infected person to become susceptible to a number of infections. The most common infections seen in HIV/AIDS patients include herpes, tuberculosis, oral or vaginal yeast infections, lymphoma and pneumonia. Some symptoms that occur with HIV infection include fever, flu, swollen glands, sweats, weakness and chills. Impact: Although American Indians and Alaska Natives represent less than 1% of reported HIV/AIDS cases, the estimated rate of HIV/AIDS among AI/AN rose from 9.5 cases/100,000 in 2001 to 11.1 cases/100,000 in The estimated rate of HIV/AIDS for all ethnicities in the U.S. decreased from 22.8 cases/100,000 in 2001 to 20.7 cases/100,000 in Risk Factors: The risk of HIV infection increases with behaviors such as having unprotected sex, having multiple sex partners, using/sharing needles during injection drug use and getting tattoos or body piercings with non-sterile equipment. Women can transmit the infection to their babies during pregnancy and nursing mothers can transmit the infection through their breast milk. Prevention: Abstinence is a guaranteed way to prevent HIV infection through sexual contact. In addition, using condoms during sex, not sharing needles for injection drug use, making sure tattoo/piercing equipment is sterile and getting tested are ways to prevent and reduce the risk of HIV infection and transmission. References: Centers for Disease Control and Prevention. HIV/AIDS Prevention Homepage: Accessed July 25, Tribal Epidemiology Center 83

92 American Indians in Utah: Selected Health Data Prevalence Rate of HIV Infections Graph 1 and Table 1 show the prevalence rate of HIV infections in the IHS Phoenix Area patient population in Utah between 2000 and The prevalence rate remained steady at 21 cases/100,000 in 2000 and 2001, and then apparently increased to 42 cases/100,000 in The rate returned to approximately 21 cases/100,000 in 2003 and These findings are based on a very small number of cases, and should be interpreted with caution. Graph 1: Prevalence rate of HIV infections in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 84 Inter Tribal Council of Arizona, Inc.

93 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of HIV infections in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 85

94 American Indians in Utah: Selected Health Data Gender and HIV Graph 2 and Table 2 show the gender distribution of HIV cases among IHS Phoenix Area patients in Utah between 2000 and With the exception of 2002, males accounted for 100.0% of HIV infections for all years between 2000 and There was an equal gender distribution of HIV cases in These findings are based on a very small number of cases, and should be interpreted with caution. Graph 2: Gender distribution of HIV cases among IHS Phoenix Area patients in Utah by year, Male Female 80 Percent of Annual Cases Year 86 Inter Tribal Council of Arizona, Inc.

95 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of HIV cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual Percent IHS Phoenix Area HIV Cases in Utah Males 90.0 Females 10.0 All Tribal Epidemiology Center 87

96 American Indians in Utah: Selected Health Data Age and HIV Graph 3 and Table 3 show the age distributions of HIV cases among IHS Phoenix Area patients in Utah for the years combined. Most of the HIV cases during this time period were between the ages of (83.3%). The second largest age category was the age group, which accounted for 16.7% of HIV cases. These findings are based on a very small number of cases, and should be interpreted with caution. Graph 3: Age distribution of HIV cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 88 Inter Tribal Council of Arizona, Inc.

97 Section 6: Federal Data Indian Health Service Table 3: Age distribution of HIV cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area HIV Cases in Utah % % % % % % % Tribal Epidemiology Center 89

98 American Indians in Utah: Selected Health Data 90 Inter Tribal Council of Arizona, Inc.

99 Section 6: Federal Data Indian Health Service Chronic Liver Diseases/Cirrhosis Definition: Chronic liver diseases are disorders in which liver tissue is irreversibly damaged or destroyed over time. The most common form of chronic liver disease is cirrhosis. Cirrhosis is characterized by the development of scar tissues following damage to the liver; these scar tissues block blood flow through the liver, and impair the liver s ability to process nutrients and eliminate drugs and toxins from the blood. Causes of liver diseases and cirrhosis: Liver damage due to alcohol abuse is the most common cause of cirrhosis. Other causes include infections (such as viral hepatitis infections), exposure to drugs or chemicals, obstructions in blood flow to the liver, autoimmune diseases, diabetes and malnutrition. Symptoms and complications: The damage caused by cirrhosis is irreversible. Common symptoms include fatigue, loss of appetite, weight loss, vomiting, swelling and abdominal pain. Complications associated with liver disease include jaundice, gallstones, kidney failure and liver cancer. Impact: An estimated 20,300 individuals die from chronic liver diseases in the United States each year, and an additional 360,000 are hospitalized each year for cirrhosis. In 2002, the mortality rate for chronic liver diseases was 9.5 deaths/100,000 population. Chronic liver diseases and cirrhosis are the sixth leading cause of death for American Indians. Risk Factors: Factors associated with increased risk for liver disease include chronic alcohol abuse, chronic hepatitis infection, blocked bile ducts, certain hereditary diseases and age. Prevention: The risk of liver disease can be reduced by reducing or stopping alcohol use, not using or sharing needles for injection drug use (reduces risk of hepatitis infection), getting vaccinated for hepatitis and maintaining a healthy diet. References: Brigham and Women s Hospital. Health Information: Risk factors for Cirrhosis. 20Factors%20for%20Cirrhosis. Accessed July 25 th, Centers for Disease Control and Prevention. Office of Minority Health. American Indian and Alaska Native Populations. Accessed July 25 th, National Institute of Diabetes and Digestive and Kidney Diseases. Accessed July 25 th, Tribal Epidemiology Center 91

100 American Indians in Utah: Selected Health Data Prevalence Rate of Liver Diseases Graph 1 and Table 1 show the prevalence rate of liver diseases in the IHS Phoenix Area patient population in Utah between 2000 and The prevalence rate of liver diseases sharply increased between 2000 and 2002, and showed signs of leveling in The rate then decreased in The prevalence rate of liver diseases increased by 73.9% overall during the five-year period, from 359 cases/100,000 in 2000 to 623 cases/100,000 in Graph 1: Prevalence rate of Liver Diseases in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 92 Inter Tribal Council of Arizona, Inc.

101 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of Liver Diseases in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 93

102 American Indians in Utah: Selected Health Data Gender and Liver Disease Graph 2 and Table 2 show the gender distribution of liver disease cases among IHS Phoenix Area patients in Utah between 2000 and On average, males accounted for 58.5% of annual cases during this time period, and made up the majority of liver disease cases between 2001 and On average, females accounted for 41.5% of annual cases between 2000 and The percentage of cases who were female decreased between 2000 and 2002, but then increased to account for 50.0% of all cases in Graph 2: Gender distribution of Liver Disease cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 94 Inter Tribal Council of Arizona, Inc.

103 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Liver Disease cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent IHS Phoenix Area Liver Disease Cases in Utah Males Females All Tribal Epidemiology Center 95

104 American Indians in Utah: Selected Health Data Age and Liver Disease Graph 3 and Table 3 show the age distribution of liver disease cases among IHS Phoenix Area patients in Utah for the years combined. The majority (86.1%) of all liver disease cases were between the ages of Of these cases, 38.2% were between the ages of 25-44, while 47.9% were between the ages of Graph 3: Age distribution of Liver Disease cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 96 Inter Tribal Council of Arizona, Inc.

105 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Liver Disease cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area Liver Disease Cases in Utah % % % % % % % Tribal Epidemiology Center 97

106 American Indians in Utah: Selected Health Data Alcohol-Related Liver Diseases Graph 4 and Table 4 show the prevalence rate of alcohol-related liver disease in the IHS Phoenix Area patient population in Utah. The prevalence rate of alcohol-related liver disease followed a similar trend to the rate of all liver diseases in this patient population (Graph 1 on page 92). The rate steadily increased between 2000 and 2003, and then decreased to 394 cases/100,000 population in The rate increased by 55.1% overall during the five-year period. Graph 4: Prevalence rate of Alcohol-Related Liver Diseases in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 98 Inter Tribal Council of Arizona, Inc.

107 Section 6: Federal Data Indian Health Service Table 4: Prevalence rate (cases/100,000 patient population) of Alcohol-Related Liver Diseases in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 99

108 American Indians in Utah: Selected Health Data 100 Inter Tribal Council of Arizona, Inc.

109 Section 6: Federal Data Indian Health Service Mental Health Disorders Definition: Mental health disorders are illnesses that disrupt the emotional, cognitive or behavioral health of an individual. These disorders can affect a person s ability to cope with everyday life by disrupting the way they think, feel, respond to situations and interact with other individuals. Some common mental disorders include depression, anxiety, schizophrenia, obsessive-compulsive disorders, eating disorders, autism and attention-deficit disorder. Mental illnesses can be caused by a combination of biological and environmental factors. The severity of mental illness often varies by person, and can also change during an individual s lifetime. The mental illnesses that are presented in this section, depression and anxiety disorders, are described in the table below. Name Symptoms Causes Depression - Persistent feelings of sadness, hopelessness or guilt; loss of interest in normal activities; difficulty thinking or concentrating; changes in sleep or appetite. These feelings interfere with everyday life over an extended period of time. - Combination of biological, environmental and psychological factors - Chemical imbalances in neurotransmitters and genetic predisposition have been identified as possible factors Anxiety - Persistent feelings of fearfulness, uncertainty, panic, unsettling thoughts, obsessive or compulsive behaviors - Combination of biological, environmental and psychological factors - Can result from past trauma (PTSD) Impact: Mental disorders are the leading cause of disability in the United States. An estimated 9.9 million adults suffer from depression each year, while an estimated 40 million adults (18.0% of the adult population) suffer from an anxiety disorder each year. Women have a higher prevalence of psychological distress than men (12.0% compared to 7.7% in 2004). The prevalence of depression among American Indians/Alaska Natives is estimated to be 8.0% of the adult population (compared to 8.5% for whites and 7.2% for blacks). Individuals who suffer from mental disorders are more likely to use illicit drugs; 27.6% of adults who suffered from psychological distress also reported using illicit drugs during the past year (vs. 11.8% of those who did not have any psychological distress). Treatment and Prevention: Most mental disorders, including depression and anxiety, are treated using a combination of medication and behavioral or cognitive therapy. Early detection and treatment often can prevent the progression of some mental illnesses. Other ways to minimize the effects of mental illness in everyday living include minimizing alcohol and drug use, eating a healthy diet and being physically active. References: National Alliance on Mental Illnesses. Accessed July 25 th, National Institute of Mental Health. Accessed July 25 th, Substance Abuse and Mental Health Services Administration. Office of Applied Statistics National Survey on Drug Use and Health: 2k4NSDUH/2k4results/2k4results.htm#ch8. Accessed July 25 th, Tribal Epidemiology Center 101

110 American Indians in Utah: Selected Health Data Prevalence Rate of Depression/Affective Disorders Graph 1 and Table 1 show the prevalence rate of depression/affective disorders in the IHS Phoenix Area patient population in Utah for the years The prevalence rate of depression/affective disorders in this patient population steadily increased between 2000 and The rate increased by 45.2% during this five year period, from 7,465 cases/100,000 in 2000 to 10,837 cases/100,000 in Graph 1: Prevalence rate of Depression/Affective Disorders in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 102 Inter Tribal Council of Arizona, Inc.

111 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of Depression/Affective Disorders in the IHS Phoenix Area patient population in Utah by year, Population Average Annual Rate IHS Phoenix Area Patient Population in Utah 7,465 8,754 9,392 10,545 10,837 9,399 Tribal Epidemiology Center 103

112 American Indians in Utah: Selected Health Data Gender and Depression/Affective Disorders Graph 2 and Table 2 show the gender distribution of Depression/Affective Disorder cases among IHS Phoenix Area patients in Utah for the years Females accounted for the majority of depression/affective disorder cases. On average, females accounted for 68.1% of annual cases, while males accounted for 31.9% of annual cases. The percentage of depression/affective disorder cases who were female appeared to be increasing over time (65.2% of all cases in 2000 compared to 69.3% of all cases in 2004). Graph 2: Gender distribution of Depression/Affective Disorder cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 104 Inter Tribal Council of Arizona, Inc.

113 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Depression/Affective Disorder cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent IHS Phoenix Area Depression / Affective Disorder Cases in Utah Males Females All Tribal Epidemiology Center 105

114 American Indians in Utah: Selected Health Data Age and Depression/Affective Disorders Graph 3 and Table 3 show the age distribution of depression/affective disorder cases among IHS Phoenix Area patients in Utah for the years combined. The largest percentage of depression/affective disorder cases were between the ages of (40.6% of all cases). Patients between the ages of accounted for the second largest percentage of cases (26.3%), followed by the age group (21.8%). Graph 3: Age distribution of Depression/Affective Disorder cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 106 Inter Tribal Council of Arizona, Inc.

115 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Depression/Affective Disorder cases among IHS Phoenix Area patients in Utah, combined. Age Group Age Distribution (Percent of All Cases) IHS Phoenix Area Depression/Affective Disorder Cases in Utah % % % % % % % Tribal Epidemiology Center 107

116 American Indians in Utah: Selected Health Data Prevalence Rate of Anxiety Graph 4 and Table 4 show the prevalence rate of anxiety in the IHS Phoenix Area patient population in Utah for the years The prevalence rate of anxiety steadily increased between 2000 and 2002, dropped slightly in 2003, and then increased in Overall, the rate of anxiety increased by 39.6% during the five-year period, from 3,108 cases/100,000 in 2000 to 4,339 cases/100,000 in Graph 4: Prevalence rate of Anxiety in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 108 Inter Tribal Council of Arizona, Inc.

117 Section 6: Federal Data Indian Health Service Table 4: Prevalence rate (cases/100,000 patient population) of Anxiety in the IHS Phoenix Area patient population in Utah by year, Population Average Annual Rate IHS Phoenix Area Patient Population in Utah 3,108 3,933 4,456 3,916 4,339 3,950 Tribal Epidemiology Center 109

118 American Indians in Utah: Selected Health Data Gender and Anxiety Graph 5 and Table 5 show the gender distribution of anxiety cases among IHS Phoenix Area patients in Utah for the years The majority of anxiety cases were female. On average, females accounted for 74.2% of annual cases, while males accounted for 25.8% of annual cases. Graph 5: Gender distribution of Anxiety cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 110 Inter Tribal Council of Arizona, Inc.

119 Section 6: Federal Data Indian Health Service Table 5: Gender distribution of Anxiety cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent Males IHS Phoenix Area Anxiety Cases in Utah Females All Tribal Epidemiology Center 111

120 American Indians in Utah: Selected Health Data Age and Anxiety Graph 6 and Table 6 show the age distribution of anxiety cases among IHS Phoenix Area patients in Utah for the years combined. The majority of anxiety cases were between the ages of (47.4% of all cases). Patients between the ages of accounted for the second largest percentage of cases (29.8%), followed by the age group (14.9%). Graph 6: Age distribution of Anxiety cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 112 Inter Tribal Council of Arizona, Inc.

121 Section 6: Federal Data Indian Health Service Table 6: Age distribution of Anxiety cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area Anxiety Cases in Utah % % % % % % % Tribal Epidemiology Center 113

122 American Indians in Utah: Selected Health Data 114 Inter Tribal Council of Arizona, Inc.

123 Section 6: Federal Data Indian Health Service Sexually Transmitted Diseases (STDs) Definition: Sexually transmitted diseases (STDs) are viral or bacterial diseases that are spread through sexual contact. Many STDs also can be transmitted from mother to child during childbirth. Bacterial STDs can be cured with antibiotics; viral STDs cannot be cured. The table below summarizes the symptoms/complications and the epidemiologic burden for the most common STDs in the United States. Name Symptoms/Complications Burden Chlamydia (Bacterial: Chlamydia trachomatis) Gonorrhea (Bacterial: Neisseria gonorrhea) Syphilis (Bacterial: Treponema pallidum) Non-congenital: spread through sexual contact Congenital: Motherto-child transmission during pregnancy Symptoms: Often no symptoms in men; discharge from vagina/penis, burning during urination, bleeding between periods in women Complications: In women, pelvic inflammation, chronic pelvic pain, infertility; in men and women, increased risk of HIV infection/transmission Symptoms: Often no symptoms; discharge from vagina/penis, burning during urination Complications: Pelvic inflammation, chronic pelvic pain, infertility in men and women, increased risk of HIV infection/transmission Symptoms: Often no symptoms for many years; primary stage characterized by appearance of sores at site of infection; secondary stage characterized by skin rash/ lesions, fever, fatigue and muscle aches Complications: If left untreated, can progress to late stage, characterized by damage to internal organs/nervous system and death; increased risk of HIV infection/ transmission Most commonly reported bacterial STD in the U.S. Estimated 2.8 million new cases in U.S. each year Reported rate in 2004 for all ethnicities: cases/100,000 population Reported rate in 2004 for AI/AN: cases/100,000 population Estimated 700,000 new cases in U.S. each year Reported rate in 2004 for all ethnicities: cases/100,000 population Reported rate in 2004 for AI/AN: cases/100,000 population Data on primary and secondary syphilis: Reported rate in 2004 for all ethnicities: 2.8 cases/100,000 population Reported rate in 2004 for AI/AN: 3.2 cases/100,000 population Risk Factors: The risk of becoming infected with an STD increases with behaviors such as having unprotected sex and having multiple sex partners. Prevention: Abstinence is a guaranteed way to prevent STD infections. In addition, using latex condoms during sex and being screened regularly for STDs are ways to prevent and reduce the risk of infection and transmission. References: Centers for Disease Control and Prevention. Sexually Transmitted Diseases Webpage: Accessed July 25 th, Tribal Epidemiology Center 115

124 American Indians in Utah: Selected Health Data Prevalence Rate of STDs Graph 1 and Table 1 show the prevalence rate of sexually transmitted diseases (STDs) in the IHS Phoenix Area patient population in Utah for the years The prevalence rate of STDs in this patient population rose sharply between 2000 and 2001, steadily decreased between 2001 and 2003, and then increased slightly in The rate of STDs increased by 68.2% overall during the five-year period, from 148 cases/100,000 in 2000 to 249 cases/100,000 in These findings should be interpreted with caution, since they are based on a relatively small number of cases. Graph 1: Prevalence rate of STDs in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 116 Inter Tribal Council of Arizona, Inc.

125 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of STDs in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 117

126 American Indians in Utah: Selected Health Data Gender and STDs Graph 2 and Table 2 show the gender distribution of STD cases among IHS Phoenix Area patients in Utah for the years There were no consistent trends in the gender distribution of STD cases between 2000 and 2004, though on average females accounted for the majority of cases during this time period. On average, females accounted for 60.3% of annual cases, while males accounted for 39.7% of annual cases. These findings should be interpreted with caution, since they are based on a small number of cases. Graph 2: Gender distribution of STD cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 118 Inter Tribal Council of Arizona, Inc.

127 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of STD cases among IHS Phoenix Area patients in Utah by year, Population Gender N % N % N % N % N % Total N ( ) Average Annual Percent Males * 57.1 * 28.6 * 33.3 * 54.5 * IHS Phoenix Area STD Cases in Utah Females * 42.9 * 71.4 * 66.7 * 45.5 * All * * * * * * The number of cases or the sample size fell below an acceptable limit to report in this category. Tribal Epidemiology Center 119

128 American Indians in Utah: Selected Health Data Age and STDs Graph 3 and Table 3 show the age distribution of STD cases among IHS Phoenix Area patients in Utah for the years combined. The majority of STD cases were in the younger age groups, with 46.4% of all cases between the ages of 15-24, and 32.1% of all cases between the ages of These findings should be interpreted with caution, since they are based on a small number of cases. Graph 3: Age distribution of STD cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 120 Inter Tribal Council of Arizona, Inc.

129 Section 6: Federal Data Indian Health Service Table 3: Age distribution of STD cases among IHS Phoenix Area patients in Utah, combined. Age Distribution (Percent of All Cases) Age Group IHS Phoenix Area STD Cases in Utah % % % % % % % Tribal Epidemiology Center 121

130 American Indians in Utah: Selected Health Data Chlamydia Graph 4 and Table 4 show the prevalence rate of chlamydia infections in the IHS Phoenix Area patient population in Utah for the years The prevalence rate of chlamydia infections in this patient population apparently rose sharply between 2000 and 2002, and then declined to approximately 20 cases/100,000 in 2003 and These rates should be interpreted with caution, since they are based on a very small number of cases and are likely unstable. Graph 4: Prevalence rate of Chlamydia Infections in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 122 Inter Tribal Council of Arizona, Inc.

131 Section 6: Federal Data Indian Health Service Table 4: Prevalence rate (cases/100,000 patient population) of Chlamydia Infections in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 123

132 American Indians in Utah: Selected Health Data Gonococcal Infections Graph 5 and Table 5 show the prevalence rate of gonococcal infections in the IHS Phoenix Area patient population in Utah for the years The rate of gonococcal infections apparently increased between 2000 and The rate increased from 21 cases/100,000 in 2000 to 62 cases/100,000 in 2004, representing a 195.2% increase during the five-year period. These findings should be interpreted with caution, as they are based on a very small number of cases. Graph 5: Prevalence rate of Gonococcal Infections in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 124 Inter Tribal Council of Arizona, Inc.

133 Section 6: Federal Data Indian Health Service Table 5: Prevalence rate (cases/100,000 patient population) of Gonococcal Infections in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 125

134 American Indians in Utah: Selected Health Data Non-Congenital Syphilis Graph 6 and Table 6 show the prevalence rate of non-congenital syphilis in the IHS Phoenix Area patient population in Utah for the years There has been an apparent increase in the prevalence rate of non-congenital syphilis infections in this patient population. The rate increased from 0 cases/100,000 in 2000 to 62 cases/100,000 in However, this rate is based on a very small number of cases and is likely unstable. Graph 6: Prevalence rate of Non-Congenital Syphilis Infections in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 126 Inter Tribal Council of Arizona, Inc.

135 Section 6: Federal Data Indian Health Service Table 6: Prevalence rate (cases/100,000 patient population) of Non-Congenital Syphilis Infections in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 127

136 American Indians in Utah: Selected Health Data 128 Inter Tribal Council of Arizona, Inc.

137 Section 6: Federal Data Indian Health Service Substance Abuse Definition: Substance abuse refers to the overuse or improper use of stimulants or depressants, including illicit drugs, alcohol, tobacco products and prescription or over-thecounter drugs. Individuals can become dependent or addicted to these substances through repeated use. Substance abuse often can adversely affect an individual s mental and overall health and well-being, and also can have detrimental effects on the greater society. Impact: The National Survey on Drug Use and Health (NSDUH) is used to collect data on alcohol and drug use/abuse among persons aged 12 years or older. Data from the NSDUH survey show that a smaller percentage of American Indians and Alaska Natives (AI/AN) reported past year alcohol use compared to members of other racial/ethnic groups (60.8% compared to 65.8%). However, a larger percentage of AI/AN reported past year alcohol use disorder (10.7% compared to 7.6% for other racial/ethnic groups). Data from the show that AI/AN have higher rates of illicit drug use compared to other racial/ ethnic groups. A larger percentage of AI/AN aged 12 years or older reported past year illicit drug use (18.4% compared to 14.6%) and past year illicit drug use disorder (5.0% compared to 2.9%). The following table highlights the most common substances that are abused in the U.S., as well as the reported number and percentage of individuals aged 12 or older who reported using these substances in Substance American Indian/Alaska Native U.S. Alcohol* 435 (33.5%) 71,414 (29.7%) Tobacco 538 (41.5%) 83,066 (34.5%) Marijuana 230 (17.7%) 25,451 (10.6%) Cocaine 43 (3.3%) 5,658 (2.4%) Opioids (Heroin) Data not available 398 (0.2%) Methamphetamine Data not available 1,440 (0.6%) *Binge alcohol use or heavy alcohol use. References: Substance Abuse and Mental Health Administration. Office of Applied Statistics. Accessed July 25 th, Substance Abuse and Mental Health Administration. Alcohol and drug information: American Indians and Alaska Natives. Accessed July 25 th, Substance Abuse and Mental Health Administration. Substance use and substance use disorders among American Indians and Alaska Natives: Data from the NSDUH Survey. Accessed February 14 th, Tribal Epidemiology Center 129

138 American Indians in Utah: Selected Health Data Prevalence Rate of Substance Abuse Related Conditions Graph 1 and Table 1 show the prevalence rate of substance abuse related conditions in the IHS Phoenix Area patient population in Utah for the years The rate of substance abuse related conditions in this patient population steadily increased between 2000 and After reaching a peak of 8,226 cases/100,000 in 2000, the rate decreased to 6,228 cases/100,000 in Graph 1: Prevalence rate of Substance Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 130 Inter Tribal Council of Arizona, Inc.

139 Section 6: Federal Data Indian Health Service Table 1: Prevalence rate (cases/100,000 patient population) of Substance Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 5,308 6,703 8,226 7,240 6,228 6,741 Tribal Epidemiology Center 131

140 American Indians in Utah: Selected Health Data Gender and Substance Abuse Graph 2 and Table 2 show the gender distribution of patients who sought care for substance abuse related conditions among IHS Phoenix Area patients in Utah for the years The majority of substance abuse cases were male. On average, males accounted for 59.5% of annual cases, while female accounted for 40.5% of annual cases. Graph 2: Gender distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah by year, Male Female Percent of Annual Cases Year 132 Inter Tribal Council of Arizona, Inc.

141 Section 6: Federal Data Indian Health Service Table 2: Gender distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah by year, Population Gender Average Annual N % N % N % N % N % Percent IHS Phoenix Area Substance Abuse Cases in Utah Males Females All Tribal Epidemiology Center 133

142 American Indians in Utah: Selected Health Data Age and Substance Abuse Graph 3 and Table 3 show the age distribution of substance abuse cases among IHS Phoenix Area patients in Utah for the years combined. The majority of substance abuse cases were between the ages of years of age (46.1% of all cases). A relatively large percentage of substance abuse cases fell into the younger age groups: 28.4% of all cases were between years of age, and 3.5% of all cases were less than 15 years of age. Graph 3: Age distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah, combined Percent of All Cases Age Group 134 Inter Tribal Council of Arizona, Inc.

143 Section 6: Federal Data Indian Health Service Table 3: Age distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah, combined. Age Group Age Distribution (Percent of All Cases) IHS Phoenix Area Substance Abuse Cases in Utah % % % % % % % Tribal Epidemiology Center 135

144 American Indians in Utah: Selected Health Data Alcohol Abuse Graph 4 and Table 4 show the prevalence rate of alcohol abuse related conditions in the IHS Phoenix Area patient population in Utah for the years Between 2000 and 2002, the rate of alcohol abuse related conditions rose to a peak of 4,706 cases/100,000. The rate then decreased to a low of 3,072 cases/100,000 in Graph 4: Prevalence rate of Alcohol Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 136 Inter Tribal Council of Arizona, Inc.

145 Section 6: Federal Data Indian Health Service Table 4: Prevalence rate (cases/100,000 patient population) of Alcohol Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 3,405 3,827 4,706 4,181 3,072 3,838 Tribal Epidemiology Center 137

146 American Indians in Utah: Selected Health Data Tobacco Dependence Graph 5 and Table 5 show the prevalence rate of tobacco dependence related conditions in the IHS Phoenix Area patient population in Utah for the years The rate of tobacco dependence related conditions in this patient population steadily rose between 2000 and 2002, and reached a peak of 1,978 cases/100,000 in The rate then decreased to 1,599 cases/100,000 in The rate increased by 80.1% overall during the five year period, from 888 cases/100,000 in 2000 to 1,599 cases/100,000 in Graph 5: Prevalence rate of Tobacco Dependence related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 138 Inter Tribal Council of Arizona, Inc.

147 Section 6: Federal Data Indian Health Service Table 5: Prevalence rate (cases/100,000 patient population) of Tobacco Dependence related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate 888 1,649 1,978 1,611 1,599 1,545 Tribal Epidemiology Center 139

148 American Indians in Utah: Selected Health Data Amphetamine Abuse Graph 6 and Table 6 show the prevalence rate of amphetamine abuse related conditions in the IHS Phoenix Area patient population in Utah for the years The rate fluctuated between 2000 and 2002, and then rose sharply between 2002 and The rate apparently increased from 63 cases/100,000 in 2000 to 208 cases/100,000 in However, these findings are based on a very small number of cases, and should be interpreted with caution. Graph 6: Prevalence rate of Amphetamine Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 140 Inter Tribal Council of Arizona, Inc.

149 Section 6: Federal Data Indian Health Service Table 6: Prevalence rate (cases/100,000 patient population) of Amphetamine Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 141

150 American Indians in Utah: Selected Health Data Cannabis Abuse Graph 7 and Table 7 show the prevalence rate of cannabis abuse related conditions in the IHS Phoenix Area patient population in Utah for the years The rate showed large fluctuations between 2000 and After reaching a peak of 396 cases/100,000 in 2002, the rate decreased to 270 cases/100,000 in The rate decreased by 24.8% overall during the five year period, from 359 cases/100,000 in 2000 to 270 cases/100,000 in The instability in the rate may be due to a relatively small number of cases. Graph 7: Prevalence rate of Cannabis Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 142 Inter Tribal Council of Arizona, Inc.

151 Section 6: Federal Data Indian Health Service Table 7: Prevalence rate (cases/100,000 patient population) of Cannabis Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 143

152 American Indians in Utah: Selected Health Data Cocaine Abuse Graph 8 and Table 8 show the prevalence rate of cocaine abuse related conditions in the IHS Phoenix Area patient population in Utah for the years The rate sharply increased from 85 cases/100,000 in 2000 to 167 cases/100,000 in 2002, and remained fairly steady between 2002 and The rate increased by 95.2% between 2000 and These findings are based on a small number of cases, and should be interpreted with caution. Graph 8: Prevalence rate of Cocaine Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 144 Inter Tribal Council of Arizona, Inc.

153 Section 6: Federal Data Indian Health Service Table 8: Prevalence rate (cases/100,000 patient population) of Cocaine Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 145

154 American Indians in Utah: Selected Health Data Opioid Abuse Graph 9 and Table 9 show the prevalence rate of opioid abuse related conditions in the IHS Phoenix Area patient population in Utah for the years The rate increased sharply to a high of 106 cases/100,000 in 2001, and then decreased to 42 cases/100,000 in The large fluctuations in the rate are likely due to a small number of cases. Graph 9: Prevalence rate of Opioid Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Prevalence Rate (Cases per 100,000 population) Year 146 Inter Tribal Council of Arizona, Inc.

155 Section 6: Federal Data Indian Health Service Table 9: Prevalence rate (cases/100,000 patient population) of Opioid Abuse related conditions in the IHS Phoenix Area patient population in Utah by year, Population IHS Phoenix Area Patient Population in Utah Average Annual Rate Tribal Epidemiology Center 147

156 American Indians in Utah: Selected Health Data Gender and Drug Type Graph 10 and Table 10 show the gender distribution of substance abuse cases by drug type among IHS Phoenix Area patients in Utah for the years combined. Males accounted for a larger percentage of all alcohol, cannabis and cocaine cases (66.6%, 70.3% and 57.1% respectively). There was an equal gender distribution for amphetamine cases. Females accounted for the majority of opioid and tobacco cases (53.3% and 55.5% respectively). Graph 10: Gender distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah by drug type, combined. 80 Male Female Percent of Cases Alcohol Amphetamines Cannabis Cocaine Opioids Tobacco Drug Type 148 Inter Tribal Council of Arizona, Inc.

157 Section 6: Federal Data Indian Health Service Table 10: Gender distribution of Substance Abuse cases among IHS Phoenix Area patients in Utah by drug type, combined. Population Gender Alcohol Amphetamines Cannabis Cocaine Opioids Tobacco IHS Phoenix Area Substance Abuse Cases in Utah* Males 66.6% 50.0% 70.3% 57.1% 46.7% 44.5% Females 33.4% 50.0% 29.7% 42.9% 53.3% 55.5% *Percents based on average of annual prevalent cases. Tribal Epidemiology Center 149

158 American Indians in Utah: Selected Health Data 150 Inter Tribal Council of Arizona, Inc.

159 Section 7: State Data Office of Vital Records and Statistics (Utah Department of Health)

160 American Indians in Utah: Selected Health Data 152 Inter Tribal Council of Arizona, Inc.

161 Section 7: State Data Utah Department of Health Mortality Tribal Epidemiology Center 153

162 American Indians in Utah: Selected Health Data Number of Deaths Graph 1a and Table 1 show the number of deaths by year for American Indians in Utah between 2000 and There were a total of 590 deaths among American Indians in Utah during this five-year period. Graph 1b and Table 1 show the number of deaths by year for all Utah residents between 2000 and There were a total of 64,599 deaths among all Utah residents during this five-year period. Graph 1a: Total number of deaths among American Indians in Utah by year, Number of Deaths Year Graph 1b: Total number of deaths among all Utah residents by year, Number of Deaths Year 154 Inter Tribal Council of Arizona, Inc.

163 Section 7: State Data Utah Department of Health Table 1: Total number of deaths among American Indians in Utah and all Utah residents by year, Number of Deaths Total American Indians in Utah All Utah residents 12,339 12,607 13,042 13,341 13,270 64,599 Tribal Epidemiology Center 155

164 American Indians in Utah: Selected Health Data Mortality Rate Graph 2 and Table 2 show the mortality rates by year for American Indians in Utah and all Utah residents between 2000 and The mortality rate for American Indians in Utah increased from deaths/100,000 in 2000 to a high of deaths/100,000 in The rate then decreased to deaths/100,000 in The mortality rate for all Utah residents remained fairly steady between 2000 and 2004, with an average annual rate of deaths/100,000. The mortality rate for American Indians in Utah was lower compared to the rate for all Utah residents for all five years. The average annual mortality rate for American Indians was deaths/100,000 compared to deaths/100,000 for all Utah residents. Graph 2: Mortality rates for American Indians in Utah and all Utah residents by year, AI in Utah Utah Mortality Rate (Deaths per 100,000 population) Year 156 Inter Tribal Council of Arizona, Inc.

165 Section 7: State Data Utah Department of Health Table 2: Mortality rates (deaths/100,000 population) for American Indians in Utah and all Utah residents by year, Mortality Rate American Indians in Utah Average Annual Rate All Utah residents Tribal Epidemiology Center 157

166 American Indians in Utah: Selected Health Data Gender Distribution Graph 3a and Table 3 show the gender distribution of deaths among American Indians in Utah for the years Males accounted for at least 50.0% of annual deaths for all years. On average, males accounted for 53.5% of annual deaths in this population, while females accounted for 46.5% of annual deaths. The gender distribution of deaths among all Utah residents showed a similar distribution (Graph 3b and Table 3). On average, males accounted for 50.3% of annual deaths in this population, while females accounted for 49.7% of annual deaths. Graph 3a: Gender distribution of deaths among American Indians in Utah by year, AI Males AI Females Percent of Annual Deaths Year Percent of Annual Death s Graph 3b: Gender distribution of deaths among all Utah residents by year, Year Utah Males Utah Females 158 Inter Tribal Council of Arizona, Inc.

167 Section 7: State Data Utah Department of Health Table 3: Gender distribution of deaths among American Indians in Utah and all Utah residents by year, Population Gender Average Annual N % N % N % N % N % Percent Males American Indians in Utah Females All Males 6, , , , , All Utah Residents Females 6, , , , , All 12, , , , , Tribal Epidemiology Center 159

168 American Indians in Utah: Selected Health Data Age Distribution Chart 1 and Table 4 show the age distribution of deaths among American Indians in Utah for the years The largest number of deaths occurred in the age group (27.1% of all deaths). The second largest number of deaths occurred in the 75+ age group (24.9%), followed by the age group (21.4%). Chart 1: Age distribution of deaths among American Indians in Utah, combined % % % % % % % 160 Inter Tribal Council of Arizona, Inc.

169 Section 7: State Data Utah Department of Health Table 4: Age distribution of deaths among American Indians in Utah by year, Age Group Total N % N % N % N % N % N % Total Tribal Epidemiology Center 161

170 American Indians in Utah: Selected Health Data Comparison of Age Distributions of Deaths Graph 4 and Table 5 compare the age distributions of deaths for American Indians in Utah and all Utah residents for the years combined. American Indians in Utah died at a younger age compared to all Utah residents during this time period. The largest percentage of deaths among American Indians occurred in the age group (27.1%), while the largest percentage of deaths among all Utah residents occurred in the 75+ age group (57.1%). The majority of deaths among American Indians occurred before the age of 65 (66.3% of all deaths, with 3.6% in the 0-4 age group, 1.4% in the 5-14 age group, 7.1% in the age group, 21.4% in the age group and 27.1% in the age group). In comparison, 27.8% of deaths among all Utah residents occurred before the age of 65 (2.4% in the 0-4 age group, 0.5% in the 5-14 age group, 2.2% in the age group, 6.6% in the age group and 16.1% in the age group). Graph 4: Comparison of age distributions of deaths for American Indians in Utah and all Utah residents, combined. 70 AI in Utah Utah Percent of Deaths Age Group *Comment: The age groups presented in Graph 4 and Table 5 are categorized, or divided, in order to represent different basic stages of life (i.e. infant and toddler, youth, teens and young adults). All of the age groups do not consist of the same number of years. For example, the year age group includes ten years, while the year age group includes 20 years. Therefore, the age groups should not be directly compared to each other and should be interpreted with caution. A suitable way to obtain information from the data is to compare the age group of American Indians in Utah to the same age group of Utah state residents. The narrative above provides examples. 162 Inter Tribal Council of Arizona, Inc.

171 Section 7: State Data Utah Department of Health Table 5: Comparison of age distributions of deaths for American Indians in Utah and all Utah residents, combined. Age Group American Indians in Utah % (N = 590) All Utah Residents % (N = 64,588) % 2.4% % 0.5% % 2.2% % 6.6% % 16.1% % 15.2% % 57.1% Total 100.0% 100.0% Tribal Epidemiology Center 163

172 American Indians in Utah: Selected Health Data Deaths due to Unnatural Causes Graph 5 and Table 6 show the percentage of deaths that occurred due to unnatural causes among American Indians in Utah and all Utah residents for the years A higher percentage of deaths among American Indians in Utah were due to unnatural causes compared to all Utah residents (21.4% compared to 9.7%). The percentage of deaths due unnatural causes among American Indians decreased from 28.3% in 2000 to 17.6% in 2002, and then increased to 23.4% in The percentage of deaths due unnatural causes among all Utah residents increased from 9.5% in 2000 to 10.3% in Graph 5: Percent of deaths due to Unnatural Causes among American Indians in Utah and all Utah residents by year, AI in Utah Utah Percent of Annual Deaths Year 164 Inter Tribal Council of Arizona, Inc.

173 Section 7: State Data Utah Department of Health Table 6: Percent of deaths due to Unnatural Causes among American Indians in Utah and all Utah residents by year, Population Measure Total American Indians in Utah All Utah Residents Deaths due to Unnatural Causes Total Number of Deaths Percent of Deaths due to Unnatural Causes Deaths due to Unnatural Causes Total Number of Deaths Percent of Deaths due to Unnatural Causes % 18.5% 17.6% 20.3% 23.4% 21.4% 1,168 1,141 1,256 1,339 1,373 6,277 12,339 12,607 13,042 13,341 13,270 64, % 9.1% 9.6% 10.0% 10.3% 9.7% Tribal Epidemiology Center 165

174 American Indians in Utah: Selected Health Data Gender Distribution of Deaths due to Unnatural Causes Graph 6 and Table 7 show the gender distribution of deaths due to unnatural causes among American Indians in Utah and all Utah residents for the years combined. The gender distributions for the two populations were almost identical. American Indian males accounted for 69.8% of deaths due to unnatural cases, compared to 30.2% of American Indian females. For all Utah residents, males accounted for 69.1% of deaths due to unnatural causes, compared to 30.9% of females. Graph 6: Gender distribution of deaths due to Unnatural Causes among American Indians in Utah and all Utah residents, combined Males Females Percent of all Deaths due to Unnatural Causes AI in Utah Utah Population 166 Inter Tribal Council of Arizona, Inc.

175 Section 7: State Data Utah Department of Health Table 7: Gender distribution of deaths due to Unnatural Causes among American Indians in Utah and all Utah residents, combined. Population Gender Deaths due to Unnatural Causes N % Males % American Indians in Utah Females % All % Males 4, % All Utah Residents Females 1, % All 6, % Tribal Epidemiology Center 167

176 American Indians in Utah: Selected Health Data Deaths due to Unnatural Causes Graph 7 and Table 8 show the distribution of deaths due to unnatural causes by specific cause of death among American Indians in Utah and all Utah residents for the years combined. For American Indians in Utah, motor vehicle accidents accounted for the largest percentage of deaths due to unnatural causes (39.7%). In comparison, motor vehicle accidents accounted for 24.8% of deaths due to unnatural causes for all Utah residents. A higher percentage of deaths among American Indians were due to assault compared to the general population (10.3% compared to 4.5%). Suicide accounted for a higher percentage of deaths among all Utah residents compared to American Indians in Utah (26.4% compared to 15.1%). Graph 7: Deaths due to unnatural causes among American Indians in Utah and all Utah residents, combined AI in Utah Utah Percent of all Unnatural Causes of Death Motor Vehicle Accidents Other Accidents Assault Suicide Events of undetermined Cause of Death intent 168 Inter Tribal Council of Arizona, Inc.

177 Section 7: State Data Utah Department of Health Table 8: Deaths due to unnatural causes among American Indians in Utah and All Utah residents, combined. Age Group American Indians in Utah % (N = 126) All Utah Residents % (N = 6,277) Motor Vehicle Accidents 39.7% 24.8% Other Accidents 23.0% 28.8% Assault (Homicide) 10.3% 4.5% Suicide 15.1% 26.4% Events of Undetermined Intent 11.9% 15.5% Total 100.0% 100.0% Tribal Epidemiology Center 169

178 American Indians in Utah: Selected Health Data 170 Inter Tribal Council of Arizona, Inc.

179 Appendix

180 American Indians in Utah: Selected Health Data 172 Inter Tribal Council of Arizona, Inc.

181 Appendix Table A.1: ICD-9 codes used for community health profile clinical indicators. Indicator Download Range Sub-categories Categorization in SAS Heart Failure 428 Cardiovascular Disease Cancer (Primary Malignant only; excludes secondary and benign) Hypertension Stroke Coronary Heart Disease ; Breast cancer Colon-rectal Cancer Kidney/Renal Pelvis 189 Prostate 185 Lung 162 Cervical 180 Type 2 Diabetes Last Digit = 0, 2 HIV Liver Disease Sexually Transmitted Diseases Mental Health Alcohol Related Chronic Hepatitis (non-viral) Other/Unspecified Congenital Syphilis Non-congenital Syphilis Gonococcal Infections Chlamydia trachomatis 99.41; Other STDs , ; Depression/Affective Disorder ; 311.0; 309.0; Anxiety Alcohol ; Opioid ; Substance Abuse: Dependent and Non-Dependent Use Combined Cocaine ; Cannabis ; Amphetamine ; Other/Mixed/Unspecified ; ; ; Tobacco Tribal Epidemiology Center 173

182 American Indians in Utah: Selected Health Data Appendix B.1: U.S. Census Bureau 1999 Poverty Thresholds Census 2000 asked people about their income in the previous calendar year. Poverty estimates in this CHP compared family income in 1999 with the corresponding 1999 poverty thresholds. The 1999 poverty measure has two components poverty thresholds (or income levels) and the family income that is compared with these thresholds. The thresholds take into account family size and the presence and number of family members under 18 years old. If a family s total income is less than the threshold for the family s size and composition, the family and everyone in it are considered poor. The poverty thresholds were not adjusted for regional, state, or local variation in the cost of living. 174 Inter Tribal Council of Arizona, Inc.

183 Appendix Appendix B.2: Poverty Thresholds (Annual Dollar Amounts) by Size of Family and Number of Related Children Under 18 years old, Size of family unit Weighted Average Thresholds Related children under 18 years None One Two Three Four Five Six Seven Eight or more One person (unrelated individual) 8,501 Under 65 years... 8,667 8, years and over... 7,990 7,990 Two persons 10,869 Householder under 65 years... 11,214 11,156 11,483 Householder 65 years and over... 10,075 10,070 11,440 Three persons 13,290 13,032 13,410 13,423 Four persons 17,029 17,184 17,465 16,895 16,954 Five persons 20,127 20,723 21,024 20,380 19,882 19,578 Six persons 22,727 23,835 23,930 23,436 22,964 22,261 21,845 Seven persons 25,912 27,425 27,596 27,006 26,595 25,828 24,934 23,953 Eight persons 28,967 30,673 30,944 30,387 29,899 29,206 28,327 27,412 27,180 Nine persons or more 34,417 36,897 37,076 36,583 36,169 35,489 34,554 33,708 33,499 32,208 Source: U.S. Census Bureau Tribal Epidemiology Center 175

184

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