Overview

American Indians and Alaska Natives, collectively referred to as Native Americans, have an overall injury-related death rate twice that of all racial or ethnic populations in the United States (IHS 1999).

Occurrence

*Injuries are the leading cause of death for Native Americans ages 1 to 44 and the third leading cause of death overall (CDC 2003).

*Injuries and violence account for 75% of all deaths among Native Americans ages 1 to 19 (Wallace 2000).

*Native Americans 19 years and younger are at greater risk of preventable injury-related deaths than others in the same age group in the United States. Compared with blacks and whites, this group had the highest injury-related death rates for motor vehicle crashes, pedestrian events, and suicide. Rates for these causes were two to three times greater than rates for whites the same age. During 1989-1998, injuries and violence caused the deaths of 3,314 Native American children living in Indian Health Service (IHS) areas (Wallace 2003).

Groups at Risk

*Native Americans as a group are at increased risk of injury, but Native American males are at even greater risk for many types of injuries. Compared to their female counterparts, Native American males ages 20 years and older are (CDC 2003)

*twice as likely to die from a motor vehicle crash.

*nearly four times more likely to die from pedestrian-related injury.

*nearly twice as likely to die from fire and burn injuries.

*five times more likely to drown.

*four times more likely to commit suicide.

*three times more likely to be murdered.

Injury rates among Native Americans vary between state and regional areas.

Risk Factors

*Motor vehicle crashes and pedestrian-related injury were the leading causes of unintentional injury-related death among Native American adults 20 years and older. Adult motor vehicle-related death rates for Native Americans were more than twice that of whites and almost twice that of blacks (CDC 2003).

*Adult pedestrian death rates for Native Americans were almost three and one-half times that of whites and twice that of blacks (CDC 2003).

*Fire-related death rates for Native Americans were almost two times greater than that of whites. Rates for blacks were almost twice as high as those for Native Americans (CDC 2003).

*Native American drowning rates were nearly three times that of whites and more than twice that of blacks (CDC 2003).

*Among Native Americans 19 years and younger, motor vehicle crashes were the leading cause of injury-related death, followed by suicide, homicide, drowning, and fires. Between 1989 and 1998, firearm-related death rates increased 13%; homicide increased 20%; and suicide rates remained unchanged (Wallace 2003).

Programs

Since 1985, CDC and the Indian Health Service (IHS) have had an interagency agreement. This agreement focuses on surveillance, risk factor identification, technical assistance, and prevention measures which will reduce injuries among U.S. Native Americans. This successful partnership was established in response to high rates of injury among Native American populations. It has become one of the longest-lived partnerships for CDC's Injury Center and has developed a number of activities and products:

*Native American Childhood Injury Mortality Atlas, 1989-1998. Injury staff developed a color atlas that details, by IHS regional area, eight major causes of injury-related death among Native Americans ages 0 to 19 during 1989-1998. This atlas will be available as a print publication and on the CDC's Injury Center website in Spring, 2004.

*United Tribes Technical College (UTTC). Graduates and students of the associate degree program in injury prevention at UTTC, supported by CDC and IHS, work for tribal health departments as injury prevention practitioners. They perform internships in traffic safety, continuing their education toward four-year degrees. The two-year injury prevention degree program was established in 1998. The program trains Native Americans to use the public health approach in preventing injuries and prepares them for work as practitioners. The Injury Prevention degree program continues to be one of the most popular among students at UTTC and is an important component in building tribal capacity to prevent injuries.

*Training program for injury prevention practitioners. CDC's Injury Center staff serves on the IHS injury prevention training workgroup. The workgroup is revising and developing three week-long training courses to educate IHS and tribal staff about community-based injury prevention. These three courses follow the Public Health Model, covering introductory material through advanced injury prevention practice. The IHS Introduction to Injury Prevention course was first conducted in 1985. It has been instrumental in helping to build capacity in injury prevention. Hundreds of IHS and tribal staff members have been trained through the original course.

Research

*Injury mortality among Native Americans 19 years and younger

*Native Americans 19 years and younger are at greater risk of preventable injury-related deaths than other U.S. children in the same age group.

*Seventy-five percent of all deaths among Native Americans in this age group are attributable to injuries and violence, according to a 2003 CDC MMWR study. This is a rate about twice that of all children and youth in the United States.

*Motor vehicle crashes were the leading cause of injury-related death, followed by suicide, homicide, drowning, and fires. Between 1989 and 1998, more than 3,300 Native Americans age 19 or younger living on or near reservations died as a result of injuries or violence (Wallace 2003).

*Traumatic brain injury among Native Americans
Traumatic brain injuries (TBI) are a major cause of disability among Native Americans. CDC scientists found that from 1992 to 1996, Indian Health Service (IHS), tribal, or contract-care hospitals recorded nearly 4,500 TBI-related hospitalizations among American Indians and Alaska Natives. Five percent were fatal. Rates of TBI among males were two and one-half times greater than that of females. Injuries resulted in more than 21,000 hospital days, and the average length of stay for a TBI hospitalization was 4.7 days. Prevention strategies should focus on the leading causes of hospitalizations for TBI: motor vehicle crashes (24%), assaults (17%), and falls (16%) (Adekoya 2002).

Prevention Resources

Indian Health Service Injury Prevention Program Website

Youth Violence: A Report of the Surgeon General

Motor Vehicle Occupant Injury from The Community Guide

References

Adekoya N, Wallace LJD. Traumatic brain injury-American Indians and Alaska Natives-United States, 1992-1996. MMWR 2002;51(14):303-5.

Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS)(2003). Available from: URL: www.cdc.gov/ncipc/wisqars.

Wallace LJD, Patel R, Dellinger A. Injury mortality among American Indian and Alaska Native Children and Youth - United States, 1989-1998. MMWR 2003;52(30):697-701.

Indian Health Service. Indian health focus: injuries, 1989-99. U.S. Department of Health and Human Services, Indian Health Service, 1999.

Wallace LJD. Injuries among American Indian and Alaska Native Children, 1985-1996. Atlanta (GA): CDC, 2000.