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Trends and disparities in American Indian/Alaska Native unintentional injury mortality from 1999 to 2016
  1. William C Kerr,
  2. Yu Ye,
  3. Edwina Williams,
  4. Nina Mulia,
  5. Cheryl J Cherpitel
  1. Alcohol Research Group, Public Health Institute, Emeryville, California, USA
  1. Correspondence to Dr William C Kerr, Alcohol Research Group, Public Health Institute, Oakland, CA 94608, USA; wkerr{at}


Introduction Alcohol and drug use are significant problems in the US, and American Indian/Alaska Native (AI/AN) communities and individuals are known to be among the most affected. This study evaluates disparities in unintentional injury mortality causes since 1999.

Methods Analyses in 2020 of unintentional injury mortality rate disparities between AI/ANs and white population over the 1999–2016 period with attention to motor vehicle crashes, alcohol poisoning, drug poisoning and all other cause types. Rates in each of the 10 states with the largest AI/AN populations were also investigated to account for geographical concentration.

Results Motor vehicle mortality rates declined for both AI/AN and white groups, but a large racial disparity was maintained. Conversely, poisoning mortality rates rose substantially in both groups, with a jump in rates in 2007 due to a coding change, resulting in a large disparity that was maintained through 2016. Comparison of alcohol and drug poisonings showed that the AI/AN alcohol poisoning rate was about eight times the white rate, whereas drug poisoning rates were similar. For ‘all other’ unintentional injuries, the highest rates were seen for AI/AN men, with rates generally rising over the study period. State-specific analyses found substantial variation in AI/AN rates, with few or no disparities in New York and Texas.

Conclusions Results indicate substantial and persisting disparities in unintentional injury mortality, with especially large differences in alcohol poisoning. The absence of disparities in New York and Texas suggest the importance of situational factors.

  • motor vehicle � occupant
  • poisoning
  • epidemiology
  • mortality
  • alcohol

Statistics from


  • Presented at An earlier version of these findings was presented as a poster at the 2019 American Public Health Association annual meeting.

  • Contributors WCK developed the study design and was primarily responsible for writing the article. YY was primarily responsibe for data analyses, contributed to writing the article and approved the final version. EW contributed to data acquisition, analyses and writing and approved the final version. NM contributed to the study design and article writing and approved the final version. CJC contributed to the study design and article writing and approved the final version.

  • Funding The work of all authors was supported by the US National Institute on Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (NIH) (grant number P50 AA005595).

  • Disclaimer Content and opinions are those of authors and do not reflect official positions of the US National Institute on Alcohol Abuse and Alcoholism or the National Institutes of Health. The study sponsor had no role in study design, analysis and interpretation of data, writing the report or the decision to submit the report for publication.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Public Health Institute’s IRB # I16-020.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data are avilable by request with a data use agreement if NCHS agrees with the request.

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