North Carolina Minority Health Facts: American Indians State Center for Health Statistics and Office of Minority Health and Health Disparities July 2010 The purpose of this report is to present basic health in 12 counties, five of which are clustered in the facts about American Indians in North Carolina in southeastern part of the state. Forty-five percent of the areas of mortality, chronic diseases, HIV and North Carolina’s American Indian population lives sexually transmitted diseases, health risk factors, in Robeson County (mostly Lumbee), accounting access to health care, quality of life, maternal and for 38 percent of that county’s total population. infant health, and child and adolescent health. But Seven percent of North Carolina’s American first we give some background information on the Indians live in Jackson and Swain counties (mostly American Indian population in the state. Cherokee), accounting for nearly 15 percent of the total population in these counties.1 Age and Geographic Characteristics of Among the American Indian tribes in North Carolina American Indians in North Carolina are eight state-recognized tribes: the Eastern Band North Carolina has the largest American Indian of Cherokee (who live primarily in Swain, Jackson, population east of the Mississippi River and the and Graham counties), Coharie Tribe (Harnett, sixth largest American Indian population in the Sampson), Haliwa Saponi Indian Tribe (Halifax, nation, according to 2008 U.S. Census Bureau Warren, Nash), Lumbee Tribe of North Carolina population estimates. According to the census, there (Robeson, Scotland, Hoke), Meherrin Indian Tribe were 108,279 American Indian/Alaskan Native (Hertford, Bertie, Gates, Northampton), Occaneechi residents of North Carolina in 2008. Although the Band of Saponi Nation (Orange, Alamance), percentage of North Carolina’s population that is Sappony (Person), and Waccamaw-Siouan Tribe American Indian has not changed since 1990, the (Columbus, Bladen). The Eastern Band of Cherokee number has increased by nearly 40 percent since is a federally-recognized tribe, and the only tribe 1990 and by 9 percent since 2000. American Indians served by the Indian Health Service of the United now represent a little more than 1 percent of the States Public Health Service. These tribes are total population of the state.1 referenced in Chapter 71 A of the North Carolina General Statutes. The state-recognized tribes hold American Indians in North Carolina are younger membership on the North Carolina Commission than the majority white population. According to of Indian Affairs. The American Indian tribes in the 2008 American Community Survey, the median Cumberland, Guilford, Johnston, Mecklenburg, and age of the state’s American Indian population was Wake counties are represented through the following 33.8 years, compared to 40.5 years for the white associations or organizations: Cumberland County population of North Carolina.2 Association for Indian People, Guilford Native Although American Indians live in each of North American Association, Metrolina Native American Carolina’s 100 counties (see 2008 data on the map, Association, and the Triangle Native American Figure 1), three-fourths of the population lives Society. In 1956, the United States Congress passed school education or less, compared to 40 percent Table 1 for whites.2 The unemployment rate for American Leading Causes of Death Among American Indians in North Carolina, 2008 Indians was 7.5 percent, compared to 5.4 percent for whites.2 Number of Rank Cause of Death Deaths 1 Cancer 145 Mortality 2 Diseases of the heart 142 Table 1 shows the leading causes of death for 3 Other unintentional injuries 38 American Indians in North Carolina in 2008. 4 Motor vehicle injuries 35 Cancer, heart disease, and other unintentional 5 Diabetes mellitus 31 6 Cerebrovascular disease 28 injuries are the top three causes of death, 7 Homicide 25 compared to heart disease, cancer, and chronic 8 Alzheimer’s disease 22 lower respiratory diseases for the white 9 Kidney diseases 21 population. Motor vehicle injuries (fourth) and 10 Chronic lung diseases 18 homicide (seventh) rank substantially higher as All other causes (residual) 194 Total Deaths — All Causes 699 causes of death among American Indians than among whites (10th and 19th, respectively). the Lumbee Act (HR 4656) which provided federal Table 2 shows 2004–2008 age-adjusted death recognition of the Lumbee tribe, but did not include rates (deaths per 100,000 population) for major health services for the Lumbee by the Indian Health causes of death, comparing American Indians, Service. whites, and African Americans. American Indian death rates were at least twice that of whites for Social and Economic Well-Being diabetes, HIV disease, motor vehicle injuries, and homicide. Low income, low educational level, and unemployment all are associated with a higher rate of health problems. The Table 2 percentage of American Indian families Age-Adjusted Death Rates* for Major Causes of Death by living below the federal poverty level Race/Ethnicity, North Carolina Residents, 2004–2008 ($21,834 annual income for a family of American African Cause of Death Indian White American four) in 2008 was 21.2 percent, compared to 6.7 percent for whites and 21.3 percent Chronic Conditions Heart disease 207.7 192.6 236.0 for African Americans. Approximately Cancer 166.4 185.2 224.0 Stroke 54.6 49.2 73.5 29 percent of American Indian family Diabetes 45.0 19.5 51.0 households were headed by females, Chronic lung disease 30.1 51.1 30.4 Kidney disease 23.5 14.8 36.5 compared to 13 percent for white family Chronic liver disease 11.8 9.3 8.4 households and 44 percent for African Infectious Diseases American family households. Thirty-eight Pneumonia/influenza 13.5 20.2 19.2 Septicemia 17.1 12.3 22.3 percent of the family households headed by HIV disease 2.9 1.2 16.5 American Indian females lived in poverty, Injury and Violence compared to 25 percent of the family Motor vehicle injuries 39.0 18.1 18.0 Other unintentional injuries 30.9 30.9 21.8 households headed by white females and Homicide 20.4 3.6 16.4 37 percent by African American females. Suicide 9.5 14.4 5.0 * Rates are age-adjusted to the 2000 U.S. standard population and are expressed as deaths per 100,000 More than 58 percent of American Indian population — using underlying cause of death. adults (ages 25 and older) had a high Minority Health Facts ♦ American Indians — July 2010 2 Office of Minority Health and Health Disparities and State Center for Health Statistics Office ofMinority HealthandDisparities StateCenterforHealthStatistics Minority HealthFacts ♦ AmericanIndians —July2010 Estimated American Indian Population North Carolina: Numbers C u Alleghany C r 80 Ashe Northampton 33 a r i Gates P m tu 123 42 a c 18 Surry 105 Warren s d k Stokes Rockingham Caswell Person 273 q e P u n 42 Hertford e o 171 Vance 72 qr ta 230 979 u n Watauga 268 44 262 Halifax im k C a Wilkes Granville h n Yadkin 61 o s 42 113 Forsyth 1911 w 21 141 Orange a Mitchell Avery 107 Guilford Franklin n 1137 Alamance 768 Bertie 37 57 30 Caldwell 2432 Durham 213 Nash Yancey Alexander 1D1a7vie 470 470 77 Madison 70 409 Edgecombe 7 44 172 Iredell Martin Washington Tyrrell Dare Burke Davidson Wake 138 127 Randolph Wilson 77 McDowell 371 394 Chatham 9 94 Buncombe 258 Catawba Rowan 541 3686 Haywood 615 165 Pitt Beaufort Swain 187 Hyde 947 459 Figure 1 Lincoln Johnston Greene 76 Graham 291 Rutherford 171 Lee 422 3543 Henderson Cabarrus 20 3787 Harnett 623 Wayne 67 587 Jackson 33 Cleveland Stanly 89 237 88 249 Polk 119 Gaston 3809 590 Moore Macon Montgomery 972 415 Lenoir Craven Cherokee Transylvania 169 623 Mecklenburg 147 652 414 Clay 107 117 429 Pamlico 33 Cumberland Jones Richmond Hoke Sampson 72 Union Anson 35 4753 Duplin 703 141 908 4084 1098 3742 298 111 Carteret Scotland Onslow Robeson Bladen 1120 48494 Pender 698 216 Number New Columbus Hanover 736 7 - 470 1804 671 Brunswick 471 - 1,911 1,912 - 4,753 4,754 - 48,494 Source: NCHS, 2008 Bridged Population 3 Cancer Incidence Table 3 Age-Adjusted Rates* for Cancer Incidence by Race/Ethnicity Table 3 shows the 2002–2006 age-adjusted North Carolina Residents, 2002–2006 rates for cancer incidence, comparing Site American Indian White African American American Indians, whites and African Americans. American Indians had Female Breast 45.6 149.5 143.0 Lung / Bronchus 60.5 76.9 69.9 substantially lower rates of breast, prostate, Prostate 84.0 136.8 242.5 lung, and colon cancers, though their age- Colon / Rectum 30.2 46.9 57.5 adjusted liver cancer rate was higher than Liver 6.2 4.4 5.1 the rate for whites. Total Cancer (All sites) 348.7 478.0 497.9 American Indians in North Carolina had a * Rates are age-adjusted to the 2000 U.S. standard population and are expressed as deaths per 100,000 population. Female and male population estimates, respectively, are used in the denominators of the lower rate of new cancer cases during 2002– female breast and prostate cancer incidence rates. 2006 than whites (age-adjusted rate of 348.7 versus 478.0 for whites). However, there is some indication that American Indian Fi gure 2 race is not always accurately captured on Pe rcentages of No rth Carolina Adults with Se lected Chronic Conditions, by Race/Ethnicity cancer and other health records (this issue (Based on Weighted 2005/2007 and 2006–2008 BRFSS Survey Data) is discussed in the section Challenges of Collecting Accurate Data); this may 50 40.8 45 42.4 partially account for the lower cancer rate 40 33.3 35 among American Indians.