Homicide Among American Indians/Alaska Natives, 1999-2009: Implications for Public Health Interventions

Objective. We determined estimates of homicide among American Indians/Alaska Natives (Al/ANs) compared with non-Hispanic white people to characterize disparities and improve Al/AN classification in incidence and mortality reporting. Methods. We linked 1999-2009 death certificate data with Indian Health Service (IHS) patient registration data to examine death rates from homicide among Al/AN and non-Hispanic white people. Our analysis focused primarily on residents of IHS Contract Health Service Delivery Area counties and excluded Hispanic people to avoid underestimation of incidence and mortality in Al/ANs and for consistency in our comparisons. We used age-adjusted death rates per 100,000 population and stratified our analyses by sex, age, and IHS region. Results. Death rates per 100,000 population from homicide were four times higher among Al/ANs (rate = 12.1) than among white people (rate = 2.8). Homicide rates for Al/ANs were highest in the Southwest (25.6 and 6.9 for males and females, respectively) and in Alaska (17.7 and 10.3 for males and females, respectively). Disparities between Al/ANs and non-Hispanic white people were highest in the Northern Plains region among men (rate ratio [RR] = 9.8, 95% confidence interval [CI] 8.5, 11.3) and among those aged 25-44 years (RR=9.0, 95% CI 7.5, 10.7) and 0-24 years (RR=7.4, 95% CI 6.1, 8.9). Conclusion. Death rates from homicide among Al/ANs were higher than previously reported and varied by sex, age, and region. Violence prevention efforts involving a range of stakeholders are needed at the community level to address this important public health issue.