Heart Disease

Heart disease encompasses a range of conditions that effect the heart and blood vessels including heart attack, coronary heart disease, and congestive heart failure. Heart disease is the leading cause of death in the United States, resulting in roughly 1 in every 4 deaths. The burden of heart disease is even greater among our American Indian/Alaska Native (AI/AN) population in the Southern Plains, where AI/ANs in Oklahoma experience an age-adjusted death rate 28% higher than the overall population from years 2011-20151.

Smoking, high cholesterol, and high blood pressure are key risk factors that contribute to the likelihood a person will develop heart disease. Roughly half of all Americans (49%) have one or more of these risk factors. There are many other lifestyle choices and medical conditions that can increase the risk of developing heart disease, which include:

  • Diabetes
  • Overweight and obesity
  • Poor diet
  • Physical inactivity
  • Excessive alcohol use2


Cancer is a devastating disease and is the 2nd leading cause of death in the United States. The four most commonly diagnosed cancers in the United States are: breast, prostate, lung and bronchus, and colorectal. The all cancer age-adjusted death rate across the U.S. is 171.2 per 100,000, but men are nearly 30% more likely to die from cancer than women (204 per 100,000 vs. 143.4 per 100,000)3.

Oklahoma AI/ANs experience the highest age-adjusted death rate due to cancer among any racial group. The age-adjusted death rate for Oklahoma AI/ANs is 256.1 per 100,000 which is 27% higher than the overall rate of 185.8 per 100,0001. The below list includes the most commonly known and heavily-studied risk factors associated with cancer today.

  • Radiation
  • Tobacco
  • Age
  • Alcohol
  • Diet
  • Chronic Inflammation
  • Sunlight3

Accidents (Unintentional Injuries)

Accident (unintentional injury) mortality refers to deaths that were unplanned. Unintentional injuries are defined as occurrences in which:

  • The injury happens in a brief period of time (seconds or minutes),
  • The negative outcome was not sought or planned, or
  • The outcome was a result of one of the forms of physical energy in the environment or normal body functions being blocked by external means (i.e., drowning).

A few of the most common causes of accidental (unintentional injury) death results from motor vehicle crashes, falls, fires, drowning, and poisonings. Unintentional injuries are the number one cause of death for AI/ANs ages 1 to 54, and is the 3rd highest contributor to death overall. Adult motor vehicle-related deaths are AI/ANs are 1.5 times higher than that of whites and that of African-Americans. Moreover, among AI/ANs 19 years and younger, motor vehicle crashes are the leading cause of unintentional injury-related death4.

In Oklahoma, from 2011-2015, the total age-adjusted death rate for unintentional injuries is 60.4 per 100,000, however the age-adjusted death rate for AI/ANs is nearly 37% higher (95.6 per 100,000) than the state-wide rate1.

Chronic Liver Disease and Cirrhosis

Chronic liver disease and cirrhosis is the 4th leading cause of death among AI/ANs in the United States5. The majority of chronic liver disease and cirrhosis cases are preventable and are attributed to excessive alcohol consumption, viral hepatitis, or nonalcoholic fatty liver disease. Roughly 40% if cirrhosis cases are asymptomatic, meaning the patient may not experience any symptoms of the illness. Death rates in patients with alcoholic liver disease are much higher than patients with other forms of cirrhosis6.

Causes and risk factors for chronic liver disease and cirrhosis include:

  • Alcoholism
  • Autoimmune disease
  • Exposure to toxins though ingestion, inhalation, or skin absorption
  • Hereditary conditions
  • Obesity (may cause fatty liver disease and non-alcoholic steatohepatitis)
  • Severe reactions to certain prescription or over-the-counter medications
  • Viruses (hepatitis A, B, or C)7.

The overall age-adjusted death rate for chronic liver disease and cirrhosis in Oklahoma from 2011-2015 is 13.6 per 100,000, while rate for AI/ANs is nearly 3 times higher (37.4 per 100,000)1.


Diabetes Mellitus

Diabetes is a disease in which blood glucose levels are higher than normal and the hemoglobin A1c levels are greater than 6.5%. When someone has diabetes, their body doesn’t make enough insulin or cannot use its insulin as well as it should. This causes sugar to build up in the bloodstream and cause discomfort and health problems in the affected individual. Risk factors associated with type 2 diabetes include:

  • Older age
  • Obesity
  • Family history of diabetes
  • Prior history of gestational diabetes
  • Impaired glucose tolerance
  • Physical inactivity
  • Race/ethnicity.

Risk factors for type 1 diabetes are not as well defined, but known factors are:

  • Autoimmune disorders
  • Genetics
  • Environmental factors.

There are currently 29.1 million people living with diabetes in the United States, that is roughly 1 out of every 11 people. Seven times more Americans have diabetes today than did in 1958 (1958: 0.93%: 2014: 7.02%)8. The overall age-adjusted death rate for diabetes mellitus in Oklahoma from 2011-2015 was 29.8 per 100,000, while Oklahoma AI/ANs experience death rate for diabetes mellitus more than twice as high (69.1 per 100,000)1.




  1. Oklahoma State Department of Health (OSDH), Center for Health Statistics, Health Care Information, Vital Statistics 2011 to 2015, on Oklahoma Statistics on Health Available for Everyone (OK2SHARE). Accessed at
  2. “Heart Disease Fact Sheet,” Center for Disease Control and Prevention,, (March 29, 2017)
  3. “Risk Factors for Cancer,” National Institute of Health: National Cancer Institute,, (March 29, 2017)
  4. “Tribal Road Safety: Get the Facts,” Center for Disease Control and Prevention,, (March 30, 2017)
  5. Heron, Melonie, “Deaths: Leading Causes for 2014,” National Vital Statistics Reports 65, no. 5 (June 30, 2016),, (March 30, 2017)
  6. HEIDELBAUGH, Joel J., and Michael BRUDERLY, “Cirrhosis and Chronic Liver Failure: Part 1. Diagnosis and Evaluation,” American Family Physician 74, no. 5 (September 1, 2006): 756-62,, (March 30, 2017)
  7. Swierzewski, Stanely J., III, “Causes and Risk Factors for Liver Disease,”, September 24, 2015,, (March 30, 2017)
  8. “Basics About Diabetes,” Centers for Disease Control and Prevention, March 31, 2015,, (March 30, 2017)