DEPARTMENT OF HEALTH & HUMAN SERVICES
Public Health Service
Centers for Disease Control and Prevention
National Center for Health Statistics
6525 Belcrest Road Hyattsville, Maryland 20782
September 16, 1998
M. Alfred Haynes, M.D., M.P.H.
Chair,
Committee on Cancer Research Among Minorities and the Medically Underserved
Institute of Medicine
2101 Constitution Avenue, N.W. Washington, D.C. 20418
Dear Dr. Haynes:
I am writing in response to your letter of July 24, 1998 in which you asked for an analysis of cancer mortality based on race. Please find enclosed a statement of the methodology we used including several caveats, a summary table, and a detailed table demonstrating the reduction in cancer deaths that could be achieved if differences by race or ethnicity could be eliminated.
A few notes on what we've done: You asked us if we could illustrate the number and percent of deaths that would be avoided if all race or ethnic groups shared the same mortality risks for specific cancer sites. You also asked that we consider that the ''best" mortality experience be the one that all groups could, at least hypothetically, experience.
We departed somewhat from the methodology you recommended in the letter with respect to sex, rates, and race:
First, in consultation with NCI, we performed the calculations separately by sex because of the major differences in cancer experience by sex.
Second, we used age-adjusted death rates to select a "best" group, and age-specific death rates to calculate the "excess" deaths.
Third, we combined both the Asian and Pacific Islander and American Indians into a total Asian and Pacific Island group and a total American Indian group. These groups were formed to stabilize estimates, to use groups for which we have estimates of the degree to which race has been misreported, and to use the most recent data available, which is only available for the broad groups.
Even with these steps, we do have some serious reservations about the procedures used and resulting conclusions because race and ethnicity-specific death rates are known to be substantially too low for certain racial/ethnic groups. The consequence is that excess deaths presented here may be substantially greater than would be the case if the rates were not a function of these errors. Indeed, we are most concerned about using the American Indian rates as a baseline or "best rate" group. Given the errors in reporting, it is difficult to believe that other groups could achieve these rates. The two kinds of errors in reported death rates include serious misclassification of race and ethnicity and misreporting of age, particularly among the elderly. These problems occur on the death certificate and also on censuses and surveys.
Given our concerns we decided to make two estimates (Method A and Method B). In Method A, for those sites for which the American Indian rates were "best," we chose the race/ethnic group that was the next lowest in death rate for that cancer site. In Method B, we used American Indian rates when they were the "best." Two sets of tables are provided, but we strongly prefer those that are not based on American Indians as the "best'' or target rate (Method A).
While Method A are preferred estimates, this method does not make any adjustment for known race misclassification. Overall we expect that the estimated number of "excess" deaths from cancer would be around ten percent fewer for women and closer to twenty percent for men. This percentage would vary by cancer site.
Please note that I strongly believe this exercise can be useful. As I mentioned on the phone, I view differences in cancer mortality risk as, first and foremost, reflecting a variety of cancer causes and differential group responses to risk factors. Illustrating the differences between groups provides clues to form hypotheses on cancer causes, risk factors or biology. Secondly, for some cancer sites, we understand the causes and processes of cancer development sufficiently to be able to say how one group can achieve the lower risk shown by another group. Perhaps the best example I know of in the second case is the low rates of cancer among Mormons in Utah and Los Angeles, which reflect life-style choices that could be replicated in other populations.
All of us at NCHS are appreciative to our NCI colleagues who made available their SEER database and helped us make the calculations.
Please contact Mr. Maurer or Drs. Hoyert or Rosenberg (301-436-8884) if you have any additional questions.
Sincerely,
Edward J. Sondik, Ph.D.
Director
National Center for Health Statistics
Methodology and Caveats
The methodology that we used in computing the requested approach is as follows:
1) |
Our basic data included 1990–95 age-adjusted death rates (using a 1970 population standard), age-specific deaths and death rates, and populations by race and ethnicity following the structure of the 1996 SEER publication cited in your letter (produced by NCI using NCHS and Census data) |
2) |
Method A: For specific cancer sites, we selected the group with the smallest age-adjusted death rate separately by sex. The groups for which the age-adjusted death rates were compared included white, black, Asian and Pacific Islander, Hispanic (total), and Non-Hispanic (total). |
|
Method B: For specific cancer sites, we selected the group with the smallest age-adjusted death rate separately by sex. The groups for which the age-adjusted death rates were compared included white, black, American Indian, Asian and Pacific Islander, Hispanic (total), and Non-Hispanic (total). |
3) |
For each cancer site, we multiplied the age-specific death rate for the "best" group by the population of each of the race or ethnic groups to determine an "expected" number of deaths. |
4) |
For each cancer site, we subtracted the "expected" number of deaths from the "observed" number of deaths to determine a value for deaths that would not have occurred. |
5) |
For each cancer site, we also divided the "expected" number of deaths by the "observed" number of deaths, subtracted 1 from the quotient, and multiply by 100. This yields the percent difference in observed and expected deaths. |
6) |
For all cancers combined (shown in the summary table), we summed the expected and observed deaths by sex and calculated the "excess" and percent difference from the summation for specific sites. |
7) |
The detail table expresses the number of deaths for the full time period. The summary table express the number of deaths per year. |
Caveats of this approach include the following:
1) |
Quality of data varies by race and ethnicity in both death certificate data and Census data. The quality of data for the white and black populations are good in contrast to that for other groups. American Indian is estimated to be underreported on the death certificate by more than 20% (probably greater than this) and Asian and Pacific Islander is underreported by about 10%. With respect to population data, perhaps, the most serious problem is the 33% increase in the American Indian population between 1960 and 1990 that reflects increased preference to self-report as an American Indian. |
2) |
Age-specific death rates, especially those for the elderly, are underestimates. |
3) |
Hispanic origin and race are separate items. We picked the best rates going across these two variables, but show the deaths for both Hispanic origin and race. |
4) |
Hispanic origin was not reported on all State death certificates in this time period. The rates used in the calculation were based on 46 States and the District of Columbia. The observed deaths count was inflated to a national total by using the reciprocal of the fraction of the Hispanic population living in these 46 States and D.C. |
5) |
The number of events, particularly at young ages for certain minority groups, are small. This would affect the stability of the rates. To counter that tendency, we used data for the 1990–95 time period. In the summary table, we have expressed the number of deaths in terms of a single year of data. |
6) |
The reduction for all cancer sites combined differs depending on whether the values are summed across specific cancer sites or is done separately. The reduction is greater when the values are summed. |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
Men |
Women |
||||||||
All cancers |
|
All cancers |
|||||||
|
Best group rates (varies by site) |
|
Best group rates (varies by site) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
140,449 |
276,146 |
|
|
TOTAL |
126,225 |
247,702 |
|
|
White |
125,372 |
239,397 |
|
|
White |
111,714 |
217,628 |
|
|
Black |
11,479 |
32,505 |
|
|
Black |
11,428 |
26,456 |
|
|
American Indian |
672 |
753 |
|
|
American Indian |
590 |
716 |
|
|
Asian Pacific Islander |
2,926 |
3,492 |
|
|
Asian Pacific Islander |
2,492 |
2,903 |
|
|
Hispanic |
6,916 |
8,374 |
|
|
Hispanic |
6,103 |
7,358 |
|
|
Non-Hispanic |
133,533 |
267,772 |
|
|
Non-Hispanic |
120,122 |
240,344 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
135,697 |
-49 |
|
|
TOTAL |
121,477 |
-49 |
|
|
White |
114,024 |
-48 |
|
|
White |
105,913 |
-49 |
|
|
Black |
21,026 |
-65 |
|
|
Black |
15,027 |
-57 |
|
|
American Indian |
81 |
-11 |
|
|
American Indian |
126 |
-18 |
|
|
Asian Pacific Islander |
566 |
-16 |
|
|
Asian Pacific Islander |
411 |
-14 |
|
|
Hispanic |
1,458 |
-17 |
|
|
Hispanic |
1,255 |
-17 |
|
|
Non-Hispanic |
134,239 |
-50 |
|
|
Non-Hispanic |
120,222 |
-50 |
Lung and bronchus |
Lung and bronchus |
||||||||
|
Best group rates (Hispanic) |
|
Best group rates (Hispanic) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
40,971 |
91,673 |
|
|
TOTAL |
19,699 |
54,951 |
|
|
White |
36,643 |
79,943 |
|
|
White |
17,526 |
49,416 |
|
|
Black |
3,296 |
10,578 |
|
|
Black |
1,725 |
4,890 |
|
|
American Indian |
191 |
239 |
|
|
American Indian |
86 |
149 |
|
|
Asian Pacific Islander |
841 |
914 |
|
|
Asian Pacific Islander |
362 |
495 |
|
|
Hispanic |
1,947 |
1,947 |
|
|
Hispanic |
886 |
886 |
|
|
Non-Hispanic |
39,024 |
89,726 |
|
|
Non-Hispanic |
18,813 |
54,065 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
50,702 |
-55 |
|
|
TOTAL |
35,252 |
-64 |
|
|
White |
43,300 |
-54 |
|
|
White |
31,890 |
-65 |
|
|
Black |
7,281 |
-69 |
|
|
Black |
3,165 |
-65 |
|
|
American Indian |
48 |
-20 |
|
|
American Indian |
63 |
-42 |
|
|
Asian Pacific Islander |
73 |
-8 |
|
|
Asian Pacific Islander |
133 |
-27 |
|
|
Hispanic |
(0) |
0 |
|
|
Hispanic |
(0) |
0 |
|
|
Non-Hispanic |
50,702 |
-57 |
|
|
Non-Hispanic |
35,252 |
-65 |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
Pancreas |
Pancreas |
||||||||
|
Best group rates (As & Pac Islander) |
Best group rates (As & Pacific Islander) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
9,008 |
12,610 |
|
|
TOTAL |
9,179 |
13,512 |
|
|
White |
8,062 |
10,951 |
|
|
White |
8,183 |
11,664 |
|
|
Black |
721 |
1,449 |
|
|
Black |
794 |
1,650 |
|
|
American Indian |
42 |
27 |
|
|
American Indian |
39 |
34 |
|
|
Asian Pacific Islander |
183 |
183 |
|
|
Asian Pacific Islander |
163 |
163 |
|
|
Hispanic |
424 |
440 |
|
|
Hispanic |
403 |
441 |
|
|
Non-Hispanic |
8,584 |
12,169 |
|
|
Non-Hispanic |
8,775 |
13,071 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
3,601 |
-29 |
|
|
TOTAL |
4,333 |
-32 |
|
|
White |
2,889 |
-26 |
|
|
White |
3,481 |
-30 |
|
|
Black |
728 |
-50 |
|
|
Black |
856 |
-52 |
|
|
American Indian |
(15) |
56 |
|
|
American Indian |
(5) |
14 |
|
|
Asian Pacific Islander |
(0) |
0 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Hispanic |
16 |
-4 |
|
|
Hispanic |
38 |
-9 |
|
|
Non-Hispanic |
3,585 |
-29 |
|
|
Non-Hispanic |
4,295 |
-33 |
|
Ovary |
||||||||
|
Best group rates (As Pacific Islander) |
||||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
6,403 |
13,081 |
||||
|
|
|
White |
5,614 |
11,888 |
||||
|
|
|
Black |
611 |
1,012 |
||||
|
|
|
American Indian |
33 |
35 |
||||
|
|
|
Asian Pacific Islander |
146 |
146 |
||||
|
|
|
Hispanic |
341 |
413 |
||||
|
|
|
Non-Hispanic |
6,062 |
12,668 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
6,678 |
-51 |
||||
|
|
|
White |
6,275 |
-53 |
||||
|
|
|
Black |
401 |
-40 |
||||
|
|
|
American Indian |
2 |
-6 |
||||
|
|
|
Asian Pacific Islander |
(0) |
0 |
||||
|
|
|
Hispanic |
72 |
-18 |
||||
|
|
|
Non-Hispanic |
6,605 |
-52 |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
|
Breast |
||||||||
|
Best group rates (As Pacific Islander) |
||||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
18,236 |
43,513 |
||||
|
|
|
White |
15,917 |
38,045 |
||||
|
|
|
Black |
1,783 |
4,932 |
||||
|
|
|
American Indian |
98 |
98 |
||||
|
|
|
Asian Pacific Islander |
438 |
438 |
||||
|
|
|
Hispanic |
1,017 |
1,328 |
||||
|
|
|
Non-Hispanic |
17,219 |
42,184 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
25,277 |
-58 |
||||
|
|
|
White |
22,128 |
-58 |
||||
|
|
|
Black |
3,149 |
-64 |
||||
|
|
|
American Indian |
(0) |
0 |
||||
|
|
|
Asian Pacific Islander |
0 |
-0 |
||||
|
|
|
Hispanic |
311 |
-23 |
||||
|
|
|
Non-Hispanic |
24,966 |
-59 |
||||
Colon/rectum |
Colon/rectum |
||||||||
|
Best group rates (Hispanic) |
Best group rates (Hispanic) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
16,753 |
28,310 |
|
|
TOTAL |
15,954 |
28,919 |
|
|
White |
14,964 |
24,974 |
|
|
White |
14,215 |
25,303 |
|
|
Black |
1,361 |
2,910 |
|
|
Black |
1,386 |
3,244 |
|
|
American Indian |
80 |
66 |
|
|
American Indian |
69 |
71 |
|
|
Asian Pacific Islander |
349 |
360 |
|
|
Asian Pacific Islander |
284 |
302 |
|
|
Hispanic |
814 |
814 |
|
|
Hispanic |
709 |
709 |
|
|
Non-Hispanic |
15,939 |
27,495 |
|
|
Non-Hispanic |
15,245 |
28,210 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
11,556 |
-41 |
|
|
TOTAL |
12,964 |
-45 |
|
|
White |
10,009 |
-40 |
|
|
White |
11,088 |
-44 |
|
|
Black |
1,550 |
-53 |
|
|
Black |
1,857 |
-57 |
|
|
American Indian |
(14) |
21 |
|
|
American Indian |
2 |
-2 |
|
|
Asian Pacific Islander |
11 |
-3 |
|
|
Asian Pacific Islander |
17 |
-6 |
|
|
Hispanic |
(0) |
0 |
|
|
Hispanic |
(0) |
0 |
|
|
Non-Hispanic |
11,556 |
-42 |
|
|
Non-Hispanic |
12,964 |
-46 |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
Stomach |
Stomach |
||||||||
|
Best group rates (White) |
Best group rates (White) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
7,329 |
8,198 |
|
|
TOTAL |
5,004 |
5,634 |
|
|
White |
6,539 |
6,540 |
|
|
White |
4,463 |
4,463 |
|
|
Black |
599 |
1,327 |
|
|
Black |
432 |
928 |
|
|
American Indian |
35 |
38 |
|
|
American Indian |
21 |
25 |
|
|
Asian Pacific Islander |
155 |
293 |
|
|
Asian Pacific Islander |
88 |
219 |
|
|
Hispanic |
362 |
519 |
|
|
Hispanic |
220 |
374 |
|
|
Non-Hispanic |
6,967 |
7,679 |
|
|
Non-Hispanic |
4,784 |
5,260 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
869 |
-11 |
|
|
TOTAL |
630 |
-11 |
|
|
White |
0 |
-0 |
|
|
White |
0 |
-0 |
|
|
Black |
728 |
-55 |
|
|
Black |
495 |
-53 |
|
|
American Indian |
3 |
-8 |
|
|
American Indian |
4 |
-14 |
|
|
Asian Pacific Islander |
138 |
-47 |
|
|
Asian Pacific Islander |
131 |
-60 |
|
|
Hispanic |
157 |
-30 |
|
|
Hispanic |
154 |
-41 |
|
|
Non-Hispanic |
712 |
-9 |
|
|
Non-Hispanic |
476 |
-9 |
|
Cervix |
||||||||
|
Best group rates (White) |
||||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
3,976 |
4,578 |
||||
|
|
|
White |
3,438 |
3,439 |
||||
|
|
|
Black |
410 |
997 |
||||
|
|
|
American Indian |
23 |
34 |
||||
|
|
|
Asian Pacific Islander |
105 |
109 |
||||
|
|
|
Hispanic |
245 |
336 |
||||
|
|
|
Non-Hispanic |
3,731 |
4,242 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
602 |
-13 |
||||
|
|
|
White |
0 |
-0 |
||||
|
|
|
Black |
588 |
-59 |
||||
|
|
|
American Indian |
10 |
-30 |
||||
|
|
|
Asian Pacific Islander |
4 |
-4 |
||||
|
|
|
Hispanic |
91 |
-27 |
||||
|
|
|
Non-Hispanic |
511 |
-12 |
Kidney/renal/pel |
Kidney/renal/pel |
||||||||
|
Best group rates (As Pac Islander) |
Best group rates (As Pacific Islander) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
2,433 |
6,350 |
|
|
TOTAL |
1,685 |
4,099 |
|
|
White |
2,163 |
5,715 |
|
|
White |
1,501 |
3,678 |
|
|
Black |
204 |
550 |
|
|
Black |
146 |
369 |
|
|
American Indian |
12 |
31 |
|
|
American Indian |
7 |
23 |
|
|
Asian Pacific Islander |
54 |
54 |
|
|
Asian Pacific Islander |
30 |
30 |
|
|
Hispanic |
127 |
257 |
|
|
Hispanic |
75 |
150 |
|
|
Non-Hispanic |
2,306 |
6,093 |
|
|
Non-Hispanic |
1,610 |
3,949 |
|
|
|
Estimated excess excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
3,917 |
-62 |
|
|
TOTAL |
2,414 |
-59 |
|
|
White |
3,552 |
-62 |
|
|
White |
2,177 |
-59 |
|
|
Black |
346 |
-63 |
|
|
Black |
222 |
-60 |
|
|
American Indian |
19 |
-61 |
|
|
American Indian |
15 |
-68 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Hispanic |
130 |
-51 |
|
|
Hispanic |
75 |
-50 |
|
|
Non-Hispanic |
3,786 |
-62 |
|
|
Non-Hispanic |
2,339 |
-59 |
Other |
|||||||||
|
Best group (Asian or Pacific Islander) |
||||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
43,975 |
88,231 |
|
|
TOTAL |
42,373 |
75,355 |
|
|
White |
39,044 |
77,673 |
|
|
White |
37,556 |
66,372 |
|
|
Black |
3,738 |
9,352 |
|
|
Black |
3,814 |
7,950 |
|
|
American Indian |
225 |
238 |
|
|
American Indian |
196 |
225 |
|
|
Asian Pacific Islander |
968 |
968 |
|
|
Asian Pacific Islander |
808 |
808 |
|
|
Hispanic |
2,363 |
3,026 |
|
|
Hispanic |
2,036 |
2,462 |
|
|
Non-Hispanic |
41,612 |
85,205 |
|
|
Non-Hispanic |
40,337 |
72,893 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
44,256 |
-50 |
|
|
TOTAL |
32,981 |
-44 |
|
|
White |
38,629 |
-50 |
|
|
White |
28,816 |
-43 |
|
|
Black |
5,614 |
-60 |
|
|
Black |
4,136 |
-52 |
|
|
American Indian |
13 |
-6 |
|
|
American Indian |
29 |
-13 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Asian Pacific Islander |
(0) |
0 |
|
|
Hispanic |
662 |
-22 |
|
|
Hispanic |
425 |
-17 |
|
|
Non-Hispanic |
43,594 |
-51 |
|
|
Non-Hispanic |
32,556 |
-45 |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
Prostate |
|
||||||||
|
Best group rates (As Pacific Islander) |
|
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
||||
|
|
TOTAL |
14,221 |
34,070 |
|
||||
|
|
White |
12,826 |
28,261 |
|
||||
|
|
Black |
1,082 |
5,477 |
|
||||
|
|
American Indian |
59 |
78 |
|
||||
|
|
Asian Pacific Islander |
254 |
254 |
|
||||
|
|
Hispanic |
587 |
917 |
|
||||
|
|
Non-Hispanic |
13,634 |
33,153 |
|
||||
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
||||
|
|
TOTAL |
19,849 |
-58 |
|
||||
|
|
White |
15,436 |
-55 |
|
||||
|
|
Black |
4,394 |
-80 |
|
||||
|
|
American Indian |
19 |
-24 |
|
||||
|
|
Asian Pacific Islander |
(0) |
0 |
|
||||
|
|
Hispanic |
330 |
-36 |
|
||||
|
|
Non-Hispanic |
19,519 |
-59 |
|
||||
Nasopharynx |
Nasopharynx |
||||||||
|
Best group rates (Hispanic) |
|
Best group rates (Hispanic) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
299 |
450 |
|
|
TOTAL |
145 |
233 |
|
|
White |
264 |
312 |
|
|
White |
128 |
186 |
|
|
Black |
26 |
62 |
|
|
Black |
13 |
24 |
|
|
American Indian |
2 |
6 |
|
|
American Indian |
1 |
2 |
|
|
Asian Pacific Islander |
7 |
71 |
|
|
Asian Pacific Islander |
3 |
21 |
|
|
Hispanic |
17 |
17 |
|
|
Hispanic |
7 |
7 |
|
|
Non-Hispanic |
282 |
433 |
|
|
Non-Hispanic |
137 |
226 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
151 |
-33 |
|
|
TOTAL |
88 |
-38 |
|
|
White |
47 |
-15 |
|
|
White |
58 |
-31 |
|
|
Black |
36 |
-58 |
|
|
Black |
10 |
-44 |
|
|
American Indian |
4 |
-71 |
|
|
American Indian |
1 |
-66 |
|
|
Asian Pacific Islander |
63 |
-90 |
|
|
Asian Pacific Islander |
18 |
-86 |
|
|
Hispanic |
0 |
-0 |
|
|
Hispanic |
0 |
-0 |
|
|
Non-Hispanic |
151 |
-35 |
|
|
Non-Hispanic |
88 |
-39 |
Summary table of annual reductions "possible" for cancer version excluding American Indians as "best" (i.e. Method A) |
|||||||||
Liver & intrahepatic bile |
Liver & intrahepatic bile |
||||||||
|
Best group rates (White) |
|
Best group rates (White) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
5,340 |
5,936 |
|
|
TOTAL |
3,571 |
3,829 |
|
|
White |
4,759 |
4,759 |
|
|
White |
3,174 |
3,174 |
|
|
Black |
440 |
752 |
|
|
Black |
315 |
461 |
|
|
American Indian |
26 |
31 |
|
|
American Indian |
16 |
21 |
|
|
Asian Pacific Islander |
114 |
394 |
|
|
Asian Pacific Islander |
66 |
174 |
|
|
Hispanic |
269 |
429 |
|
|
Hispanic |
163 |
252 |
|
|
Non-Hispanic |
5,071 |
5,507 |
|
|
Non-Hispanic |
3,407 |
3,577 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
596 |
-10 |
|
|
TOTAL |
258 |
-7 |
|
|
White |
(0) |
0 |
|
|
White |
0 |
-0 |
|
|
Black |
312 |
-41 |
|
|
Black |
146 |
-32 |
|
|
American Indian |
4 |
-15 |
|
|
American Indian |
5 |
-23 |
|
|
Asian Pacific Islander |
280 |
-71 |
|
|
Asian Pacific Islander |
108 |
-62 |
|
|
Hispanic |
160 |
-37 |
|
|
Hispanic |
89 |
-35 |
|
|
Non-Hispanic |
436 |
-8 |
|
|
Non-Hispanic |
169 |
-5 |
Summary table of annual reductions ''possible" for cancer (Method B) |
|||||||||
Men |
Women |
||||||||
All cancers |
All cancers |
||||||||
|
Best group rates (varies by site) |
Best group rates (varies by site) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
133,397 |
276,146 |
|
|
TOTAL |
125,214 |
247,702 |
|
|
White |
119,013 |
239,397 |
|
|
White |
110,822 |
217,628 |
|
|
Black |
10,942 |
32,505 |
|
|
Black |
11,335 |
26,456 |
|
|
American Indian |
643 |
753 |
|
|
American Indian |
585 |
716 |
|
|
Asian Pacific Islander |
2,799 |
3,492 |
|
|
Asian Pacific Islander |
2,471 |
2,903 |
|
|
Hispanic |
6,624 |
8,374 |
|
|
Hispanic |
6,052 |
7,358 |
|
|
Non-Hispanic |
126,773 |
267,772 |
|
|
Non-Hispanic |
119,161 |
240,344 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
142,749 |
-52 |
|
|
TOTAL |
122,488 |
-49 |
|
|
White |
120,383 |
-50 |
|
|
White |
106,806 |
-49 |
|
|
Black |
21,562 |
-66 |
|
|
Black |
15,120 |
-57 |
|
|
American Indian |
110 |
-15 |
|
|
American Indian |
131 |
-18 |
|
|
Asian Pacific Islander |
693 |
-20 |
|
|
Asian Pacific Islander |
431 |
-15 |
|
|
Hispanic |
1,750 |
-21 |
|
|
Hispanic |
1,306 |
-18 |
|
|
Non-Hispanic |
140,999 |
-53 |
|
|
Non-Hispanic |
121,182 |
-50 |
Lung and bronchus |
Lung and bronchus |
||||||||
|
Best group rates (Hispanic) |
Best group rates (Hispanic) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
40,971 |
91,673 |
|
|
TOTAL |
19,699 |
54,951 |
|
|
White |
36,643 |
79,943 |
|
|
White |
17,526 |
49,416 |
|
|
Black |
3,296 |
10,578 |
|
|
Black |
1,725 |
4,890 |
|
|
American Indian |
191 |
239 |
|
|
American Indian |
86 |
149 |
|
|
Asian Pacific Islander |
841 |
914 |
|
|
Asian Pacific Islander |
362 |
495 |
|
|
Hispanic |
1,947 |
1,947 |
|
|
Hispanic |
886 |
886 |
|
|
Non-Hispanic |
39,024 |
89,726 |
|
|
Non-Hispanic |
18,813 |
54,065 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
50,702 |
-55 |
|
|
TOTAL |
35,252 |
-64 |
|
|
White |
43,300 |
-54 |
|
|
White |
31,890 |
-65 |
|
|
Black |
7,281 |
-69 |
|
|
Black |
3,165 |
-65 |
|
|
American Indian |
48 |
-20 |
|
|
American Indian |
63 |
-42 |
|
|
Asian Pacific Islander |
73 |
-8 |
|
|
Asian Pacific Islander |
133 |
-27 |
|
|
Hispanic |
(0) |
0 |
|
|
Hispanic |
(0) |
0 |
|
|
Non-Hispanic |
50,702 |
-57 |
|
|
Non-Hispanic |
35,252 |
-65 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
|
Breast |
||||||||
|
Best group rates (As Pacific Islander) |
||||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
18,236 |
43,513 |
||||
|
|
|
White |
15,917 |
38,045 |
||||
|
|
|
Black |
1,783 |
4,932 |
||||
|
|
|
American Indian |
98 |
98 |
||||
|
|
|
Asian Pacific Islander |
438 |
438 |
||||
|
|
|
Hispanic |
1,017 |
1,328 |
||||
|
|
|
Non-Hispanic |
17,219 |
42,184 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
25,277 |
-58 |
||||
|
|
|
White |
22,128 |
-58 |
||||
|
|
|
Black |
3,149 |
-64 |
||||
|
|
|
American Indian |
(0) |
0 |
||||
|
|
|
Asian Pacific Islander |
0 |
-0 |
||||
|
|
|
Hispanic |
311 |
-23 |
||||
|
|
|
Non-Hispanic |
24,966 |
-59 |
||||
Colon/rectum |
Colon/rectum |
||||||||
|
Best group rates (American Indian) |
Best group rates (Hispanic) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
13,258 |
28,310 |
|
|
TOTAL |
15,954 |
28,919 |
|
|
White |
11,805 |
24,974 |
|
|
White |
14,215 |
25,303 |
|
|
Black |
1,100 |
2,910 |
|
|
Black |
1,386 |
3,244 |
|
|
American Indian |
65 |
66 |
|
|
American Indian |
69 |
71 |
|
|
Asian Pacific Islander |
288 |
360 |
|
|
Asian Pacific Islander |
284 |
302 |
|
|
Hispanic |
676 |
814 |
|
|
Hispanic |
709 |
709 |
|
|
Non-Hispanic |
12,582 |
27,495 |
|
|
Non-Hispanic |
15,245 |
28,210 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
15,052 |
-53 |
|
|
TOTAL |
12,964 |
-45 |
|
|
White |
13,169 |
-53 |
|
|
White |
11,088 |
-44 |
|
|
Black |
1,811 |
-62 |
|
|
Black |
1,857 |
-57 |
|
|
American Indian |
0 |
-0 |
|
|
American Indian |
2 |
-2 |
|
|
Asian Pacific Islander |
72 |
-20 |
|
|
Asian Pacific Islander |
17 |
-6 |
|
|
Hispanic |
138 |
-17 |
|
|
Hispanic |
(0) |
0 |
|
|
Non-Hispanic |
14,914 |
-54 |
|
|
Non-Hispanic |
12,964 |
-46 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
Pancreas |
Pancreas |
||||||||
|
Best group rates (Mer Indian) |
Best group rates (American Indian) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
5,504 |
12,610 |
|
|
TOTAL |
8,168 |
13,512 |
|
|
White |
4,910 |
10,951 |
|
|
White |
7,290 |
11,664 |
|
|
Black |
450 |
1,449 |
|
|
Black |
701 |
1,650 |
|
|
American Indian |
27 |
27 |
|
|
American Indian |
34 |
34 |
|
|
Asian Pacific Islander |
117 |
183 |
|
|
Asian Pacific Islander |
142 |
163 |
|
|
Hispanic |
273 |
440 |
|
|
Hispanic |
353 |
441 |
|
|
Non-Hispanic |
5,232 |
12,169 |
|
|
Non-Hispanic |
7,815 |
13,071 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
7,105 |
-56 |
|
|
TOTAL |
5,344 |
-40 |
|
|
White |
6,041 |
-55 |
|
|
White |
4,374 |
-37 |
|
|
Black |
999 |
-69 |
|
|
Black |
950 |
-58 |
|
|
American Indian |
0 |
-0 |
|
|
American Indian |
0 |
-0 |
|
|
Asian Pacific Islander |
65 |
-36 |
|
|
Asian Pacific Islander |
20 |
-13 |
|
|
Hispanic |
167 |
-38 |
|
|
Hispanic |
88 |
-20 |
|
|
Non-Hispanic |
6,938 |
-57 |
|
|
Non-Hispanic |
5,255 |
-40 |
|
Ovary |
||||||||
|
|
Best group rates (As Pacific Islander) |
|||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
6,403 |
13,081 |
||||
|
|
|
White |
5,614 |
11,888 |
||||
|
|
|
Black |
611 |
1,012 |
||||
|
|
|
American Indian |
33 |
35 |
||||
|
|
|
Asian Pacific Islander |
146 |
146 |
||||
|
|
|
Hispanic |
341 |
413 |
||||
|
|
|
Non-Hispanic |
6,062 |
12,668 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
6,678 |
-51 |
||||
|
|
|
White |
6,275 |
-53 |
||||
|
|
|
Black |
401 |
-40 |
||||
|
|
|
American Indian |
2 |
-6 |
||||
|
|
|
Asian Pacific Islander |
(0) |
0 |
||||
|
|
|
Hispanic |
72 |
-18 |
||||
|
|
|
Non-Hispanic |
6,605 |
-52 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
Stomach |
Stomach |
||||||||
|
Best group rates (White) |
Best group rates (White) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
7,329 |
8,198 |
|
|
TOTAL |
5,004 |
5,634 |
|
|
White |
6,539 |
6,540 |
|
|
White |
4,463 |
4,463 |
|
|
Black |
599 |
1,327 |
|
|
Black |
432 |
928 |
|
|
American Indian |
35 |
38 |
|
|
American Indian |
21 |
25 |
|
|
Asian Pacific Islander |
155 |
293 |
|
|
Asian Pacific Islander |
88 |
219 |
|
|
Hispanic |
362 |
519 |
|
|
Hispanic |
220 |
374 |
|
|
Non-Hispanic |
6,967 |
7,679 |
|
|
Non-Hispanic |
4,784 |
5,260 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
869 |
-11 |
|
|
TOTAL |
630 |
-11 |
|
|
White |
0 |
-0 |
|
|
White |
0 |
-0 |
|
|
Black |
728 |
-55 |
|
|
Black |
495 |
-53 |
|
|
American Indian |
3 |
-8 |
|
|
American Indian |
4 |
-14 |
|
|
Asian Pacific Islander |
138 |
-47 |
|
|
Asian Pacific Islander |
131 |
-60 |
|
|
Hispanic |
157 |
-30 |
|
|
Hispanic |
154 |
-41 |
|
|
Non-Hispanic |
712 |
-9 |
|
|
Non-Hispanic |
476 |
-9 |
|
Cervix |
||||||||
|
Best group rates (White) |
||||||||
|
|
|
|
Expected deaths |
Observed deaths |
||||
|
|
|
TOTAL |
3,976 |
4,578 |
||||
|
|
|
White |
3,438 |
3,439 |
||||
|
|
|
Black |
410 |
997 |
||||
|
|
|
American Indian |
23 |
34 |
||||
|
|
|
Asian Pacific Islander |
105 |
109 |
||||
|
|
|
Hispanic |
245 |
336 |
||||
|
|
|
Non-Hispanic |
3,731 |
4,242 |
||||
|
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
||||
|
|
|
TOTAL |
602 |
-13 |
||||
|
|
|
White |
0 |
-0 |
||||
|
|
|
Black |
588 |
-59 |
||||
|
|
|
American Indian |
10 |
-30 |
||||
|
|
|
Asian Pacific Islander |
4 |
-4 |
||||
|
|
|
Hispanic |
91 |
-27 |
||||
|
|
|
Non-Hispanic |
511 |
-12 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
Kidney/renal/pel |
Kidney/renal/pel |
||||||||
|
Best group rates (As Pac Islander) |
Best group rates (As Pacific Islander) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
2,433 |
6,350 |
|
|
TOTAL |
1,685 |
4,099 |
|
|
White |
2,163 |
5,715 |
|
|
White |
1,501 |
3,678 |
|
|
Black |
204 |
550 |
|
|
Black |
146 |
369 |
|
|
American Indian |
12 |
31 |
|
|
American Indian |
7 |
23 |
|
|
Asian Pacific Islander |
54 |
54 |
|
|
Asian Pacific Islander |
30 |
30 |
|
|
Hispanic |
127 |
257 |
|
|
Hispanic |
75 |
150 |
|
|
Non-Hispanic |
2,306 |
6,093 |
|
|
Non-Hispanic |
1,610 |
3,949 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
3,917 |
-62 |
|
|
TOTAL |
2,414 |
-59 |
|
|
White |
3,552 |
-62 |
|
|
White |
2,177 |
-59 |
|
|
Black |
346 |
-63 |
|
|
Black |
222 |
-60 |
|
|
American Indian |
19 |
-61 |
|
|
American Indian |
15 |
-68 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Hispanic |
130 |
-51 |
|
|
Hispanic |
75 |
-50 |
|
|
Non-Hispanic |
3,786 |
-62 |
|
|
Non-Hispanic |
2,339 |
-59 |
Other |
Other |
||||||||
|
Best group (Asian or Pacific Islander) |
Best group rates (As Pacific Islander) |
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
43,975 |
88,231 |
|
|
TOTAL |
42,373 |
75,355 |
|
|
White |
39,044 |
77,673 |
|
|
White |
37,556 |
66,372 |
|
|
Black |
3,738 |
9,352 |
|
|
Black |
3,814 |
7,950 |
|
|
American Indian |
225 |
238 |
|
|
American Indian |
196 |
225 |
|
|
Asian Pacific Islander |
968 |
968 |
|
|
Asian Pacific Islander |
808 |
808 |
|
|
Hispanic |
2,363 |
3,026 |
|
|
Hispanic |
2,036 |
2,462 |
|
|
Non-Hispanic |
41,612 |
85,205 |
|
|
Non-Hispanic |
40,337 |
72,893 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
44,256 |
-50 |
|
|
TOTAL |
32,981 |
-44 |
|
|
White |
38,629 |
-50 |
|
|
White |
28,816 |
-43 |
|
|
Black |
5,614 |
-60 |
|
|
Black |
4,136 |
-52 |
|
|
American Indian |
13 |
-6 |
|
|
American Indian |
29 |
-13 |
|
|
Asian Pacific Islander |
0 |
-0 |
|
|
Asian Pacific Islander |
(0) |
0 |
|
|
Hispanic |
662 |
-22 |
|
|
Hispanic |
425 |
-17 |
|
|
Non-Hispanic |
43,594 |
-51 |
|
|
Non-Hispanic |
32,556 |
-45 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
Prostate |
|
||||||||
|
Best group rates (As Pacific Islander) |
|
|||||||
|
|
|
Expected deaths |
Observed deaths |
|
||||
|
|
TOTAL |
14,221 |
34,070 |
|
||||
|
|
White |
12,826 |
28,261 |
|
||||
|
|
Black |
1,082 |
5,477 |
|
||||
|
|
American Indian |
59 |
78 |
|
||||
|
|
Asian Pacific Islander |
254 |
254 |
|
||||
|
|
Hispanic |
587 |
917 |
|
||||
|
|
Non-Hispanic |
13,634 |
33,153 |
|
||||
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
||||
|
|
TOTAL |
19,849 |
-58 |
|
||||
|
|
White |
15,436 |
-55 |
|
||||
|
|
Black |
4,394 |
-80 |
|
||||
|
|
American Indian |
19 |
-24 |
|
||||
|
|
Asian Pacific Islander |
(0) |
0 |
|
||||
|
|
Hispanic |
330 |
-36 |
|
||||
|
|
Non-Hispanic |
19,519 |
-59 |
|
||||
Nasopharynx |
Nasopharynx |
||||||||
|
Best group rates (Hispanic) |
|
Best group rates (Hispanic) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
299 |
450 |
|
|
TOTAL |
145 |
233 |
|
|
White |
264 |
312 |
|
|
White |
128 |
186 |
|
|
Black |
26 |
62 |
|
|
Black |
13 |
24 |
|
|
American Indian |
2 |
6 |
|
|
American Indian |
1 |
2 |
|
|
Asian Pacific Islander |
7 |
71 |
|
|
Asian Pacific Islander |
3 |
21 |
|
|
Hispanic |
17 |
17 |
|
|
Hispanic |
7 |
7 |
|
|
Non-Hispanic |
282 |
433 |
|
|
Non-Hispanic |
137 |
226 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
151 |
-33 |
|
|
TOTAL |
88 |
-38 |
|
|
White |
47 |
-15 |
|
|
White |
58 |
-31 |
|
|
Black |
36 |
-58 |
|
|
Black |
10 |
-44 |
|
|
American Indian |
4 |
-71 |
|
|
American Indian |
1 |
-66 |
|
|
Asian Pacific Islander |
63 |
-90 |
|
|
Asian Pacific Islander |
18 |
-86 |
|
|
Hispanic |
0 |
-0 |
|
|
Hispanic |
0 |
-0 |
|
|
Non-Hispanic |
151 |
-35 |
|
|
Non-Hispanic |
88 |
-39 |
Summary table of annual reductions "possible" for cancer (Method B) |
|||||||||
Liver & Intrahepatic bile |
Liver & Intrahepatic bile |
||||||||
|
Best group rates (White) |
|
Best group rates (White) |
||||||
|
|
|
Expected deaths |
Observed deaths |
|
|
|
Expected deaths |
Observed deaths |
|
|
TOTAL |
5,340 |
5,936 |
|
|
TOTAL |
3,571 |
3,829 |
|
|
White |
4,759 |
4,759 |
|
|
White |
3,174 |
3,174 |
|
|
Black |
440 |
752 |
|
|
Black |
315 |
461 |
|
|
American Indian |
26 |
31 |
|
|
American Indian |
16 |
21 |
|
|
Asian Pacific Islander |
114 |
394 |
|
|
Asian Pacific Islander |
66 |
174 |
|
|
Hispanic |
269 |
429 |
|
|
Hispanic |
163 |
252 |
|
|
Non-Hispanic |
5,071 |
5,507 |
|
|
Non-Hispanic |
3,407 |
3,577 |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
|
Estimated excess deaths |
Percent difference in observed and expected deaths |
|
|
TOTAL |
596 |
-10 |
|
|
TOTAL |
258 |
-7 |
|
|
White |
(0) |
0 |
|
|
White |
0 |
-0 |
|
|
Black |
312 |
-41 |
|
|
Black |
146 |
-32 |
|
|
American Indian |
4 |
-15 |
|
|
American Indian |
5 |
-23 |
|
|
Asian Pacific Islander |
280 |
-71 |
|
|
Asian Pacific Islander |
108 |
-62 |
|
|
Hispanic |
160 |
-37 |
|
|
Hispanic |
89 |
-35 |
|
|
Non-Hispanic |
436 |
-8 |
|
|
Non-Hispanic |
169 |
-5 |
This page in the original is blank. |