This article reviews the most current data on the leading causes of death in Alaska and the United States as a whole, and then focuses more closely on homicide and suicide. Policymakers often use data such as these to inform decisions about prevention programs and allocation of resources.
The five leading causes of death by age group for the U.S. in 2010 and for Alaska for the period 2007-2009 include suicide and/or homicide for ages 5 through 64 in Alaska, and ages 0 (birth) to 54 nationwide (see Table 1). These data are from the National Vital Statistics Report (NVSR) and from the Alaska Bureau of Vital Statistics. Both sets of data come from the causes of death reported on death certificates, and reflect causes of death classified according to the International Classification of Diseases (ICD). The ICD, now in its tenth version, is used by World Health Organization member states and allows for the coding of over 14,400 different disease and health problems. The death rates shown in Table 1 are age-specific death rates-the number of deaths per 100,000 persons in a particular age range in one year. For example, the age-specific death rate for SIDS for those aged 0 to 4 in Alaska is 26.0. This means that over the three-year time span of 2007-2009, in an average year, 26 out of 100,000 individuals in that age group died of SIDS. The Alaska data uses a three-year time span because our small population makes rates unstable. Just a small increase or decrease in numbers of deaths in an age group for a particular cause can make rates go up or down by large amounts. To better control for this variation, a period of three years is used.
Leading Causes of Death
The five leading causes of death for people up to age 25 are generally similar for both Alaska and the United States: cancer, heart disease, accidents, suicide, and homicide. The exceptions are children aged birth to 4 years, where a large portion of those deaths occur in the first year and are due to congenital malformations, conditions originating in the perinatal period, and sudden infant death syndrome (SIDS). Through ages 45-64, chronic conditions such as diabetes mellitus, chronic lower respiratory disease (e.g., asthma, emphysema and bronchitis), and chronic liver disease, become more frequent as causes of deaths. Among individuals over 65 years of ages, cerebrovascular diseases and Alzheimer's disease move into the top five causes of death. Unnatural death is more common among the young than the old.
Unintentional injury (accident) is the leading cause of death for all age groups from 5 to 44 years of age. The other unnatural death causes-homicide and suicide-are also in the top five for these age groups in the United States. In Alaska, for those aged 5 to 14 influenza and pneumonia combined cause more deaths than homicide, and for those aged 25 to 44 chronic liver disease and cirrhosis combined kill at the same rate as or higher than homicide.
While there are general similarities in the rankings of causes of death between Alaska and the United States, the differences in rates are notable, especially for accidents and suicides. The age-specific rate of accidental death is higher in Alaska than the United States for all age groups, even for those groups in which accidents are not among the five leading causes of death (see Table 2). The difference ranges between 111 percent higher (for those aged 55 to 64) and 261 percent higher (for those between 5 to 14 years old). A recent report by the Alaska Division of Public Health, the Alaska Injury Surveillance Report 2011, explores accidental death in great detail, and concludes that Alaska has a high rate of death due to unintentional injury for reasons such as many people being employed in high-risk jobs (i.e., mining, construction, oil extraction, and fishing) and regional characteristics in rural and frontier areas (i.e., weather conditions, occupations and lifestyle, and great distances to health care).
To develop a picture of homicide and suicide in Alaska, and compare it to other states, data from the National Violent Death Reporting System (NVDRS), a state-based reporting system operated by the Centers for Disease Control and Prevention (CDC), were used. The NVDRS connects data from a variety of sources, including death certificates, police reports, coroner or medical examiner records, and crime labs. The result is a database of homicides and suicides with details about things such as relationship between victim and offender, weapon usage, victim demographics, and place of incident. These anonymous data can be accessed by the public through the Web-based Injury Statistics Query and Reporting System (WISQARS) at http://www.cdc.gov/injury/wisqars/.
There are 18 states participating in the NVDRS, which began collecting data in 2003. In addition to Alaska, data from 15 other states were used in the analyses presented in this article: Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin.
During the years 2005-2010, there were 218 homicides in Alaska that were reported to the NVDRS. Table 3 compares the demographic characteristics of Alaska homicide victims to those from the other 15 states. When viewing these tables, the most important thing to look at is the death rates. These are standardized, so it is possible to compare populations of different sizes. A caveat about death rates is that they should be interpreted with caution when they are based on a raw number below 20; the NVDRS does not even report death rates when there are fewer than five deaths.
Overall, the death rate from homicide in Alaska is 5.27 deaths per 100,000 per year, which is slightly greater than the homicide death rate of 5.15 for the other 15 states. Comparing age groups, the Alaska death rate is higher than the death rate for the other 15 states for all age groups except those aged 15 to 24 and 25 to 34 (Table 3). While the homicide rate peaks in the 15 to 24 age group for the other 15 states, it does not peak until the 35 to 44 age group in Alaska.
With respect to race and ethnicity (Tables 3b and 3c), the age- and race-adjusted death rate (that is, a death rate based on the number of deaths in a year in a population of 100,000 people who are in both a particular age group and a certain racial or ethnic group) for whites is very close in Alaska and the other 15 states (3.00 versus 2.84). As seen in Figure 1, the big differences are found for blacks/African Americans (9.54 in Alaska and 15.62 in the other 15 states), Alaska Natives/American Indians (12.12 in Alaska and 6.79 in the other 15 states), and Asians/Pacific Islanders (7.12 in Alaska and 1.81 in the other 15 states). Blacks/African Americans were 9.6 percent of homicide victims in Alaska, but 52.7 percent of homicide victims in the other 15 states. Alaska Natives/American Indians comprised 36.4 percent of homicide victims in Alaska, and 2.1 percent in the other 15 states. These large percentage differences for blacks/African Americans and Alaska Natives/American Indians are primarily due to the differences in the racial makeup of the overall population in Alaska and in the other states included in the NVDRS.
Table 3d shows homicide by gender of the victim. In both Alaska and the other 15 states, males are killed at a much higher rate than females. In Alaska, males are killed at 2.25 times the rate of females. In the other fifteen states, males are killed 3.38 times the rate of females. Females are murdered at a higher rate (3.17) in Alaska than females in the other 15 states (2.35).
The combination of victim race/ethnicity and gender is shown in Table 3e. In Alaska, Alaska Native/American Indian males have the highest death rate due to homicide (16.27), followed by black/African American males (15.26), Asian/Pacific Islander males (11.31), and Alaska Native/American Indian females (7.88). In the other 15 states, black/African American males have the highest rate (27.43), followed by Alaska Native/American Indian males (10.68). All other combinations of race and gender in both samples have rates below 5.00 per 100,000 persons. In Alaska, Hispanics of both genders have lower death rates due to homicide compared to non-Hispanics. In the other 15 states, that pattern is true only for females; Hispanic males have a slightly higher death rate (8.03) than do non-Hispanic males (7.81).
Overall patterns of circumstances of death for homicide victims in Alaska and the other 15 states are similar (see Table 4). "Other argument, abuse, conflict" is the most common circumstance; "precipitated by another crime," "crime in progress," a "drug involvement," and "intimate partner violence related" rank among the top five. Drug involvement, arguments over money or property, person using weapon, and jealousy are more likely circumstances of death in Alaska than in the other 15 states.
The place of injury that led to death for homicide victims is shown in Table 5. For both Alaska and the other 15 states, dwellings and places around homes, such as driveways, porches and yards, is the most common place for injury to occur, followed by a transport area-public highway, street or road. Alaska homicide victims, compared to those in the other 15 states, are more likely to be fatally injured in or around a dwelling (60.1% versus 51.7%).
Comparisons between the 879 suicides that occurred in Alaska in the years 2005 to 2010 and those that occurred in the other 15 states show striking differences (Table 6). Suicide by age group is shown in Table 6a. Age-specific suicide rates for all age groups are higher in Alaska. Not only do Alaskans commit suicide at a higher rate than the comparison population (21.28 versus 11.34), they tend to do so at younger ages. The 10 to 14-year-old group in Alaska has a rate of 2.88, which is over 2.5 times greater than the rate of 1.13 per 100,000 in the other 15 states. The greatest difference between the rates is for the 15 to 24-year-old group. The Alaska rate is 34.77, over 3.5 times larger than the other 15 states' rate of 9.85. The rate of 44.01 for Alaskans aged 85 and over (as well as the rate for the 10-14 age group) should be interpreted with caution because of the low numbers upon which the rates were calculated.
The racial and ethnic characteristics of suicide victims are shown in Tables 6b and 6c. Alaska Natives/American Indians in Alaska have the highest suicide rate of all groups (39.75), but in the other 15 states, this group's suicide rate is not only four times lower (9.90), it is lower than that for whites, who have the highest suicide rate of any racial group in the other 15 states, at 12.76. Overall, blacks/African Americans, Asians/Pacific Islanders, and Hispanics have lower suicide rates than whites, although the suicide rate for Hispanics in Alaska is 15.41, higher than the suicide rate for whites in the other 15 states. The differences across racial groups and samples are displayed graphically in Figure 2.
Males commit suicide at much higher rates than females. While the death rates are higher for both sexes in Alaska, there were 3.8 male suicide deaths for every female suicide death in both Alaska and the other 15 states (see Table 6d).
If data for gender and race/ethnicity are combined, Alaska Native/American Indian males in Alaska have the highest suicide rate of any group (see Table 6e). Indeed, their suicide rate of 61.25 is almost four times as high as the suicide rate for Alaska Natives/American Indians in the other 15 states. Even though females have a much lower suicide rate, the risk factor of being Alaska Native/American Indian living in Alaska trumps gender; Alaska Native/American Indian females in Alaska have the third highest suicide rate overall (17.74), higher than the suicide rate of Alaska Native/American Indian males living in the other 15 states (15.55), and almost four times higher than the suicide rate of Alaska Native/American Indian females in the other 15 states (4.59). The lowest suicide rates were for Asian/Pacific Islander and black/African American females in the other 15 states (3.34 and 1.49 respectively). In Alaska, there were so few suicides within these two groups over the six years included in the data that death rates were not calculated.
This article compared Alaska to the United States as a whole with respect to the leading causes of death. While the ranking of causes of death in Alaska is similar to the United States' ranking, age-specific death rates are higher in Alaska for two unnatural causes of death: suicide and unintentional injury (accidents).
A closer focus on homicide and suicide compared Alaska to a group of 15 other states who also participate in the National Violent Death Reporting System: Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin. Alaska's death rate due to homicide is about the same as it is in these other 15 states taken as a whole, but the death rate for Alaska Natives/American Indians and Asians/Pacific Islanders in Alaska is higher than it is for these groups in the other 15 states. Conversely, the homicide death rate is much higher for blacks/African Americans in the other 15 states than it is in Alaska.
The suicide rate in Alaska is almost twice that in the other 15 states. Suicide in Alaska is particularly prevalent among young people (aged 15 to 24), Alaska Natives/American Indians, and males. The age-specific death rate by suicide for Alaska Native/American Indian males between 15 and 24 years old is 154.15, a rate over seven times greater than that for the entire Alaska population (data not shown in tables).
The high rate of suicide among young Alaska Native/American Indian people is well-known. A 2012 bulletin from the Epidemiology Section of the Alaska Department of Health and Human Services uses data similar to those used for this article, and describes the characteristics of suicide more comprehensively than is possible in this short space. (See resource list below.)
In response to the high rate of suicide among Alaska's population, prevention efforts have been implemented statewide by a number of Alaska agencies and organizations. The Alaska Department of Health and Social Services (DHSS) Statewide Suicide Prevention Council has a five-year state suicide prevention plan (FY 2012-2017) and a community-based suicide prevention program. This program includes the Alaska Youth Suicide Prevention Project. Alaska has also launched the Alaska Suicide Prevention Web Portal at http://www.stopsuicidealaska.org/.
Prevention efforts focused on the Alaska Native community include an approach taken by Chugachmiut, a tribal consortium of seven Native communities in the Chugach region of Alaska, which is framed around the concept of adverse childhood experiences (ACEs) and focuses on reducing negative coping behaviors. In northwest Alaska, suicide-prevention wilderness camps for youth are offered by the Maniilaq Association and the Kawerak Association. The Alaska Native Tribal Health Consortium has developed an initiative aimed at reducing the number of suicides and suicide attempts by Alaska Native people by 15 percent by the year 2015.
Sharon Chamard is an associate professor with the Justice Center.