health of native americans in the united states health of native americans in the united states native americans are affected by noncommunicable illnesses related to social changes and contemporary eating habits. increasing rates of obesity, poor nutrition, sedentary lifestyle, and social isolation affect many americans. while subject to the same illnesses, native americans have higher morbidity and mortality to diabetes and cardiovascular disease as well as certain forms of cancer. social and historical factors tend to promote unhealthy behaviors including suicide and alcohol dependence. reduced access to health care in native american communities means that these diseases as well as infections affect more people for longer periods of time. noncommunicable diseases the leading causes of death by percentage for native americans and alaska natives for 2005. heart disease accounted for 25% of deaths, cancer 22%, accidents 19%, diabetes 7%, liver disease 6%, suicide 6%, respiratory diseases 6%, stroke 4%, homicide 3%, and influenza and pneumonia 3%. native americans share many of the same health concerns as their non-native american, united states citizen counterparts. for instance, native americans' leading causes of death include "heart disease, cancer, unintentional injuries (accidents), diabetes, and stroke". other health concerns include "high prevalence and risk factors for mental health and suicide, obesity, substance use disorder, sudden infant death syndrome (sids), teenage pregnancy, liver disease, and hepatitis." the leading causes of death for native americans include the following: heart disease, cancer, diabetes, and chronic liver disease / cirrhosis. overall, native american life expectancy at birth (as of 2008) is 73.7 years, 4.4 years shorter than the united states average. though these diseases are also prevalent among non-native americans, some present a much greater threat to native americans' health. american indians and alaska natives die at greater rates from: chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries, assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases. these discrepancies in disease patterns vary significantly among diseases, but have a significant effect on the population. the genetic composition of native americans and clans can have an influence on many diseases and their continuing presence. the commonly lower socioeconomic status limits the ability of many to receive adequate health care and make use of preventive measures. also, certain behaviors that take place commonly in the native american culture can increase risk of disease. when the period of tribal termination in the 20th century occurred, some tribes that were terminated could no longer afford to keep their hospitals open. in the early 21st century, native americans were documented as having higher rates of tobacco use than white, asian, or black communities. native american men are about as likely to be moderate to heavy drinkers as white men, but about 5–15% more likely to be moderate to heavy drinkers than black or asian men. native americans are 10% less likely to be at a healthy weight than white adults, and 30% less likely to be at a healthy weight than asian adults. on a similar note, they have far greater rates of obesity, and were also less likely to engage in regular physical activity than white adults. data collected by means of secondary sources, such as the us census bureau and the centers for disease control and prevention's national center for health statistics, showed that from 1999 to 2009, alaska natives and native americans had high mortality rates from infectious diseases when compared to the mortality rate of white americans. alaska natives from the age groups 0–19 and 20–49 had death rates 4 to 5 times higher than compared to whites. native americans from the 20–49 age group in the northern plains were 4 to 5 times more likely to die to infectious diseases than whites. native american and alaska natives were 13 times more likely to contract tuberculosis than whites. native americans were at least twice as likely to have unmet medical needs due to cost. they were much less likely to have seen a dentist within the last five years compared with white or asian adults, putting them at risk for gingivitis and other oral diseases. native american/ alaska natives face high rates of health disparity compared to other ethnic groups. heart disease the leading cause of death of native americans is heart disease. in 2005, 2,659 native americans died of this cause. heart disease occurs in native american populations at a rate 20 percent greater than all other united states races. additionally, the demographic of native americans who die from heart disease is younger than other united states races, with 36% dying of heart disease before age 65. the highest heart disease death rates are located primarily in south dakota and north dakota, wisconsin, and michigan. heart disease among native americans is due not only to diabetic complications, but also to higher rates of hypertension. native american populations have been documented as being more likely to have high blood pressure than other groups, such as white european americans. some studies associate the exposure to stress and trauma to an increased rate of heart disease. it has been documented in native american populations that adverse childhood experiences, which are significantly more common in the native american demographic, have a positively linear relationship with heart disease, as well an increasing influence on symptoms of heart disease. cancer cancer is documented among native americans. the rates of certain types of cancer exceed that of the general population of the united states. for instance, in 2001–05 native american males were twice as likely to have liver cancer than in white males. women are 2.4 times as likely to contract and die from liver cancer as their white counterparts. rates of alcohol use disorder of native americans are greater than in the general population. stomach cancer was 1.8 times more common in native american males than white males, and was twice as likely to be fatal. other cancers, such as kidney cancer, are more common among native american populations. but overall cancer rates are lower among native americans than among the white population of the united states. for cancers that are more prevalent in native americans than the white united states population, death rates are higher. diabetes the rates of death by diabetes for each race and ethnicity in the united states in 2005 diabetes has posed a significant health risk to native americans. type i diabetes is rare among native americans. type ii diabetes is a much more significant problem; it is the type of diabetes discussed in the remainder of this section. diabetes began to occur at higher rates among native americans in the middle of the twentieth century and has increased into what is called an epidemic. this time frame relates to generations having grown up on reservations, and, in some cases, adopting mainstream food and cultural patterns. they were largely prevented from following their traditional patterns of hunting and gathering, and they changed their traditional eating patterns. about 16.3% of native american adults have been diagnosed with diabetes. type two diabetes and its complications have become chronic illnesses within native american and alaska native communities. native americans and alaska natives have high rates of end-stage renal disease, which is mainly driven by, and directly correlates with, the increase in diabetes within their communities. native americans are about 2.8 times more likely to have type ii diabetes than whites of comparable age. the rates of diabetes among native americans continue to rise. from 1990 to 1998, the rate of diabetes increased 65% among the native american population. this is very significant growth, and this growth continues in the present day. the highest rates of diabetes in the world are found among a native american tribe. the pima tribe of arizona took part in a research study on diabetes which documented diabetes rates within the tribe. this study found that the pimas had diabetes rates 13 times that of population of rochester, minnesota, which is predominately european american in ethnicity. diabetes was documented in over one third of the pima from ages 35–44, and in over sixty percent of those over 45 years of age. there are multiple factors contributing to the prevalence of diabetes among native americans: genetic predispositionnative americans with the "least genetic admixture with other groups" have been found to be at a higher risk of developing diabetes. the genetic makeup of the american indian allowed their bodies to store energy for use in times of famine. when food was plentiful, their bodies stored excess carbohydrates through an exaggerated secretion of insulin called hypersulinemia, and were able to use this stored energy when food was scarce. when feast or famine was no longer an issue, and food was always plentiful, with modern, high caloric foods, their bodies may not have been able to handle the excess fat and calories, resulting in type ii diabetes. obesityobesity is a significant health problem for native americans, as they are 1.6 times more likely to be obese than white americans. native americans are as likely as black adults to be obese. obesity is known as a general causative factor of diabetes, and is related to the changes if diet as noted above. low birth weightthe correlation between low birth weight and increased risk of diabetes has been documented in native american populations. dietchanges in native american diets have been associated with the increase in diabetes, as more high calorie and high fat foods are consumed, replacing the traditionally agriculturally driven diet. some tribes have begun programs to encourage their people to return to traditional ways to include growing, preparing, and eating traditional foods. several federal agencies are also trying to help. the centers for disease control and prevention (cdc) has also encouraged this approach; in 2013, it produced a public service announcement (psa), in which cherokee actors discussed diabetes, and the significance of diet on their increased risk. in the early 21st century, such agencies as the ihs (part of the u.s. public health svc.) & the division of diabetes treatment and prevention (ddtp) have offered 19 diabetes programs, 12 control officers, and 399 grant programs such as sdpi (special diabetes program for indians), aimed at aiding native americans to abolish diabetes for good. diabetes' effects the prevalence of diabetes has resulted in related health complications, such as end-stage renal disease. each of these is more prevalent in the native american population. diabetes has increased the rate of premature death of native americans by vascular disease, especially among those diagnosed with diabetes later in life. it has been reported among the pima tribe to cause elevated urinary albumin excretion. native americans with diabetes have a significantly higher rate of heart disease than those without diabetes. cardiovascular disease is the "leading underlying cause of death in diabetic adults" in native americans. diabetes can cause nephropathy, leading to renal function deterioration, failure, and disease. prior to the increase in cardiovascular disease among diabetic native americans, renal disease was the leading cause of death for this population. another complication documented in diabetic native americans, as well as other diabetic populations, is retinopathy, causing the loss of sight. because of vascular and nerve damage from diabetes, native americans have a higher rate of lower extremity amputations than european americans. in studies of the pima tribes, those with diabetes were also found to have much higher prevalence of periodontal disease, and higher rates of bacterial and fungal infection. for instance, "diabetic sioux (lakota people) tribes were four times as likely to have tuberculosis as those without diabetes." native americans with diabetes have a death rate three times higher than those in the non-native population. diabetes can shorten a person's life by approximately 15 years. as of 2012, diabetes was not the leading cause of death for native americans but contributed significantly to the top leading causes of death. the barriers for native americans and alaskan natives to receive proper health care include the isolated locations of some tribes, and social isolation related to poverty. travel to health facilities can be too difficult, given distance, hazardous roads, high rates of poverty, and too few staff in hospitals near reservations. diabetes is the primary cause of end-stage renal disease. dialysis treatments and kidney transplants remain the most effective methods of treatment, but distance limits access to the first, as noted above. in addition, native people are documented as having