Skip directly to searchSkip directly to the site navigationSkip directly to the page's main content
Skip directly to searchSkip directly to the site navigationSkip directly to this page's context menuSkip directly to the page's main content
State of Alaska

Complete Health Indicator Report of Cancer Mortality Rate - All (HA2020 Leading Health Indicator: 1)

Definition

Rate of mortality from all cancers per 100,000 population.

Numerator

Number of deaths due to cancer for a specific time period in the resident population.

Denominator

Mid-year resident population for a specific time period.

Data Interpretation Issues

Cancer cases are invasive, except for special instances such as bladder cancers that include in situ. Mortality rates may vary from source to source. This may be due to using provisional data or using different population databases. The cancer mortality rates provided by the [http://dhss.alaska.gov/dph/chronic/pages/cancer/registry.aspx Alaska Cancer Registry] use population estimates provided by the [http://seer.cancer.gov/ Surveillance, Epidemiology, and End Results Program (SEER)] of the [http://www.cancer.gov/ National Cancer Institute]. In contrast, the [http://dhss.alaska.gov/dph/VitalStats/Pages/data/default.aspx Alaska Bureau of Vital Statistics] uses [http://labor.alaska.gov/research/pop/popest.htm population estimates] provided by the State Demographer in the [http://laborstats.alaska.gov/ Research and Analysis Section] of the [http://labor.alaska.gov/ Alaska Department of Labor and Workforce Development].

Why Is This Important?

Although there have been declines in the death rates for cancer overall over the past decade, cancer remains the leading cause of mortality among all Alaskans and among Alaska Native people. Cancer mortality represents an important public health concern not only because of the burden of cancer among the population, but because there are effective means for cancer prevention and for the early detection and treatment of cancer. Monitoring cancer mortality rates is an important way to assess efforts being made to prevent and treat cancer, including screening efforts. Several other HA2020 leading health indicators are related to this objective because they monitor risk factors associated with cancer, such as tobacco use, physical activity, and diet.

Healthy People Objective: Reduce the overall cancer death rate

U.S. Target: 160.6 deaths per 100,000 population
State Target: Healthy Alaskans 2020 Target: 162.0 per 100,000 population

How Are We Doing?

Malignant neoplasms, or cancer, is the number one leading cause of death in Alaska. In 2015, cancer claimed the lives of 962 Alaskans. More Alaskans died from cancer of the trachea, bronchus, and lung than any other type of cancer; 145 males and 112 females.^1^ Among the leading causes of death in Alaska, cancer ranked second in total years of potential life lost with 9,214 years lost. On average, 9.6 years of life were lost prematurely for each cancer death.^1^ Since 2006, the crude death rate for cancer has increased 12.6%. During this same time period, the age-adjusted death rate for cancer has decreased 14.4%.^1^ In 2015, the age-adjusted cancer mortality rate for all Alaskans was 152.9 per 100,000 population. Alaska Native residents had an age-adjusted cancer mortality rate of 235.9 per 100,000, over 50% higher than the rate for all Alaskans. Overall cancer mortality has decreased by a third in Alaska from levels of over 200 individuals per 100,000 in the period between 1990 and 2000 to just under 155 individuals in 2015. Cancer mortality levels for Alaska Native people have been statistically higher than for white Alaskans for the period from 2000. The Northern region had the significantly highest cancer mortality with a rate of 238.1 per 100,000 in the 5-year period from 2010-2014. The next highest cancer mortality level was in the Southwest region with 219.7 per 100,000, which was significantly higher than the remaining regions of Alaska. In 2015, the cancer mortality rate for all Alaskans remained below the Healthy Alaskans 2020 goal of 162.0 deaths per 100,000 population.[[br]][[br]] ---- {{class .SmallerFont 1. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2015 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2015.pdf]. Accessed February 7, 2017. }}

How Do We Compare With the U.S.?

Overall cancer mortality in Alaska has tracked closely with the rate for the United States as a whole. In 2014, the cancer mortality rate for the U.S. was 161.2 per 100,000 and 159.1 per 100,000 for all Alaskans. Although the annual rates for Alaska are more variable, they are following the same downward tend seen nationally.

What Is Being Done?

The [http://dhss.alaska.gov/Pages/default.aspx Alaska Department of Health and Social Services] initiated the [http://dhss.alaska.gov/dph/Chronic/Pages/Cancer/comprehensive.aspx Alaska Comprehensive Cancer Control Program (CCCP)], a statewide partnership whose goal is to reduce the burden of cancer. The mission of the CCCP is to lower cancer incidence and mortality in Alaska through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, lung, prostate, skin, breast, ovarian, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation and prevention.

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, groups of Alaskan subject matter experts met over a period of months in a rigorous review process to identify and prioritize strategies to address the 25 health priorities. Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. '''Strategy 1:''' [[br]]Increase breast, cervical and colorectal cancer screening. '''Evidence Base:''' [[br]]Screening increases the chances of detecting certain cancers early, when they are most likely to be curable. Increasing screening rates will reduce the rate of deaths due to cancer in those cancers that can be screened for (breast, cervical and colorectal cancer). Currently 61% of Alaskans have been screened for colorectal cancer, 72% for breast cancer and 81% for cervical cancer (Alaska BRFSS 2010). '''Sources:''' [[br]] [http://archive.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide2012/abstract.htm Recommendations of the U.S. Preventive Services Task Force] [[br]][http://www.thecommunityguide.org/index.html The Community Guide] '''Strategy 2:''' [[br]]Increase participation in clinical trials. '''Evidence Base:''' [[br]]Participation in clinical trials promotes the development of new cancer treatments and expands the number of options available to a cancer patient. Clinical trials also offer opportunities to try potentially effective new treatments. More effective diagnostic and treatment options will reduce cancer incidence and mortality. Only modest gains have been achieved in cancer mortality since 1993. Successful development of new cancer therapies requires translation of laboratory observations into the clinic, with clinical trials representing the application of the scientific method to this process. Fewer than 5% of adult cancer patients enroll in clinical trials. '''Source:''' [[br]][http://www.clinicaltrials.gov ClinicalTrials.gov] '''Strategy 3:''' [[br]]Increase use of patient navigation for improving access to cancer screening, timely diagnosis and treatment, and palliative care. '''Evidence Base:''' [[br]]Successful patient navigation supports those diagnosed with suspected cancers by eliminating barriers to timely screening, treatment, and supportive care of cancer and other chronic diseases. When implemented at the organizational level within a community, it results in increased efficiencies and improved screening rates. '''Source:''' [[br]][http://www.hpfreemanpni.org/our-model/ Harold P. Freeman Patient Navigation Institute] A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_1_Cancer.pdf].

Health Program Information

'''Strategy 1:''' [[br]]Increase breast, cervical and colorectal cancer screening. '''Action 1:''' [[br]]Conduct community education around cancer screening through evidence based interventions. Examples include: [http://www.cdc.gov/cancer/nbccedp/ National Breast and Cervical Cancer Early Detection Program (NBCCEDP)] Activities: [[br]]1) Outreach to rarely/never screened women utilizing paycheck stuffers and worksite presentations on Breast and Cervical Cancer Health Check (BCHC) programs [[br]]2) Outreach to underserved populations (those living in poverty, English as a second language) utilizing YWCA/BCHC Outreach ToolKit [[br]]3) Identify and provide outreach to regions with lowest statewide screening rates Colorectal Cancer Screening activities: [[br]]4) Present on colorectal cancer screening at professional and community conferences and meetings [[br]]5) Develop promotional videos by Alaskans who have been screened for colorectal cancer and make them available statewide through [http://www.alaskacolonhealth.org/] '''Key Partners:''' [[br]][http://anthctoday.org/community/ Alaska Native Tribal Health Consortium, Community Health Services (CHS)], Cancer Programs [http://www.cancer.org American Cancer Society] [http://50.28.64.252/services/hospital-services/screening-for-life-services/ Arctic Slope Native Association, Screening for Life] [https://www.southcentralfoundation.com/services/health-and-wellness-programs/cancer-preventionsupport/ Southcentral Foundation, Screening and Prevention Programs] [http://searhc.org/service/health-promotion/ SouthEast Alaska Regional Health Consortium, Breast and Cervical Health Program] [http://dhss.alaska.gov/dph/Chronic/Pages/Cancer/comprehensive.aspx Alaska Dept. of Health and Social Services (DHSS), Comprehensive Cancer Control Program] [http://www.muni.org/departments/health/pages/default.aspx Municipality of Anchorage, Health and Human Services] [http://dhss.alaska.gov/dph/wcfh/Pages/bchc/default.aspx Alaska DHSS, Breast and Cervical Health Check Program] [http://www.ykhc.org/services/womens-health/ Yukon Kuskokwim Health Corporation, Breast and Cervical Health Check Program]


Related Indicators

Relevant Population Characteristics

The risk of developing cancer increases with increasing age.

Related Relevant Population Characteristics Indicators:


Related Health Care System Factors Indicators:


Risk Factors

Increasing age is a risk factor for developing cancer.

Related Risk Factors Indicators:




Graphical Data Views

Cancer mortality rate, all ages (age-adjusted), all Alaskans, Alaska Natives, and U.S., 2001-2020

::chart - missing::
confidence limits

Alaska ComparisonsYearCancer mortality per 100,000 populationLower LimitUpper LimitNumer- atorDenom- inator
Record Count: 56
All Alaskans2000209.6205.9213.4708626,932
All Alaskans2001193.3189.7196.9680632,716
All Alaskans2002191.2187.8194.6712641,729
All Alaskans2003190.2186.8193.6732649,466
All Alaskans2004186.5183.2189.8723659,653
All Alaskans2005171.7168.6174.8723667,146
All Alaskans2006178.7175.6181.8781674,583
All Alaskans2007184.0181.0187.1837680,169
All Alaskans2008180.9178.0183.9856686,818
All Alaskans2009184.5181.5187.4891697,828
All Alaskans2010176.1173.3179.0880710,231
All Alaskans2011174.0935722,818
All Alaskans2012163.4923731,191
All Alaskans2013167.51,012735,662
All Alaskans2014158.8968735,601
All Alaskans2015152.9962
Alaska Native people2000239.3229.1249.6125107,929
Alaska Native people2001255.5245.0265.9141108,430
Alaska Native people2002251.5241.2261.9143109,873
Alaska Native people2003248.7238.6258.8141111,314
Alaska Native people2004275.2264.9285.5153112,356
Alaska Native people2005212.0202.8221.2134113,773
Alaska Native people2006243.7234.0253.5159114,977
Alaska Native people2007274.6264.5284.7180115,421
Alaska Native people2008223.2214.2232.2154115,969
Alaska Native people2009251.2242.1260.2173117,974
Alaska Native people2010238.9230.0247.8178120,433
Alaska Native people2011240.7177
Alaska Native people2012242.3233.6250.9181122,687
Alaska Native people2013275.3213123,217
Alaska Native people2014213.1170
Alaska Native people2015235.9190
U.S.2000199.6
U.S.2001196.5
U.S.2002194.3
U.S.2003190.9
U.S.2004186.8
U.S.2005185.1
U.S.2006181.8
U.S.2007179.3
U.S.2008176.4
U.S.2009173.5
U.S.2010172.8
U.S.2011169.0
U.S.2012166.5
U.S.2013163.2
U.S.2014161.2
U.S.2015158.5
Healthy Alaskans Goal2013162.0
Healthy Alaskans Goal2014162.0
Healthy Alaskans Goal2015162.0
Healthy Alaskans Goal2016162.0
Healthy Alaskans Goal2017162.0
Healthy Alaskans Goal2018162.0
Healthy Alaskans Goal2019162.0
Healthy Alaskans Goal2020162.0

Data Notes

Age-adjusted to U.S. 2000 population. Number of deaths due to cancer defined as International Classification of Diseases (ICD)-9 codes 140-208 and ICD-10 codes C00-C97) as the underlying cause of death among residents during a calendar year. Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions. Interpretation of increases or decreases in cancer mortality can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect cancer mortality. In addition, certain cancers are not amenable to primary prevention or screening.   Alaska/Alaska Native - Alaska Bureau of Vital Statistics U.S. - Centers for Disease Control and Prevention - National Center for Health Statistics - Mortality Data Release Series

Data Sources

  • [http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Health Analytics and Vital Records], Division of Public Health, Alaska Department of Health and Social Services
  • National Center for Health Statistics


Cancer Death Rate, Alaska and U.S., 1990-2015

::chart - missing::
confidence limits

Geog: Alaska vs. U.S.YearRate per 100,000 (age-adjusted)Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 52
All Alaskans1990213.0208.2217.9469550,043
All Alaskans1991215.8211.0220.6499569,054
All Alaskans1992221.8217.1226.4515586,722
All Alaskans1993223.8219.2228.4565596,906
All Alaskans1994213.6209.2218.0566600,622
All Alaskans1995203.7199.5207.8572601,581
All Alaskans1996222.5218.2226.7651605,212
All Alaskans1997197.8193.9201.7615609,655
All Alaskans1998202.3198.4206.2649617,082
All Alaskans1999192.5188.8196.1622622,000
All Alaskans2000209.6205.9209.6708626,932
All Alaskans2001193.3189.7196.9680632,716
All Alaskans2002191.2187.8194.6712641,729
All Alaskans2003190.2186.8193.6732649,466
All Alaskans2004186.5183.2189.8723659,653
All Alaskans2005171.7168.6174.8723667,146
All Alaskans2006178.7175.6181.8781674,583
All Alaskans2007184.0181.0187.1837680,169
All Alaskans2008180.9178.0183.9856686,818
All Alaskans2009184.5181.5187.4891697,828
All Alaskans2010176.1173.3179.0880710,231
All Alaskans2011174.0935722,818
All Alaskans2012163.5923731,191
All Alaskans2013167.51,012735,662
All Alaskans2014158.8968735,601
All Alaskans2015152.9962
U.S.1990203.2505,322
U.S.1991204.1514,657
U.S.1992204.1520,578
U.S.1993205.6529,904
U.S.1994205.2534,310
U.S.1995204.9538,455
U.S.1996203.4539,533
U.S.1997201.6539,577
U.S.1998200.3541,532
U.S.1999201.6549,838
U.S.2000199.6553,091281,421,906
U.S.2001196.5553,768284,968,955
U.S.2002194.3557,271287,625,193
U.S.2003190.9556,902290,107,933
U.S.2004186.8553,888292,805,298
U.S.2005185.1559,312295,516,599
U.S.2006181.8559,888298,379,912
U.S.2007179.3562,875301,231,207
U.S.2008176.4565,469304,093,966
U.S.2009173.5567,628306,771,529
U.S.2010172.8574,743308,745,538
U.S.2011169.0576,691311,591,917
U.S.2012166.5582,623313,914,040
U.S.2013163.2584,881316,128,839
U.S.2014161.2591,699
U.S.2015158.5

Data Notes

Age-adjusted to U.S. 2000 population. Number of deaths due to cancer defined as International Classification of Diseases (ICD)-9 codes 140-208 and ICD-10 codes C00-C97) as the underlying cause of death among residents during a calendar year. Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions. Interpretation of increases or decreases in cancer mortality can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect cancer mortality. In addition, certain cancers are not amenable to primary prevention or screening.   The International Classification of Diseases has been revised approximately every ten years since 1900. The latest revision, ICD-10, was implemented in 1999 replacing ICD-9, the standard since 1979. ICD-10 differs from ICD-9 in several respects. ICD-10 is far more detailed with about 8,000 categories compared with 5,000 in ICD-9. Some of the coding rules and rules for selecting the underlying cause of death have also been changed. These changes create discontinuities in cause-of-death statistics and are critical to the interpretation of mortality trends. Comparability ratios have been created for many cause-of-death classifications in order to reduce the impact of these changes but caution should be used when interpreting trends across the Ninth and Tenth ICD revisions.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Health Analytics and Vital Records], Division of Public Health, Alaska Department of Health and Social Services


Cancer mortality rate, all ages (age-adjusted), Alaska Natives, white, and all Alaskans, 2000-2015

::chart - missing::
confidence limits

Race: AK Native, White, AlaskaYearRate per 100,000 (age-adjusted)Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 47
Alaska Native people2000239.3229.1249.6125107,929
Alaska Native people2001255.5245.0265.9141108,430
Alaska Native people2002251.5241.2261.9143109,873
Alaska Native people2003248.7238.6258.8141111,314
Alaska Native people2004275.2264.9275.2153112,356
Alaska Native people2005212.0202.8221.2134113,773
Alaska Native people2006243.7234.0253.5159114,977
Alaska Native people2007274.6264.5284.7180115,421
Alaska Native people2008223.2214.2232.2154115,969
Alaska Native people2009251.2242.1260.2173117,974
Alaska Native people2010238.9230.0247.8178120,433
Alaska Native people2011240.7177122,102
Alaska Native people2012242.3233.6250.9181122,687
Alaska Native people2013275.3213123,217
Alaska Native people2014213.1170123,528
Alaska Native people2015235.9190
White2000205.4201.2209.7531460,021
White2001184.7180.7188.7497463,075
White2002182.9182.9186.7522468,097
White2003184.4180.6188.2549472,059
White2004174.6171.0178.2530478,660
White2005164.9161.4168.3528482,786
White2006173.2169.7176.7581487,277
White2007170.1166.7173.4599490,232
White2008175.4172.1178.8635493,820
White2009181.3177.9184.6671499,690
White2010165.7162.6168.8631507,457
White2011165.3685514,166
White2012154.6672517,933
White2013150.8710519,200
White2014154.0728517,168
White2015142.9696
All Alaskans2000209.6205.9209.6708626,932
All Alaskans2001193.3189.7196.9680632,716
All Alaskans2002191.2187.8194.6712641,729
All Alaskans2003190.2186.8193.6732649,466
All Alaskans2004186.5183.2189.8723659,653
All Alaskans2005171.7168.6174.8723667,146
All Alaskans2006178.7175.6181.8781674,583
All Alaskans2007184.0181.0184.0837680,169
All Alaskans2008180.9178.0183.9856686,818
All Alaskans2009184.5181.5187.4891697,828
All Alaskans2010176.1173.3179.0879710,231
All Alaskans2011174.1171.3176.8934722,818
All Alaskans2012163.5160.9166.1923731,191
All Alaskans2013167.7165.1170.31,012735,662
All Alaskans2014159.1156.6161.6968735,601

Data Notes

Age-adjusted to U.S. 2000 population. Number of deaths due to cancer defined as International Classification of Diseases (ICD)-9 codes 140-208 and ICD-10 codes C00-C97) as the underlying cause of death among residents during a calendar year. Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions. Interpretation of increases or decreases in cancer mortality can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect cancer mortality. In addition, certain cancers are not amenable to primary prevention or screening.   Data updated by BVS Research on May 2, 2016.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Health Analytics and Vital Records], Division of Public Health, Alaska Department of Health and Social Services


Cancer mortality rate, all ages (age-adjusted), by Alaska Economic Regions, 2010-2014 (5-year average)

::chart - missing::
confidence limits

Rate per 100,000 (age-adjusted)Lower LimitUpper LimitNumer- atorDenom- inator
Record Count: 7
Anchorage - Mat-Su162.1160.5163.72,4121,955,928
Gulf Coast156.3153.2159.4623400,602
Interior169.3166.1172.4650565,714
Northern238.1229.5246.7191135,612
Southeast166.8163.5166.8596399,585
Southwest219.7212.7226.7221178,062
Statewide167.3166.1168.54,7063,635,503

Data Notes

Age-adjusted to U.S. 2000 population. Number of deaths due to cancer defined as International Classification of Diseases (ICD)-9 codes 140-208 and ICD-10 codes C00-C97) as the underlying cause of death among residents during a calendar year. Cancer is not a single disease, but rather numerous diseases with different causes, risks, and potential interventions. Interpretation of increases or decreases in cancer mortality can be made only by examination of specific types of cancers. Because certain cancers have a long latency period, years might pass before changes in behavior or clinical practice patterns affect cancer mortality. In addition, certain cancers are not amenable to primary prevention or screening.   Data updated by Alaska Bureau of Vital Statistics, May 2, 2016.

Data Source

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Alaska Health Analytics and Vital Records], Division of Public Health, Alaska Department of Health and Social Services

References and Community Resources

'''References:''' 1. Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2015 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2015.pdf]. Accessed February 7, 2017. '''Resources:''' Alaska Comprehensive Cancer Control Program. [http://dhss.alaska.gov/dph/Chronic/Pages/Cancer/comprehensive.aspx ] Alaska Department of Health and Social Services, Division of Public Health, Health Analytics and Vital Records Section. Alaska Vital Statistics 2015 Annual Report. [http://dhss.alaska.gov/dph/VitalStats/Documents/PDFs/VitalStatistics_Annualreport_2015.pdf]. Susan G. Komen Foundation. [http://www.komen.org] American Cancer Society. [http://www.cancer.org] National Cancer Institute. [http://www.cancer.gov] [http://www.cdc.gov Centers for Disease Control and Prevention] American Society of Clinical Oncology. [http://www.asco.org]

More Resources and Links

Alaska and national goals may be found at the following sites:

Alaska health promotion resources may be found at the following site:

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Maps of health indicators for various subdivisions of Alaska may be found at the following site:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

AK-IBIS Web Citation

Use and reproduction of the information published on this website are encouraged and may be done without permission. The following citation should accompany information from this website whenever it is used, reproduced, or published:

AK-IBIS Indicator Citation:
"[Indicator name]. Retrieved on [insert date] from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Example:
Diabetes Prevalence. Retrieved on March 25, 2016, from Alaska Department of Health and Social Services, Indicator-Based Information System for Public Health (AK-IBIS) website: http://ibis.dhss.alaska.gov/.

Page Content Updated On 02/07/2017, Published on 02/07/2017
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health (Ak-IBIS) web site (http://ibis.dhss.alaska.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 26 February 2017 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Alaska Indicator-Based Information System for Public Health web site: http://ibis.dhss.alaska.gov ".

Content updated: Tue, 7 Feb 2017 09:21:31 AKST
The information provided above is from the Alaska Department of Health and Social Services' Center for Health Data and Statistics AK-IBIS web site (http://ibis.dhss.alaska.gov/). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Sun, 26 February 2017 10:10:21 from Alaska Department of Health and Social Services, Center for Health Data and Statistics, Indicator-Based Information System for Public Health Web site: http://ibis.dhss.alaska.gov/ ".

Content updated: Tue, 7 Feb 2017 09:21:31 AKST