The death rates for American Indians and Alaska Natives (AI/AN) are significantly higher than what is officially reported in vital statistics, as revealed by a recent study led by a researcher from Boston University School of Public Health (BUSPH). Published in JAMA, the study found that at least 41% of AI/AN decedents were not correctly identified as AI/AN on their death certificates, with their race often being misreported as “white.”
This misreporting of race on death certificates leads to a significant underestimation of AI/AN mortality rates, an overestimation of AI/AN life expectancy, and a minimization of the mortality disparities between AI/AN individuals and other Americans. The study showed that the actual gap in life expectancy between AI/AN individuals and the national average is 6.5 years, which is nearly three times larger than what is reported in official statistics. This life expectancy gap has been increasing over the years, reaching 8 years between 2017-2019.
Throughout the 11-year study period, AI/AN life expectancy averaged only 72.7 years, comparable to the life expectancy in countries like El Salvador and Bangladesh. The study also highlighted that AI/AN mortality rates were particularly high for young and middle-aged adults, surpassing the national average for AI/AN individuals residing both on and off reservations. Even AI/AN individuals with a college education had a significantly lower life expectancy compared to their non-AI/AN counterparts.
The study identified heart disease, cancer, and diabetes as the leading causes of death contributing to the mortality gap between AI/AN individuals and other Americans. The research was the first of its kind to prospectively assess mortality among self-identified AI/AN individuals in a nationally representative study. By linking data from the 2008 American Community Survey with mortality data from US vital statistics, the study was able to provide accurate insights into AI/AN mortality rates and life expectancy.
Dr. Jacob Bor, the lead author of the study and an associate professor at BUSPH, emphasized the need for increased investment in AI/AN health and the importance of accurate public health data to address health inequities. The study’s findings underscored the historical trauma experienced by Indigenous communities in the United States and its impact on health outcomes.
The researchers highlighted the importance of collaboration with AI/AN tribes in accurately measuring AI/AN health, updating misclassification ratios in vital statistics, and training funeral directors to collect precise race and ethnicity data. By addressing these issues, it is hoped that a more accurate understanding of AI/AN health disparities can be achieved, leading to targeted interventions and improved health outcomes for Indigenous communities.
For more information, you can access the study titled “Life Expectancy of American Indian and Alaska Native Persons and Underreporting of Vitality in Vital Statistics” in JAMA. This research was conducted by a team of researchers from various institutions, including Boston University, the Kewa Pueblo tribe, the University of California, Berkeley, and Harvard Medical School.
