The disparities in mortality rates among American Indians and Alaska Natives (AI/AN) are much higher than previously reported in official vital statistics, according to a recent study led by a researcher from Boston University School of Public Health (BUSPH). Published in JAMA, the study revealed that death certificates for over 41% of AI/AN individuals did not correctly identify them as such, with many being misreported as “white”.
This misclassification leads to a significant underestimation of AI/AN mortality rates, an overestimation of life expectancy, and a gross understatement of the mortality disparities between AI/AN individuals and the rest of the population. The study found that the actual life expectancy gap between AI/AN and the national average is 6.5 years, nearly three times larger than previously reported. This gap has been increasing over the years, reaching 8 years between 2017-2019.
The average life expectancy for AI/AN individuals over the 11-year study period was only 72.7 years, similar to countries like El Salvador and Bangladesh. The study also highlighted that AI/AN mortality rates were notably higher for young and middle-aged adults, as well as for those living both on and off reservations. Even AI/AN individuals with a college education experienced premature mortality compared to their non-AI/AN counterparts.
The leading causes of death contributing to the mortality gap between AI/AN individuals and the general population were heart disease, cancer, and diabetes. The study, which analyzed data from the 2008 American Community Survey linked with mortality data, aimed to provide a more accurate representation of AI/AN mortality rates without the bias of underreporting race on death certificates.
Dr. Jacob Bor, the lead author of the study, emphasized the need for increased investment in AI/AN health and accurate public health data to address the existing health inequities. The historical trauma experienced by AI/AN communities, including forced assimilation, economic marginalization, and the loss of lands, continues to contribute to high rates of psychological distress, substance use, chronic illnesses, and injuries.
Study co-author Dr. Michael Bird, a member of the Kewa Pueblo tribe, highlighted the ongoing invisibility of AI/AN communities in public health data and the need for accurate data collection and collaboration with tribal communities to address these disparities. The researchers recommended measures such as training funeral directors to collect accurate race and ethnicity data and updating misclassification ratios in vital statistics to reflect the true mortality rates among AI/AN individuals.
Overall, the study underscores the importance of acknowledging and addressing the health disparities faced by AI/AN communities and the necessity of accurate data collection to drive effective public health interventions. More research and collaboration with tribal communities are crucial to improving the health outcomes and life expectancy of AI/AN individuals.
