American Indians and Alaska Natives in the United States have a life expectancy that is nearly four years lower than what official statistics indicate. A recent study published in JAMA revealed that their life expectancy of 72.7 years is more in line with that of a typical citizen of El Salvador (72 years) rather than the overall U.S. life expectancy of 78 years.
The discrepancy in life expectancy stems from the misreporting of race and ethnicity data on death certificates. The study found that in 41% of American Indian and Alaska Native (AI/AN) deaths, race and ethnicity were mistakenly marked as “white.” This misclassification results in the statistical invisibility of thousands of AI/AN individuals who have passed away.
Lead author Jacob Bor, an associate professor of global health and epidemiology at Boston University School of Public Health, described the study as an effort to make the invisible visible. By analyzing data from the U.S. Census Bureau and the Centers for Disease Control spanning from 2008 to 2019, the authors aimed to address the longstanding issue of health disparities in AI/AN populations.
The study highlighted a widening gap in life expectancy between AI/AN individuals and the broader U.S. population. Factors contributing to this gap include misclassification of race on death certificates and increased mortality rates from causes such as drug overdoses, diabetes, and heart disease.
The analysis revealed that older individuals, those living in urban areas outside reservations, and those with higher education levels were more likely to be misclassified on death certificates. Heart disease deaths had the highest misclassification rate, while deaths from assault and legal intervention were less likely to be misreported.
Siobhan Wescott, who directs the American Indian Health Program at the University of Nebraska Medical Center’s College of Public Health, praised the study for shedding light on a longstanding issue in Indigenous health. By emphasizing the importance of self-identification in racial classification, the authors hope to empower individuals to define their own race.
The study’s co-authors called for more research on specific tribes to better understand their unique experiences. Michael Bird, a study co-author and member of the Kewa Pueblo tribe in New Mexico, underscored the need to consider historical and cultural determinants of health in addition to social determinants.
Through their research, the authors aim to spark conversations about why Indigenous people remain invisible in society. By addressing the misclassification of race and ethnicity data, they hope to bring attention to the health disparities faced by AI/AN communities and work towards more accurate representation and understanding of their experiences.
