Q & A with Author: Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019

November 9, 2021

Questions for Elizabeth Arias, Health Statistician and Lead Author of “Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019.”

Q: Is the first report on non-Hispanic American Indian or Alaska Native (AIAN) mortality? 

EA: Yes. This is the first report that NCHS publishes exclusively on non-Hispanic AIAN mortality.  Limited mortality statistics for this population has been included in our standard mortality reports.

Q: Why is there an issue of misclassification of race and ethnicity on U.S. death certificates for the AIAN population?

EA: We do not know exactly why individuals who self-identify as AIAN while alive have a higher rate of being classified as a different race on their death certificates than other racial and ethnic populations.  What we know is that funeral directors who are responsible for filling out the demographic portion of the death certificate may rely on visual observation rather than ask family informants the race of decedent.  An important factor in visual misclassification is that the proportion of multiple race individuals, predominantly individuals who identify as both AIAN and white, within the AIAN population is relatively large.   

Q: Are there any differences in the leading causes of death order for the AIAN population compared to U.S. overall?

EA: Most of the 15 leading causes of death experienced by the non-Hispanic AIAN population are the same as those affecting the total US population.  However, there are important differences.  For the non-Hispanic AIAN population, homicide is the 13th leading cause of death whereas homicide is not one of the 15 leading causes of death for the total population. The order of the 15 leading causes of death differs for the non-Hispanic AIAN population.  Of note, Chronic liver disease and cirrhosis is the 4th leading cause for this population but the 11th cause for the US overall, Suicide is the 8th vs 10th cause, and Alzheimer is the 11th vs 6th cause.

Q: Is there any trend data on life expectancy for the AIAN population prior to 2019?

EA: We publish death counts, and age-specific and age-adjusted death rates for the AIAN population annually in our final mortality reports.  However, these estimates are not adjusted for misclassification.  The most reliable mortality estimates published prior to this report were based on a linkage of Indian Health Service (HIS) patient registration data and vital statistics mortality data covering years 1990-2009.  The data covered 65% of the non-Hispanic AIAN population, those living in Contract Health Service Delivery Areas of the IHS.  A special issue of the American Journal of Publish Health was published (see American Journal of Public Health – Volume 104, Issue S3 (aphapublications.org).

Q: What is the main takeaway message from this report?

EA: Racial and ethnic health and mortality disparities in the US are profound.  The non-Hispanic AIAN mortality profile resembles that of some of the populations in the poorest, under developed countries in the world.

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Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014–2018

August 6, 2020

Questions for Maria Villarroel, Health Statistician and Lead Author of “Health of American Indian and Alaska Native Adults, by Urbanization Level: United States, 2014–2018.”

Q: Why did you decide to do a report on health in American Indian and Alaska Native (AIAN) adults?

MV: There is limited information about the health of the American Indian and Alaska Native adults at the national level. Few national surveys are large enough to be able to provide reliable estimates about American Indian and Alaska Native adults. The National Health Interview Survey (NHIS) is one such survey that can inform on the health status and health conditions of civilian non-institutionalized adults residing in households across the country who identify as American Indian and Alaska Native.

Q: Can you summarize how the data varied by urbanization level?

MV: This report has two objectives.

The first objective was to compare the health of American Indian and Alaska Native adults by urbanization level.  The report findings indicate that the conditions examined did not follow a single pattern by urbanization level. The percentage of American Indian and Alaska Native adults with disabilities increased with higher urbanization level, multiple chronic conditions increased with lower urbanization level, diagnosed diabetes was highest in rural areas, diagnosed hypertension was highest for those in medium and small metropolitan areas and in rural areas, and those in fair or poor health status did not differ by urbanization level.

The second objective was to assess whether the percentage of American Indian and Alaska Native adults with selected conditions was similar to the percentage found, on average, among all U.S. adults. The report findings indicate that American Indian and Alaska Native adults were more likely to be in fair or poor health, have a disability, have multiple chronic conditions, and to have been diagnosed with hypertension and diabetes compared with all U.S. adults. This finding was consistent across most urbanization levels.

Q: Was there a specific finding in the data that surprised you from this report?

MV: Among American Indian and Alaska Native adults, the selected conditions examined did not follow a single pattern by urbanization level, and that across most urbanization levels, the percentage of American Indian and Alaska Native adults with these selected conditions was higher than found on average among U.S. adults.

Q: Is this the first time you have reported data on AIAN?  If not, do you have any trend data?

MV: Yes, this is the first time we have used NHIS data to examine selected health conditions among American Indian and Alaska Native adults in the US. We are not aware of a previous trend report and have not examined trends among this population ourselves.

Q: What is the take home message for this report?

MV: Among American Indian and Alaska Native adults, the conditions examined did not follow a single pattern by urbanization level, and across most urbanization levels, the percentage of American Indian and Alaska Native adults with these selected conditions was higher than found on average among U.S. adults.

Leave a Comment » | adults, AIAN, diabetes, Hypertension, National Health Interview Survey | Permalink
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