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.