Native Americans and Alaska Natives

Mortality

Mortality data for American Indians are subject to three primary sources of error: misclassifications of cause of death, misidentifications of race of decedent, and inaccurate population estimates. Studies have documented that mortality is underestimated by 10% to 21%, especially for those age 65 years and older, urban residents, and those with lower Indian blood quantum.

A number of studies have noted the recent shift in mortality and morbidity from acute and infectious diseases to chronic and degenerative diseases. Despite this trend, far fewer American Indians than Whites live to old age, with 86% of all deaths among Whites, compared with only 59% of all deaths among Indians, occurring among individuals age 55 years and older. Much of this difference is attributable to premature mortality among Indian males from accidents, suicides, chronic liver disease and cirrhosis, and homicides. Between 1994 and 1996, only 39% of American Indian male deaths were among those age 65 years and older, compared with 53% of American Indian female deaths.

Based on age-specific mortality rates, a “mortality crossover” occurs during advanced old age, although the precise age has not been established. After 55 years of age, differences in life expectancy between Whites and American Indians are greatest in the younger age groups and for women. Overall, elderly Indian female life expectancy is 20% to 25% longer than that of Indian males.

Slightly more than half of all deaths among American Indians age 65 years and older are attributed to heart disease or cancer, and approximately three quarters of all deaths were the result of the top two causes plus diabetes, cerebrovascular disease, pneumonia, and chronic obstructive pulmonary disease (COPD). Indians in this age group have 20% to 30% lower death rates than do Whites of the same age group from heart disease, cancer, cerebrovascular disease, and COPD. In contrast, older Indians experience higher mortality rates for diabetes mellitus (2.9 times), chronic liver disease and cirrhosis (2.4 times), and nephritis, nephritic syndrome, and nephrosis (1.6 times).

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