The largest reported mortality increases were in young people. Among 25-year-old AI/ANs, mortality increased 2.7% annually for men and 5% annually for women between 1999 and 2014.
“Increases in premature mortality of this magnitude have rarely been observed in the US,” NCI investigator Meredith S. Shiels, PhD, told JAMA.
But experts say the real picture could be even worse for the 5.2 million people in the United States who identify as AI/AN. Their deaths are notoriously underreported due to racial misclassification on death certificates. An astounding 40% of AI/ANs who die are listed as a different race—usually white—on their death certificates by funeral home directors, according to a 2016 report from the Centers for Disease Control and Prevention (CDC).
Shiels and her coauthors estimated AI/AN mortality based on death certificates from Indian Health Service (IHS) regions known as Contract Health Services Delivery Areas (CHSDAs), where racial misclassification tends to be lower. But even here, around 20% of AI/ANs are still misclassified as other races on their death certificates. By comparison, only 3% of Hispanics and Asians and Pacific Islanders and almost no whites or blacks are racially misclassified on death certificates, according to the CDC.
“What this basically translates to is an underestimation of mortality for the American Indian population,” said Elizabeth Arias, PhD, director of the US Life Table Program at the CDC’s National Center for Health Statistics (NCHS).