Trends in Physical and Mental Health, Mortality, Life Expectancy, and Social Inequalities Among American Indians and Alaska Natives, 1990-2019

Abstract

Objective: To address the continuing gap in data and research on health and socioeconomic inequities characterizing Native Americans in the United States, this study examines major health and social inequality trends for the American Indian and Alaska Native (AIAN) populations covering several broad areas, including infant and child health, life expectancy and leading causes of death, physical and mental health, chronic disease prevalence, disability, health-risk behaviors, and health care access and quality. Methods: We used trend data from the 1990-2019 National Vital Statistics System, 2014-2018 National Health Interview Survey, and 2014-2018 American Community Survey to examine health, health care, mortality, and disease patterns for AIANs in relation to other racial/ethnic groups and the general population. Life tables, age-adjusted rates, risk ratios, and logistic regression were used to examine health inequalities. Results: In 2019, life expectancy of AIANs was 76.9 years, 11.3 years shorter than that for Asian/Pacific Islanders. The infant mortality rate for AIANs was 8.7 per 1,000 live births, 79% higher than the rate for non-Hispanic Whites. Risks of infant mortality from birth defects, low birthweight/prematurity, maternal complications, SIDS, and unintentional injury were significantly greater among AIANs compared with non-Hispanic Whites. Excess mortality among AIANs, particularly in rural areas, was found for working ages, diabetes, liver cirrhosis, alcoholrelated causes, youth suicide, and unintentional injuries. About 18% of AIANs assessed their overall health as fair or poor, at twice the rate of non-Hispanic Whites or the general population. About 10% of AIAN adults experienced serious psychological distress, 2-to-5 times higher than the prevalence for other racial/ethnic groups. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates in the US, with differences in these indicators varying markedly across the AIAN tribes. Conclusion and Implications for Translation: AIANs remain a disadvantaged segment of the US population in a number of key health indicators and in socioeconomic and living conditions, with poverty rates in some tribal groups approaching or exceeding 40%.