A groundbreaking new study published in JAMA reveals a profound underestimation of mortality rates and life expectancy deficits among American Indian and Alaska Native (AI/AN) populations in the United States, driven largely by systemic racial misclassification in vital records. The research, spearheaded by epidemiologists at Boston University School of Public Health (BUSPH), exposes a disturbing reality: official death certificates fail to accurately identify a significant proportion of AI/AN individuals, leading to a glaring “statistical erasure” of these communities from public health data. This erroneous reporting distorts the true scale of health disparities and has perpetuated a narrative that dramatically understates the mortality crisis facing Indigenous peoples.
Central to this study is the link between self-identified race from the 2008 American Community Survey (ACS) and subsequent mortality data derived from U.S. death certificates extending through 2019. By integrating these datasets using Social Security numbers, researchers were able to directly compare the race that individuals self-identified as with what was recorded on their death certificates. An alarming finding emerged: at least 41 percent of AI/AN decedents were misclassified on death records, predominantly labeled as “White." This misclassification severely biases mortality statistics and conceals the true burden of premature death in these populations.
Consequently, official vital statistics have grossly overestimated life expectancy for AI/AN individuals and underestimated their mortality rates. The study quantifies the life expectancy gap between AI/AN populations and the national average at 6.5 years—nearly three times larger than previously reported figures derived from unadjusted death records. Not only is this gap more pronounced than understood before, but it has also widened precipitously over the study period, rising from 4.1 years during 2008-2010 to an alarming 8 years by 2017-2019. Such increases underscore an urgent health equity crisis that has been masked by flawed data collection.
Intriguingly, the average life expectancy for AI/AN persons measured by this method was just 72.7 years—comparable to nations grappling with significantly limited healthcare infrastructures like El Salvador and Bangladesh. These findings reveal a profound disparity within the wealthiest nation globally and highlight the profound effects of historical and contemporary social determinants, systemic inequities, and health care access barriers. The premature mortality burden extends across diverse geographies, with elevated death rates evident both on and off reservations, challenging arguments attributing disparities solely to location.
The elevated mortality risk for AI/AN populations is especially acute among young and middle-aged adults, indicating the loss of productive years and generations at the peak of life. Even when controlling for socioeconomic status, AI/AN individuals with higher educational attainment still exhibit significantly shorter life spans than non-AI/AN counterparts. This suggests that structural and systemic factors beyond education, such as historic trauma, discrimination, and inadequate healthcare, persistently shape poor health outcomes for Indigenous peoples.
The diseases driving the mortality gap are largely chronic conditions: heart disease accounts for 16 percent of the excess mortality, cancer for 11 percent, and diabetes 10 percent. These chronic diseases reflect long-standing inequities in healthcare access, social determinants of health, and exposures to adverse environmental and lifestyle factors. The high prevalence and fatality of these illnesses signal the need for targeted, culturally responsive public health interventions customized to AI/AN communities’ unique histories and needs.
Researchers emphasize that this study is the first contemporary, nationally representative prospective assessment of AI/AN mortality that adjusts for race/ethnicity misclassification. The innovative methodology combining ACS self-reports with mortality data sidesteps prior challenges of inadequate racial data and provides the most accurate picture of Indigenous mortality disparities to date. This methodological advancement is crucial given the routine underreporting of AI/AN status in official datasets, a flaw that has long impeded effective monitoring and intervention.
Underlying these statistical challenges are historical forces stemming from European colonization that decimated Indigenous populations through violence, disease, and forced displacement. Drastic population declines of up to 95 percent have been documented due to these genocidal campaigns, compounded over centuries by forced assimilation policies, ongoing economic marginalization, and complex political sovereignty arrangements. The intergenerational trauma generated has persisted, manifesting today in elevated psychological distress, substance use disorders, chronic illnesses, and injury rates—all contributing to the shortened life expectancy uncovered by this study.
Coauthor Dr. Michael Bird, a member of the Kewa Pueblo and past president of the American Public Health Association, underscores that the data gaps reflect ongoing invisibility and erasure. “Millions of us perished with no record,” he remarks, highlighting how genocidal policies sought to obliterate Indigenous presence not only physically but statistically. The study validates Indigenous communities’ lived experiences and challenges the minimization of historical violence in public discourse.
The researchers call for systemic reforms in public health data collection, underscoring the crucial need for collaboration with AI/AN tribes to improve the accuracy of mortality data, enhance the training of funeral directors who record death certificates, and update misclassification ratios used for statistical adjustments. Reliable data are foundational for understanding and dismantling the profound health inequities faced by Indigenous Americans.
This revealing investigation not only exposes severe shortcomings in vital statistics but also demands an immediate and intensified investment in public health infrastructure, tailored healthcare delivery, and culturally competent interventions aimed at reducing mortality disparities among AI/AN populations. The findings compel policymakers, researchers, and health practitioners to confront uncomfortable truths and prioritize Indigenous health with scientific rigor and moral urgency. Only by recognizing and rectifying the “statistical erasure” can this marginalized population’s health crisis be meaningfully addressed.
In sum, the study confronts a longstanding public health blind spot by illuminating the vast undercounting of AI/AN mortality and revealing the true severity of inequities that have remained invisible in official statistics. It is a pivotal step toward recognizing Indigenous Americans’ health burdens on their own terms and a clarion call for transformative action. The data urge society not just to remember but to reckon with the persistent legacies of colonization and to redress the ongoing disparities through committed collaboration and systemic reform.
Subject of Research: People
Article Title: Life Expectancy of American Indian and Alaska Native Persons and Underreporting of Vitality in Vital Statistics
News Publication Date: 16-Jun-2025
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Keywords: American Indian, Alaska Native, AI/AN, life expectancy, mortality disparities, vital statistics, racial misclassification, public health, health inequities, indigenous health, statistical erasure, chronic disease, social determinants of health