Life expectancy for Native Americans has stagnated — even long before Covid

Native American and Alaska Native populations were the only Americans to see no increase whatsoever in life expectancy in the two decades preceding the Covid pandemic, living 73.1 years on average in 2019 — nearly six years less than white Americans.

The figures were included in a new detailed analysis of life expectancy published Thursday that showed that overall life expectancy for Americans rose slightly over the period, to 79.1 years in 2019, but that persistent and widespread disparities remained between different racial and ethnic groups.

The study, published in the Lancet, is the first national analysis at the county level that includes American Indian/Alaska Native and Asian/Pacific Islander life expectancies over such a long period.

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These populations have frequently been left out of studies at the county level because of their sometimes small population sizes and because data on racial and ethnic groups is often misclassified on death certificates. The current work attempted to correct for such misclassifications and small sample sizes using estimates based on work to validate death certificates and other statistical modeling techniques.

As a group, Asian/Pacific Islander populations lived the longest, at 85.7 years, followed by Hispanic populations at 82.2 years, and white populations at 78.9 years. Despite a 3.9-year gain in life expectancy over the past two decades, Black Americans lived 75.3 years, 3.6 years less than white Americans.

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To Laura Dwyer-Lindgren, one of the paper’s authors, the lack of progress in improving health outcomes for Native American/Alaska Native populations stood out immediately. “To have that long of a period of time and no increase in life expectancy was probably the most shocking finding,” said Dwyer-Lindgren, an assistant professor of health metric sciences at the University of Washington’s Institute for Health Metrics and Evaluation. “That’s not true for any other group.”

Siobhan Wescott, a physician who directs the American Indian Health Program at the University of Nebraska Medical Center, called the study a “landmark publication for American Indians/Alaska Natives.” Wescott said she remained concerned about the issue of race misclassification on death certificates but said the finding that Native Americans/Alaska Natives lived 12.6 years less than Asians/Pacific Islanders came as a shock. “This paper should be a call to action to determine how to lengthen the lives of Native Americans, who hold the knowledge of their ancestors,” she said.

The study did not include the drop in life expectancy caused by the Covid-19 pandemic, which has erased much of the gains made in the past two decades, particularly among Black and brown people. A new analysis of data from 2020 and 2021, posted on medRxiv and not yet peer-reviewed, shows that life expectancy during the pandemic dropped 4.7 years for Native Americans/Alaska Natives, four years for Hispanic Americans, 3.25 years for Black Americans, and 1.3 years for white Americans.

The Covid pandemic “came on top of cracks in the U.S. health system and continued disparities that need to be addressed,” said the authors of the new Lancet paper, a group from the IHME and the National Institutes of Health.

The study confirmed earlier findings that showed most gains in life expectancies, for all groups, occurred between 2000 and 2010 but then largely stagnated, in part due to higher rates of overdose deaths and suicide.

Though the new data are more granular in many respects than in previous reports, there were concerns about how the study analyzed life expectancy for Native Hawaiians and Pacific Islanders, groups that often have poor health outcomes. In this study, as in most others, Native Hawaiians and Pacific Islanders were lumped in with Asian populations, which are known to have the highest life expectancies.

“One must ask whether the methods used in the authors’ analysis are perhaps a perpetuation of systemic racism,” wrote Kekoa Taparra, a Native Hawaiian resident physician at Stanford and Karen Pellegrin, a researcher at the University of Hawaii at Hilo, in an editorial that accompanied the new paper. “The authors’ systematic erasure of known NHPI disparities, through use of the API population category, obscures the truth and reinforces the marginalization of these Indigenous people.”

Dwyer-Lindgren said she agreed with the criticism and said that Native Hawaiian and Pacific Islander populations should be separated from Asian populations in studies but her group could not do so because such categories were not offered by federal data collection systems until 1997 and not implemented on death certificates in all states until 2017. “The categories are outdated and problematic,” she said, adding that new research will continue to refine categories by racial and ethnic groups.

Jane Delgado, president and CEO of the National Alliance for Hispanic Health, has long pushed back against how the so-called Latino paradox — the fact that Hispanic people live longer despite many risk factors — is interpreted by researchers, saying many have missed the opportunity to use such findings to rethink existing views on how to improve health.

The focus on life expectancy data in the new paper “distorts the health profile for Hispanics and Asians who may have longer lives but have other health issues,” she told STAT. “Hispanics live long and suffer.”

Much of the study’s usefulness may come in the extreme granularity of the data. Freely available, the results will allow researchers and health advocates to examine life expectancy data in small geographic regions, down to the level of each of the nation’s 3,110 counties. The life expectancy differences between counties as of 2019 was wide, ranging from 64.5 years (Oglala Lakota County, in South Dakota’s Pine Ridge Indian Reservation) to 91.7 years (Summit County, a 92% white county in Colorado that includes Breckenridge). In general, the southeastern portion of the United States was the least long-lived, the study showed.

This study did not focus on cause of death, but the local-level, detailed data on life expectancy could support targeted efforts to eliminate the disparities leading to shorter lives, which differ by locale.

“I’m not a person who thinks we need more data to show that structural racism exists,” said Dwyer-Lindgren. “I’m hoping this data, which didn’t exist before at the county level, may help us figure out what to do about it.”