Abstract
OBJECTIVES: Accurate mortality data for American Indian and Alaska Native (AI/AN) people are critical for describing health disparities and program planning needs. We describe the rates of leading causes of death among non-Hispanic AI/AN as compared with non-Hispanic White populations living in the same area, by sex and Indian Health Service (IHS) Area in 2020. METHODS: We used the 2020 US Cancer Statistics AI/AN Mortality Database and SEER*Stat software to calculate sex-specific age-adjusted death rates (per 100 000 population) for the 15 leading causes of death among non-Hispanic AI/AN and non-Hispanic White people in the United States overall (all areas combined), by IHS Area, and by age group. We restricted analyses to non-Hispanic AI/AN and non-Hispanic White people living in Purchased/Referred Care Delivery Area counties. RESULTS: Death rates were higher among non-Hispanic AI/AN people than among non-Hispanic White people in the United States overall (rate ratio = 1.90) and in every IHS Area (rate ratio range = 1.11-2.78). Death rates also varied by sex and age. Death rates were nearly 4 times higher among non-Hispanic AI/AN people than among non-Hispanic White people in the 25- to 44-year age group. Leading causes of death among non-Hispanic AI/AN males and females included COVID-19, heart disease, unintentional injury, cancer, and chronic liver disease. CONCLUSIONS: Death rates differed between non-Hispanic AI/AN and non-Hispanic White people by IHS Area, sex, and age when data corrected for racial misclassification were used. Our findings have important implications for guiding future public health practice to address disparities in mortality, particularly in the context of public health emergencies.