Are we living longer or not? It may be a simple question. But for Indian Country the answer is complicated.
The Centers for Disease Control and Prevention reported last week in three reports that life expectancy, which averaged 78.6 years in 2017, declined slightly from the year before (a decrease of just 0.1 of a year). The cause for decline was said to be suicide and drug overdoses. The report said more than 70,000 people died of drug overdoses last year alone, a nearly 10 percent increase from 2016 and the highest ever in the United States for a single year. (As a comparison: Only about 17,000 people died of overdoses in 1999.)
The latest data show that the U.S. life expectancy has declined over the past few years,” said the center’s director, Robert R. Redfield. He said in a statement: “Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide. Life expectancy gives us a snapshot of the nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable. CDC is committed to putting science into action to protect U.S. health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.”
But what about Indian Country?
The official response: The “National Center for Health Statistics does not routinely calculate life expectancy for American Indians and Alaska Natives because of data quality issues, so we do not have this data available.”
The data comes from death certificates. This has long been a problem in Indian Country because there is often a misclassification of tribal citizens at the time of death. One study reported only slightly more than half of American Indians and Alaska Natives were correctly identified on death certificates in a three decade study between 1979 and 2011.
The data reported last week comes from three reports: Mortality in the United States, 2017; Drug Overdoses in the United States, 1999-2017; and, Suicide Mortality in the United States, 1999-2017.
The first report on mortality said the top ten causes of death have not changed from the previous year, namely, heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer disease, diabetes, influenza and pneumonia, kidney disease, and suicide. The 10 leading causes accounted for 74 percent of all deaths in the United States in 2017.
The most recent data for Indian Country however shows significant differences. A 2016 mortality report for American Indians and Alaska Natives lists heart disease, cancer, accidents, diabetes, chronic liver disease and cirrhosis, chronic lower respiratory diseases, suicide, Alzheimer’s disease, and influenza and pneumonia.
The second report ranks suicide has ranked as the 10th leading cause of death for all ages in the United States since 2008. (Compared to the 8th most often cited cause of death in Indian Country.) “In 2016,” the Centers reported, “suicide became the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54 Although the Healthy People 2020 target is to reduce suicide rates to 10.2 per 100,000 by 2020, suicide rates have steadily increased in recent years.”
The Indian Health Service in its latest fact sheet reports that suicide rates for American Indians and Alaska Natives are 1.7 times higher than the general population.
The third report by the Centers says there were 70,237 70,237 drug overdose deaths in the United States last year. And, the age-adjusted rate of drug overdose deaths in 2017 (21.7 per 100,000) was 9.6 percent higher than the rate in 2016.
In testimony to Congress last March, Michael E. Toedt, IHS’ chief medical officer said: “The impact of the opioid crisis on American Indians and Alaska Natives is immense. The Centers for Disease Control and Prevention reported that American Indians and Alaska Natives had the highest drug overdose death rates in 2015 and the largest percentage increase in the number of deaths over time from 1999-2015 compared to other racial and ethnic groups. During that time, deaths rose more than 500 percent among American Indians and Alaska Natives. In addition, because of misclassification of race and ethnicity on death certificates, the actual number of deaths for American Indians and Alaska Natives may be underestimated by up to 35 percent.”
So is life expectancy getting better or worse? The logical answer is to say that if the age of death is declining in the general population, then it's probably the same trend in Indian Country. But the data is not there.
Mark Trahant is editor of Indian Country Today. He is a member of the Shoshone-Bannock Tribes. Follow him on Twitter -@TrahantReports