Native Americans left out of research on 'deaths of despair'

Americans for more than a decade have been dying younger than people living in other developed countries. In 2015, two economists came up with the concept "deaths of despair" in the wake of an analysis showing that an increasing number of middle-aged white Americans were dying from suicide, drug overdoses and alcoholic liver disease. 

A recent study published in The Lancet showed that, in the shadow of the deaths of despair, an entire group of people was left out of the original 2015 study — Native Americans, who have been affected by deaths of despair far more than white communities.

Between 1999 and 2013, the midlife mortality of white people has increased about 9 percent. In contrast, midlife mortality rose among Native Americans during the same period and has increased about 30 percent, according to data from the US Centers for Disease Control and Prevention (CDC).

The study, published last week in The Lancet by researchers from the University of California at Los Angeles (UCLA), noted that this midlife mortality increase among native communities was more than three-times greater than the observed increase among white Americans. 

The 2015 study, published by two Princeton economists, looked at death rates from 1999 to 2013 of white people ages 45 to 54 , and compared the numbers by race and ethnicity and found that deaths of despair is the highest among middle-age white people. 

Since then, the deaths-of-despair concept has emerged as a key notion for understanding US exceptionalism in mortality. The concept premised the increasing number of deaths were unique to white communities. 

However, the UCLA research published last week claimed the 2015 study failed to consider Native Americans in the analysis, nor in most follow-up studies on the topic of mortality stemming from deaths of despair.

Mortality from overdoses, suicides and alcoholic liver disease have collectively been higher among native communities than white communities in every available year of data since 1999, the study said. 

The inequities have grown over time, especially throughout the COVID-19 pandemic. In 2019, the midlife native American mortality was about 71 percent higher than that of white Americans. In 2020, the number has increased by about 111 percent, according to the study.

The idea of the uniqueness of white people being at greater risk to die from suicide, drug overdoses and alcoholic liver disease was "only made possible by the erasure of data describing Native American mortality", the researchers wrote.

"The omission of these data for Native American groups is commonplace, with serious implications for attending to and remedying health inequities, underfunded programs, and inaccessible services," the study noted. 

Middle-aged Americans are more than twice as likely to die than those in some other developed countries, according to data from the Institute for Health Metrics and Evaluation. And the life expectancy in the US ranks lowest among countries with large economies.

According to CDC data, COVID-19 and drug overdoses led to a second-straight year of declining US life expectancy. Native Americans are disproportionately affected by both factors. 

The current opioid-related overdose death rate is 13.7 deaths per 100,000 Native Americans, which exceeds the national rate of 13.1 per 100,000, according to the data from the CDC.

"If you look at matters of poverty, education, decreased employment opportunities, restricted access to other kinds of resources that are typically associated with these kinds of health disparities, they're very powerful and widely present in American and Alaska Native communities," Spero Manson, director of the University of Colorado's Centers for American Indian and Alaska Native Health who wasn't involved in the new study, told NPR.

The idea of the uniqueness of white people being at greater risk to die from suicide, drug overdoses and alcoholic liver disease was "only made possible by the erasure of data describing Native American mortality".