How Much Did Native American Life Expectancy Drop During COVID-19?

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The Issue:

A growing body of research has consistently shown that the pandemic exacerbated pre-existing racial disparities in health in the United States. Many Native Americans were particularly hard hit during COVID-19. The life expectancy of non-Hispanic, single-race American Indian/Alaska Native people declined from 71.8 years in 2019 to 65.2 years in 2021, a striking reduction of almost seven years since the start of the pandemic, according to a recent report published by the Centers for Disease Control and Prevention (CDC). However, these findings relate to a subset of the overall Native American population. A more nuanced understanding of the health conditions of Native Americans emerges when you expand the lens to include multi-racial individuals. The issue illustrates the challenges of analyzing trends by race and ethnicity in a diverse nation, especially when it comes to groups that make up a small share of the population. At the same time, the dramatic magnitude of the impact borne by those who identify as single-race Native American highlights the importance of disaggregating the Native American population in order to gain a better understanding of the issues and formulate appropriate policy responses.

The post-pandemic estimate of life expectancy at birth for those who identify as single-race Native Americans — 65.2 years in 2021 — is so low that it is roughly identical to the life expectancy of the U.S. population in 1944.

The Facts:

• Life expectancy statistics serve as a useful measure of the overall health of a population at a moment in time. Life expectancy at birth does not literally predict how long a baby who is born today will live. Rather, life expectancy measures how long someone who is born today is expected to live if they lived their entire life under the mortality rates that exist today. Since mortality rates at each age will likely change over time, life expectancy measures do not claim to predict how long an individual will live. Life expectancies (at each age) serve as a summary statistic of the health conditions of a population at a point in time. For instance, the deterioration in the health environment during COVID resulted in a large increase in mortality rates in the U.S. and was reflected in an overall drop in life expectancy at birth in the United States.

• The post-pandemic estimate of life expectancy at birth for those who identify as single-race Native Americans — 65.2 years in 2021 — is so low that it is roughly identical to the life expectancy of the U.S. population in 1944. CDC researchers find that the life expectancy for single-race American Indian/Alaska Native people was lower than the life expectancy of both non-Hispanic Whites and Blacks prior to the pandemic, and, since the pandemic, has decreased by more than any other racial and ethnic group (see chart). The CDC researchers used state-level mortality data, intercensal population counts, and restricted-use data from the U.S. Census Bureau (to account for infant and old-age mortality, and to correct for racial misclassification in death records) to arrive at their estimates. Independent research published in Demographic Research, which relied only on public use data, found similar life expectancy declines for the non-Hispanic single-race American Indian/Alaska Native population.

• However, the Native American population is highly diverse and prevailing methods miss most American Indian/Alaska Native people. Due to small sample sizes in federal surveys, American Indians and Alaska Natives are often left out of analyses that break down population impacts by different racial and ethnic groups. The 2020 Census — which made it easier for individuals to identify as multi-racial — lists 9.7 million people as American Indian or Alaska Native alone or in combination with other races, making up roughly 3% of the overall U.S. population. Of these, roughly a third (3.7 million) identified as single-race American Indian/Alaska Native. Federal datasets typically collect and report self-identified race and ethnicity categories using standards on race and ethnicity set by the U.S. Office of Management and Budget (OMB) in 1997. These categories are often decomposed into non-overlapping race and ethnic groups which often leads researchers to use non-Hispanic, single-race groupings to study racial disparities. For the Native American population, this approach can be problematic because it fails to account for the legacy of U.S. assimilationist policies (like the Federal Indian Boarding School Initiative, fostering adoption of Indigenous children, and the American Indian Urban Relocation Program) which aggressively incorporated Native individuals into mainstream culture. Largely as a result of these policies, the current Native American population is more likely than any other race to identify with another race or ethnicity. For example, according to the 2020 Census, 75% of all those who identified as non-Hispanic Native American indicated that they were multi-racial. The comparable percentage for Whites, Blacks, Asians, and Native Hawaiians or other Pacific Islanders is 6%, 10%, 15%, and 53%, respectively.

• There is a substantial difference in life expectancy for Native Americans when you expand the group to include those who identify as multiracial. In 2019, the life expectancy of the overall Native American population, including multi-racial individuals, was 77 years — five years longer than the life expectancy of the narrower single-race Native American group and also greater than non-Hispanic Blacks and comparable to the life expectancy of non-Hispanic Whites (see chart). Pandemic-era drops in life expectancy are still salient no matter how you define the Native American population; however, the size of the decline in life expectancy in the overall American Indian/Alaska Native population seems to be driven by deterioration in health of the non-Hispanic single-race population. This result is consistent with research that finds that the single-race American Indian/Alaska Native population experiences a large economic disadvantage relative to multi-racial Native Americans. See Liebler et al. (2018), Burnette and Zhang (2019), and Huyser et al. (2014).

• More research is needed to understand the factors that contributed to the dramatic decline in life expectancy for the segment of the Native American population that was disproportionately impacted by the pandemic. It is possible that individuals who identify as single-race Native American are also more likely to share other characteristics that differ from the larger multi-racial Native American population and put them at risk for a disproportionate pandemic impact.

• Political data sources could provide an alternative way to tally the overall Native American population. Because of the government-to-government relationship established through historical treaties, there is also a political and legal element to the Native American population. At present, there are 574 federally recognized Native nations and more than 60 additional tribes that are formally recognized by state governments. Each federally recognized Native nation establishes its own requirements for citizenship, but some federal statutes require protections and services for Native Americans to be extended only to those eligible to receive a Certificate of Degree of Indian or Alaska Native Blood (CDIB) card from the federal government. No federal dataset collects information on whether an individual is an enrolled member of a tribe or eligible for a CDIB card; however, in theory, these rules could be used to capture the overall Native American population.