American Indian/Alaskan Native Child and Adolescent Mortality

The American Indian/Alaskan Native (AI/AN) population experiences substantial health disparities, but the extent is not well characterized especially among children and adolescents. In data from the National Center for Health Statistics, AI/AN persons are often not recognized as such on death certificates. As AI/AN deaths are undercounted, racial/ethnic comparisons showing greater death rates among AI/AN are Estimates of Minimal Difference (EMD): the difference in rates between groups that is an estimate of the minimal difference. It is the minimal difference because that difference would only be increased by more accurate race/ethnic classification on certificates as more AI/AN individuals would be counted as such. We compare rates of non-Hispanic AI/AN leading causes of death to non-Hispanic White (n-HW) and non-Hispanic Black (n-HB) children and adolescents using annual reports for Deaths: Leading Causes from 2015 to 2017 from the National Vital Statistics System. Among AI/AN 1-19 year-olds, suicide deaths are significantly higher (p<0.00001) than among n-HB (OR=4.34; CI=3.68-5.1) and n-HWs (p<0.007; OR=1.23; CI=1.05-1.42); deaths from accidents are significantly higher (p<0.001) than among n-HB (OR=1.71; CI=1.49-1.93); and deaths due to assault (homicide) are significantly higher (p<0.00002) than among n-HWs (OR=1.64; CI=1.3-2.05). The appearance of suicide as a leading cause of death among AI/AN children and adolescents occurs in the 10-14-year age group and is significantly more common in the 15-19-year age group compared to both n-HB (p<0.00001; OR=5.35; CI=4.40-6.48) and n-HW (p=0.00064; OR=1.36; CI=1.14-1.63). Even without adjusting for undercounting, EMDs show that there are significant health disparities for preventable deaths of AI/AN children and adolescents to be addressed by public health policy.

Automated summary

The AI/AN population, especially children and adolescents, experiences significant health disparities, highlighted by the high rates of suicide, accidents, and homicides compared to non-Hispanic White and Black individuals. Undercounting of AI/AN deaths contributes to the underestimation of these disparities. Addressing these preventable deaths among AI/AN children and adolescents is crucial for public health policy.