Emily A. Haozous, PhD, RN

Improvements in diagnosing and treating chronic killers like cancer and heart disease have beaten back death rates for adults under age 65 in this century – but not for all ethnic groups.

A study of U.S. mortality data by researchers at the National Cancer Institute, the UNM College of Nursing and others has found that premature death rates actually rose for whites and American Indians and Alaska Natives between 1999 and 2014, and that these disparities are growing. The increase is due largely to drug overdoses, alcohol-related deaths, and suicide, the researchers concluded, and parallels the rise in heroin and opioid use over the last two decades.

While the surprising increase in premature deaths among white Americans was widely reported last year based on Centers for Disease Control and Prevention data, the researchers also wanted to investigate health disparities among Native Americans. Lead researcher Meredith S. Shiels of the National Cancer Institute called on Emily A. Haozous, PhD, RN, a Native researcher and associate professor in the UNM College of Nursing, to help.

As reported in the Jan. 25 Lancet, the researchers looked more closely at cause-of-death data from the National Center for Health Statistics, coupled with census data for the period 1999-2014. While they expected disparities across demographic groups, they were stunned by how stark it was for Native Americans, Haozous said.

American Indians and Native Alaskans had the highest mortality across all age groups in the period 2011-2014, after the highest increases in mortality for most age groups from the period 1999-2002.

Most other ethnic groups saw premature death rates fall between those two periods, thanks to improvements in prevention and treatment of cancer, heart disease and HIV. But such declines were not seen in the Native American groups, where heart disease deaths actually increased.

Haozous, who is Fort Sill Apache and studies Native health trends, said the reasons are complicated and political, related partly to inadequate funding for the Indian Health Service – which faces a “heartbreaking” prognosis under current plans to scrap the Affordable Care Act. Three-quarters of Native Americans live in urban areas and lack adequate access to care, she said. “These numbers reflect that.”

Overall, black Americans showed the greatest improvements in premature death rates, though they still die at one to five times the rate of whites in the same age group. Premature mortality has likewise fallen for Hispanics and Asian-Pacific Islanders across all age groups since 1999, thanks largely to declines in smoking and medical advances in treating chronic diseases.

But for young and middle-aged whites, as well as the Native American groups, any such improvements have been canceled out by the rise in drug overdoses, alcohol-related deaths (liver disease) and suicides. The largest increases were seen in young adults, age 25 to 30, especially women, and in regions such as West Virginia and Kentucky for whites.

“Mental health is a place where the whole population needs to address this problem,” Haozous said. “I really hope this study will lead to not only more research, but action.”

Increases of 2 to 5 percent per year in death rates, as seen among younger whites and Native Americans, are exceedingly rare in developed countries outside emergencies such as the AIDS epidemic, the researchers noted. In Canada, England and Wales, premature death rates declined steadily over the study period.

U.S. drug overdose deaths have more than doubled since 2000, and the United States now leads the world in per-capita use of prescription opioids.