Volume 45 - Article 39 | Pages 1185–1218 Editor's Choice Author has provided data and code for replicating results

COVID-19 risk factors and mortality among Native Americans

By Katherine Leggat-Barr, Fumiya Uchikoshi, Noreen Goldman

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Date received:23 Mar 2021
Date published:17 Nov 2021
Word count:6500
Keywords:American Indian, COVID-19, homelands, mortality, Native Americans, risk, United States of America
Additional files:readme.45-39 (text file, 8 kB)
 45-39_online appendix (pdf file, 266 kB)
 demographic-research.45-39 (zip file, 127 MB)


Background: Academic research on the disproportionate impact of COVID-19 among Native Americans has largely been restricted to particular indigenous groups or reservations.

Objective: We estimate COVID-19 mortality for Native Americans relative to other racial/ethnic groups and explore how state-level mortality is associated with known risk factors.

Methods: We use the standardized mortality ratio (SMR), adjusted for age, to estimate COVID-19 mortality by racial/ethnic groups for the United States and 16 selected states that account for three-quarters of the Native American population. The prevalence of risk factors is derived from the American Community Survey and the Behavioral Risk Factor Surveillance System.

Results: The SMR for Native Americans greatly exceeds those for Black and Latino populations and varies enormously across states. There is a strong positive correlation across states between the share of Native Americans living on a reservation and the SMR. The SMR for Native Americans is highly correlated with the income-poverty ratio, the prevalence of multigenerational families, and health insurance (excluding the Indian Health Service). Risk factors associated with socioeconomic status and comorbidities are generally more prevalent for Native Americans living on homelands, a proxy for reservation status, than for those living elsewhere.

Conclusions: Most risk factors for COVID-19 are disproportionately high among Native Americans. Reservation life appears to increase the risk of COVID-19 mortality.

Contribution: We assemble and analyze a broader set of COVID-19-related risk factors for Native Americans than previous studies, a critical step toward understanding the exceptionally high COVID-19 death rates in this population.

Author's Affiliation

Katherine Leggat-Barr - Princeton University, United States of America [Email]
Fumiya Uchikoshi - Princeton University, United States of America [Email]
Noreen Goldman - Princeton University, United States of America [Email]

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