Volume 45 - Article 39 | Pages 1185–1218  

COVID-19 risk factors and mortality among Native Americans

By Katherine Leggat-Barr, Fumiya Uchikoshi, Noreen Goldman

Abstract

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 - Harvard University, United States of America EMAIL
• Noreen Goldman - Princeton University, United States of America EMAIL

Other articles by the same author/authors in Demographic Research

Life expectancy loss among Native Americans during the COVID-19 pandemic
Volume 47 - Article 9

Marriage intentions, desires, and pathways to later and less marriage in Japan
Volume 44 - Article 3

Calloused hands, shorter life? Occupation and older-age survival in Mexico
Volume 42 - Article 32

Order matters: The effect of premarital pregnancy on second childbearing in Japan
Volume 39 - Article 48

Self-Reported Versus Performance-Based Measures of Physical Function: Prognostic Value for Survival
Volume 30 - Article 7

Most recent similar articles in Demographic Research

Can we estimate crisis death tolls by subtracting total population estimates? A critical review and appraisal
Volume 52 - Article 23    | Keywords: conflict demography, death tolls, demographic methods, historical demography, mortality, mortality crises, mortality estimates, population balance

Uncovering the underlying causes for the narrowing, stalling, and widening Black–White mortality gap from 2000 to 2022 in the United States
Volume 52 - Article 18    | Keywords: cause of death, decomposition, mortality trends, racial disparities, United States of America, years of life lost (YLL)

The use of mobile phone surveys for rapid mortality monitoring: A national study in Burkina Faso
Volume 52 - Article 16    | Keywords: age-specific mortality patterns, data quality, Demographic Health Surveys, direct estimation, health and security crises, low-and-middle-income countries, mobile phones, mortality, sample selection, surveys, under-five mortality

The changing inter-relationship between partnership dynamics and fertility trends in Europe and the United States: A review
Volume 52 - Article 7    | Keywords: childbearing, Europe, family complexity, fertility, fertility, marriage, partnership, United States of America

Interrogating the quality and completion of mortality mobile phone interviews conducted in Malawi during COVID-19: An examination of interviewer–respondent interactions
Volume 51 - Article 46    | Keywords: audio-recording, LMICs, Malawi, mobile phone survey, mortality, RaMMPS