1. Period Life Tables for the Non- Hispanic American Indian and Alaska Native Population in CHSDA Counties Elizabeth Arias, Ph.D. Mortality Statistics Branch Division of Vital Statistics National Center for Health Statistics 2014 Concurrent NAPHSIS Annual Meeting and VSCP Project Directors Meeting Seattle, Washington June 8-11, 2014

2. Background  Period life tables provide the most succinct snapshot of the mortality profile of a population at a point in time.  Age-specific life expectancy  Age-specific probability of dying  Age-specific probability of surviving  The life table is used to describe the mortality profile of populations by race, ethnicity, SES, and other demographic and social characteristics

3. Background  Official US life tables have been produced decennially since 1900 and annually since 1945  From inception, the racial categories included in the program are white and black,  With 2006 data, the ethnic and racial categories Hispanic, non-Hispanic white and black were added to the program.  To date, as a result of concerns about poor data quality, official US life tables for the AI/AN or API populations have not been produced

4. Data Quality Issues  I) Ethnic and racial incongruence between the two data systems used to estimate death rates:  Numerators are derived from death certificates  Denominators are derived from census population estimates  Evaluation studies show that the main reason for the incongruence is misclassification on the death certificate.  Nationally, approximately 30% of self-identified AI/AN are classified as some other race upon death.  In CHSDA counties, 20% and in non-CHSDA counties 82%.

5. Data Quality Issues  II) Age misstatement (misreporting) in the oldest ages results in the underestimation of death rates at the oldest ages  NCHS uses Medicare data to supplement vital statistics data at the oldest ages for the total, white and black populations.  Unfortunately, reliable Medicare data is not available for the AI/AN population.

6. Data and Methods  We used the AI/AN Mortality Data Base (AMD). AMD consists of National Vital Statistics System (NVSS) mortality data corrected for AI/AN misclassification on death certificates and covers years 1990-2009.  Indian Health Service (IHS) patient registration records were linked to the National Death Index (NDI) to identify IHS AI/AN deaths.  IHS AI/AN records identified as deceased through the NDI linkage were then linked to the NVSS mortality files, adding an additional AI/AN identifier to the files.

7. Data and Methods  We use 3-years (2007-2009) final death counts for ages 0-99 from the AMD.  Final death counts classified as AI/AN used to estimate the life tables include those classified as AI/AN in the NVSS mortality files AND those identified as AI/AN as a result of the linkage of the IHS to the NDI. Further, deaths were classified as non-Hispanic if so designated on the death certificate.  We used midyear 2008 sex and age-specific census revised bridged race inter-censal population estimates.

8. Data and Methods

9. Age Pattern of Mortality Comparisons Between the Non-Hispanic American Indian and Alaska Native and the Non-Hispanic White Population MalesFemales ---NH-AI/AN Vital ---NH-AI/AN Brass ---NH-White

10. Results

11. Life Expectancy at Birth

12. Life Expectancy at Age 65

13. Life Expectancy at Age 85

16. Ratio of Non-Hispanic American Indian and Alaska Native to Hispanic, Non-Hispanic White and Non-Hispanic Black Age-Specific Probabilities of Dying Males Females ---NH-AI/AN to Hispanic ---NH-AI/AN to NH-White ---NH-AI/AN to NH-Black

17. Percent Surviving by Age, Females

18. Percent Surviving by Age, Males

19. Percent Surviving to Selected Ages, Males

20. Percent Surviving to Selected Ages, Females

21. Summary and Conclusions  The AMD largely eliminated the problem of racial/ethnic misclassification on death certificates  Therefore, for the first time ever, we were able to produce reliable life tables for the NH-AI/AN population in CHSDA counties  NH-AI/AN life expectancy at birth was lower by close to a decade in comparison to the national Hispanic and non-Hispanic white populations  The mortality disadvantage of the NH-AI/AN population remained exceedingly large throughout the younger ages and only diminished in the very oldest ages

22. Limitations  The life tables represent the mortality profile of a segment of the AI/AN population:  Represent 64% of the NH-AI/AN population  The use of the Brass Relational Logit Model to estimate mortality in ages 85 – 100+ fit very well and produced robust estimates, but relied on an unverified assumption that the relationship between the standard and the NH-AI/AN population in ages 45-84 extended to ages 85 and older.

24. Contact Information  Elizabeth Arias, PhD  National Center for Health Statistics  3311 Toledo Road, Room 7331  Hyattsville, MD 20782  (301)458-4727  EArias@cdc.gov