Mortality of American Indian and Alaska Native workers by occupation and industry, 2020-2022

Little occupational health and safety information exists on American Indian or Alaska Native (AI/AN) workers. The objective of this study is to describe the leading underlying causes of death among AI/AN workers by occupation and industry.

Mortality data indicating decedents' race as: (1) 'American Indian/Alaska Native' (AI/AN) single-race or (2) AI/AN single-race and AI/AN in combination with any other race(s) were abstracted from 2020 to 2022 public use multiple cause of death files maintained in the National Vital Statistics System. Records with decedents: (a) 15 years of age and older, (b) residing in the United States, and (c) having both usual industry and usual occupation were included in this analysis. Mortality data were analyzed by occupation and industry for the 15 leading causes of death and COVID-19. Age-adjusted proportionate mortality ratios (PMRs) and 95% confidence intervals were calculated for usual occupation groups and usual industry groups for these causes of death.

Occupation groups with the highest number and proportion of deaths were construction and extraction (AI/AN single-race 15.9%; AI/AN combined 14.9%) and production (AI/AN single-race and combined 8.8%). The industry groups with the highest number and proportion of deaths include construction (AI/AN single-race 15.7%; AI/AN combined 14.9%) and healthcare and social assistance (AI/AN single-race 12.3%; AI/AN combined 12.2%). The three highest PMRs by occupation were suicide in the military and computer and mathematical occupations and homicide in construction and extraction occupations. The three highest PMRs by industry were suicide in the military and utilities industries and hypertension in the information industries. The top three causes of death for AI/AN combined race decedents were heart disease, cancer, and COVID-19.

These results indicate that causes of death among AI/AN workers vary by specific occupations and industries. Focusing intervention and prevention in these highest risk occupations and industries may reduce morbidity and mortality among workers.

The results of this study can be used by tribes, tribal organizations, tribal leaders, and researchers to assist in prevention, control methods, and tailored communication efforts.