The impact of COVID-19 on longevity trends and disparities among Native Americans and Whites in the Four Corners States.

Prior research has shown suboptimal health and longevity among Native Americans in the Four Corners region of the United States, which encompasses Arizona, New Mexico, Colorado, and Utah. Our study (1) investigates how life expectancy trends and disparities changed among non-Hispanic Native Americans and Whites in the Four Corners States (FCS) during the COVID-19 pandemic and (2) examines the extent to which longevity changes are directly attributable to COVID-19, relative to other causes of death. Data sources include mortality data from the National Center for Health Statistics and population data from the U.S. Census Bureau. Life expectancy at birth for four race-sex groups in the FCS (Native American and White females and males) was calculated using abridged life table procedures, both pre-pandemic (2018-19) and peak pandemic (2020-22). Gaps in life expectancy between groups (and changes within groups) were decomposed into multiple causes of death to determine which causes contributed most to life expectancy gaps and changes across time periods. Life expectancy declined in the FCS over the study period; whereas Native American male and female longevity decreased by 7.33 years and 6.76 years, respectively, White male and female longevity decreased by 2.11 years and 1.72 years, respectively. Results indicate that the peak pandemic life expectancy gap between Native Americans and Whites widened by over 5 years, regardless of sex. Although COVID-19 was the single largest contributor to longevity changes within and between groups, causes of death related to drug and alcohol use also made notable contributions, especially among Native Americans. Restoring longevity to pre-pandemic levels in the FCS will require improved management of COVID-19 as well as heightened attention to the deleterious role of substance use in indigenous communities.