Research on excess deaths among American Indians and Alaska Natives: a critical review.

American Indians and Alaska Natives die younger and at higher rates proportionately than members of the general United States population. Causes of death among Native peoples in the U.S. have been the subject of numerous studies by health care professionals and social scientists. Many of these deaths are considered excess deaths, that is, deaths that occur statistically beyond the rate of incidence of the larger population. This paper examines 46 studies of excess deaths published within five years (1987 to 1993) and based on data gathered within ten years (1982 to 1992) and critiques the studies for methodology and context. Existing studies of excess death among Native peoples are limited by a lack of definitional clarity, ethnic misclassifications, lack of multidisciplinary and Native representation on research terms, superficial analysis of statistical findings, overrepresentation of data for some tribes and underrepresentation for others, bias for quantitative research methods and unbalanced prioritization.