An increase in mortality among middle-aged Americans — largely attributed to “deaths of despair” from suicide, drug overdoses and alcoholic liver disease — has been frequently portrayed as a phenomenon affecting white communities. Under a common narrative, these deaths have often been explained by the perceived loss of status felt by many less-educated white Americans as their economic opportunities declined and their social standing diminished.

However, a new analysis led by UCLA researchers and published in the Lancet shows that Native American people aged 45 to 54 actually have had the biggest increases in mortality in recent decades, and are now dying at twice the rate of white people of the same age. Further, Native American communities collectively have the highest rates of mortality from each of the causes of deaths of despair.

This tragic toll has been overlooked in mainstream discussion about deaths of despair because health policy data on Native American communities are often ignored or incomplete, the researchers write. That includes an influential 2015 study that coined the term and sparked a national conversation about deaths of despair, but which did not consider Native American mortality data.

Many of the follow-up studies on the topic also did not include data on Native Americans.

“Many people reading about the deaths of despair in recent years could easily have thought that white individuals were the most affected by premature mortality and decreases in life expectancy, because the theory focused on the ‘uniqueness’ of this phenomenon for white communities,” said Joseph Friedman of the David Geffen School of Medicine at UCLA, the paper’s corresponding author. “But a careful read of the data shows that Native individuals have had the biggest increases in premature mortality, and overall Black and Native communities have been the most affected in all years of available data. It’s important that these inequalities be shown and discussed, rather than hidden, so that we can mobilize resources and work to improve them.”

Read the full news release on the UCLA Health website.