{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:07:54Z","timestamp":1779127674283,"version":"3.51.4"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007199","name":"Utah Agricultural Experiment Station","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007199","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>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\u221219) and peak pandemic (2020\u221222). 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.<\/jats:p>","DOI":"10.1371\/journal.pone.0347924","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:25:40Z","timestamp":1779125140000},"page":"e0347924","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of COVID-19 on longevity trends and disparities among Native Americans and Whites in the Four Corners States"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7594-5964","authenticated-orcid":true,"given":"Ashley M.","family":"Lenarz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyojun","family":"Park","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max T.","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anwesha","family":"Pan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin Trouth","family":"Hofmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric N.","family":"Reither","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"pone.0347924.ref001","author":"S Sabo","year":"2023"},{"key":"pone.0347924.ref002","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.4054\/DemRes.2021.45.39","article-title":"COVID-19 risk factors and mortality among Native Americans","volume":"45","author":"K Leggat-Barr","year":"2021","journal-title":"DemRes"},{"issue":"1","key":"pone.0347924.ref003","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/jrh.12505","article-title":"American Indian and Alaska Native People: Social Vulnerability and COVID-19","volume":"37","author":"ED Hathaway","year":"2021","journal-title":"J Rural Health"},{"issue":"8","key":"pone.0347924.ref004","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256307","article-title":"Contributors to reduced life expectancy among Native Americans in the Four Corners States","volume":"16","author":"OA Omisakin","year":"2021","journal-title":"PLoS One"},{"key":"pone.0347924.ref005","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4054\/DemRes.2022.47.9","article-title":"Life expectancy loss among Native Americans during the COVID-19 pandemic","volume":"47","author":"N Goldman","year":"2022","journal-title":"Demogr Res"},{"key":"pone.0347924.ref006","first-page":"846","article-title":"Life expectancy among Native Americans during the COVID-19 pandemic: estimates, uncertainty, and obstacles","volume":"193","author":"N Goldman","year":"2024"},{"key":"pone.0347924.ref007","unstructured":"Norris T, Vines PL, Hoeffel EM. The American Indian and Alaska Native Population: 2010. 2012."},{"key":"pone.0347924.ref008","author":"Indian Health Services."},{"key":"pone.0347924.ref009","author":"Arizona Department of Education"},{"key":"pone.0347924.ref010","author":"S Angell","year":"2023"},{"key":"pone.0347924.ref011","author":"A Meisenhemier"},{"key":"pone.0347924.ref012","author":"Native American Election Information Program"},{"key":"pone.0347924.ref013","unstructured":"Branch B, Conway D. Health Insurance Coverage by Race and Hispanic Origin: 2021. 2021."},{"key":"pone.0347924.ref014","doi-asserted-by":"crossref","DOI":"10.5888\/pcd15.170387","article-title":"Education, Income, and Employment and Prevalence of Chronic Disease Among American Indian\/Alaska Native Elders","volume":"15","author":"C Adamsen","year":"2018","journal-title":"Prev Chronic Dis"},{"key":"pone.0347924.ref015","unstructured":"Labor force characteristics by race and ethnicity, 2021. 2023. https:\/\/www.bls.gov\/opub\/reports\/race-and-ethnicity\/2021\/"},{"issue":"1","key":"pone.0347924.ref016","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1186\/s12916-021-02058-6","article-title":"Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence","volume":"19","author":"M Treskova-Schwarzbach","year":"2021","journal-title":"BMC Med"},{"issue":"1","key":"pone.0347924.ref017","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s10865-023-00443-5","article-title":"COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust","volume":"47","author":"VM Gonzalez","year":"2024","journal-title":"J Behav Med"},{"issue":"3","key":"pone.0347924.ref018","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1037\/cdp0000587","article-title":"Associations of historical trauma and racism with health care system distrust and mental health help-seeking propensity among American Indian and Alaska Native college students","volume":"29","author":"TJ Stewart","year":"2023","journal-title":"Cultur Divers Ethnic Minor Psychol"},{"issue":"8","key":"pone.0347924.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0272089","article-title":"Din\u00e9 Navajo Resilience to the COVID-19 pandemic","volume":"17","author":"WF Denetclaw","year":"2022","journal-title":"PLoS One"},{"key":"pone.0347924.ref020","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/jrh.12451","article-title":"Susceptibility of Southwestern American Indian Tribes to Coronavirus Disease 2019 (COVID-19)","volume":"37","author":"M Kakol","year":"2021","journal-title":"J Rural Health"},{"issue":"4","key":"pone.0347924.ref021","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/PHH.0000000000001206","article-title":"American Indian Reservations and COVID-19: Correlates of Early Infection Rates in the Pandemic","volume":"26","author":"D Rodriguez-Lonebear","year":"2020","journal-title":"J Public Health Manag Pract"},{"key":"pone.0347924.ref022","unstructured":"National Center for Health Statistics. CDC Wonder, Underlying Cause of Death 2018-2023. https:\/\/wonder.cdc.gov\/deaths-by-underlying-cause.html"},{"key":"pone.0347924.ref023","author":"Division of Vital Statistics DV","year":"2022"},{"key":"pone.0347924.ref024","unstructured":"US Census Bureau. Single-race Population Estimates, United States, 2010-2022. 2023. https:\/\/wonder.cdc.gov\/wonder\/help\/single-race.html#About%202020-2022"},{"key":"pone.0347924.ref025","unstructured":"Revision of profile: Hispanic\/Latino Americans. https:\/\/minorityhealth.hhs.gov\/node\/10\/revisions\/524\/view 2023. 2025 May 11."},{"issue":"4","key":"pone.0347924.ref026","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1353\/hpu.2010.0630","article-title":"Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes","volume":"13","author":"LS Morales","year":"2002","journal-title":"J Health Care Poor Underserved"},{"key":"pone.0347924.ref027","unstructured":"Centers for Disease and Prevention, National Center for Health Statistics. Instruction Manual ICD-10 Cause-of-Death Lists for Tabulating Mortality Statistics. 2009."},{"key":"pone.0347924.ref028","unstructured":"Centers for Disease Control and Prevention. Alcohol Related Disease Impact (ARDI) Application Website. www.cdc.gov\/ARDI. 2024."},{"key":"pone.0347924.ref029","volume-title":"Demography: measuring and modeling population processes","author":"SH Preston","year":"2001"},{"issue":"8","key":"pone.0347924.ref030","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.annepidem.2014.05.006","article-title":"Mortality inequality in populations with equal life expectancy: Arriaga\u2019s decomposition method in SAS, Stata, and Excel","volume":"24","author":"N Auger","year":"2014","journal-title":"Ann Epidemiol"},{"issue":"6","key":"pone.0347924.ref031","doi-asserted-by":"crossref","first-page":"107968","DOI":"10.1016\/j.amepre.2025.107968","article-title":"Racial and Ethnic Disparities in Alcohol Consumption and Mortality in the U.S","volume":"69","author":"TS Naimi","year":"2025","journal-title":"Am J Prev Med"},{"issue":"9","key":"pone.0347924.ref032","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.2337\/dc15-0710","article-title":"Alcohol Consumption and the Risk of Type 2 Diabetes: A Systematic Review and Dose-Response Meta-analysis of More Than 1.9 Million Individuals From 38 Observational Studies","volume":"38","author":"C Knott","year":"2015","journal-title":"Diabetes Care"},{"key":"pone.0347924.ref033","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1186\/s12916-014-0182-6","article-title":"Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers","volume":"12","author":"M Roerecke","year":"2014","journal-title":"BMC Med"},{"key":"pone.0347924.ref034"},{"issue":"3","key":"pone.0347924.ref035","first-page":"203","article-title":"Alcohol abuse: critical pathophysiological processes and contribution to disease burden","volume":"29","author":"PE Molina","year":"2014","journal-title":"Physiology (Bethesda)"},{"key":"pone.0347924.ref036","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.37665","article-title":"Follow-up survey of US adult reports of mental health, substance use, and suicidal ideation during the COVID-19 pandemic, September 2020","volume":"4","author":"M\u00c9 Czeisler","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"7","key":"pone.0347924.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0306395","article-title":"Evolution of an epidemic: Understanding the opioid epidemic in the United States and the impact of the COVID-19 pandemic on opioid-related mortality","volume":"19","author":"R Laing","year":"2024","journal-title":"PLoS One"},{"key":"pone.0347924.ref038","doi-asserted-by":"crossref","first-page":"111424","DOI":"10.1016\/j.jpsychores.2023.111424","article-title":"COVID-19 pandemic effects on emotional health and substance use among urban American Indian and Alaska Native people","volume":"172","author":"C Haskins","year":"2023","journal-title":"J Psychosom Res"},{"issue":"2","key":"pone.0347924.ref039","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/1078390319888266","article-title":"Historical Trauma, Ethnic Experience, and Mental Health in a Sample of Urban American Indians","volume":"26","author":"N Guenzel","year":"2020","journal-title":"J Am Psychiatr Nurses Assoc"},{"issue":"1","key":"pone.0347924.ref040","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1186\/s12889-023-15587-x","article-title":"The Culture is Prevention Project: measuring cultural connectedness and providing evidence that culture is a social determinant of health for Native Americans","volume":"23","author":"P Masotti","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0347924.ref041","article-title":"Broken promises: Continuing federal funding shortfall for Native Americans","author":"US Commission on Civil Rights","year":"2018"},{"key":"pone.0347924.ref042","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s40615-020-00940-2","article-title":"Structural inequalities established the architecture for COVID-19 pandemic among Native Americans in Arizona: a geographically weighted regression perspective","volume":"9","author":"AJ Yellow Horse","year":"2022","journal-title":"J Racial and Ethnic Health Disparities"},{"issue":"1","key":"pone.0347924.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/19320248.2016.1227750","article-title":"Food Insecurity among American Indians and Alaska Natives: A National Profile using the Current Population Survey-Food Security Supplement","volume":"12","author":"VBB Jernigan","year":"2017","journal-title":"J Hunger Environ Nutr"},{"issue":"19","key":"pone.0347924.ref044","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1001\/jama.1990.03450190043026","article-title":"Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study","volume":"264","author":"DA Regier","year":"1990","journal-title":"JAMA"},{"issue":"5","key":"pone.0347924.ref045","doi-asserted-by":"crossref","first-page":"3297","DOI":"10.1177\/15248380221126184","article-title":"Trauma and Substance Use among Indigenous Peoples of the United States and Canada: A Scoping Review","volume":"24","author":"NS Spillane","year":"2023","journal-title":"Trauma Violence Abuse"},{"issue":"11","key":"pone.0347924.ref046","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1001\/archgenpsychiatry.2011.120","article-title":"Racial\/ethnic variations in substance-related disorders among adolescents in the United States","volume":"68","author":"L-T Wu","year":"2011","journal-title":"Arch Gen Psychiatry"},{"issue":"6","key":"pone.0347924.ref047","doi-asserted-by":"crossref","first-page":"2116","DOI":"10.1007\/s11469-020-00304-1","article-title":"Prevalence of Mental Disorders from Adolescence through Early Adulthood in American Indian and First Nations Communities","volume":"19","author":"M Walls","year":"2020","journal-title":"Int J Ment Health Addict"},{"issue":"3","key":"pone.0347924.ref048","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1192\/bjp.bp.112.123992","article-title":"Mental disorders and risk of accidental death","volume":"203","author":"C Crump","year":"2013","journal-title":"Br J Psychiatry"},{"key":"pone.0347924.ref049","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1192\/bjp.185.5.422","article-title":"Mental illness and accidental death. Case-control psychological autopsy study","volume":"185","author":"SSF Gau","year":"2004","journal-title":"Br J Psychiatry"},{"key":"pone.0347924.ref050","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1146\/annurev-clinpsy-080921-072950","article-title":"Community Mental Health Services for American Indians and Alaska Natives: Reconciling Evidence-Based Practice and Alter-Native Psy-ence","volume":"19","author":"JP Gone","year":"2023","journal-title":"Annu Rev Clin Psychol"},{"key":"pone.0347924.ref051","article-title":"Leading causes of death and all-cause mortality in American Indians and Alaska Natives","volume":"104","author":"DK Espey","year":"2014","journal-title":"Am J Public Health"},{"key":"pone.0347924.ref052","volume-title":"The Validity of race and Hispanic origin reporting on death certificates in the United States","author":"E Arias","year":"2008"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347924","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:25:48Z","timestamp":1779125148000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0347924"}},"subtitle":[],"editor":[{"given":"Kala M.","family":"Mehta","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":52,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0347924","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}