Native Hawaiians comprise 24.3% of Hawai‘i's population, but only 12.6% of the state's older adults. Few published studies have compared health indicators across ethnicities for the state's older adult population or focused on disparities of Native Hawaiian elders. The current study examines data from two state surveillance programs, with attention to cause of death and social-behavioral factors relevant to elders. Findings reveal that Native Hawaiians have the largest years of productive life lost and the lowest life expectancy, when compared to the state's other major ethnic groups. Heart disease and cancer are leading causes of premature mortality. Native Hawaiian elders are more likely to report behavioral health risks such as smoking and obesity, live within/below 100–199% of the poverty level, and find cost a barrier to seeking care. Indicated is the need for affordable care across the lifespan and health services continuum. Future research might explain behavioral factors as influenced by social determinants, including historical trauma on Native Hawaiian longevity. 1. Introduction Native Hawaiians are descendents of the aboriginal peoples inhabiting the Hawaiian archipelago prior to western contact in 1778 and exercising sovereign governance prior to the 1892 overthrown of the Hawaiian Kingdom by the United States (USA) [1, 2]. The 2000 US census enumerated 401,000 Americans (0.1% of the total population) of full or part-Hawaiian ethnicity, about 60% of whom reside in the State of Hawai‘i. Native Hawaiians comprise about 24.3% of the state’s current population [3]. As in other states, the population of Hawai‘i is aging, with an increasing number of residents living into old age. Although life expectancy in Hawai‘i exceeds that of other US states, studies conducted within the state reveal continuing ethnic differences in life expectancy [3]. As depicted in Figure 1, over six decades (1950–2000) Native Hawaiians have consistently had the lowest life expectancy when compared to the state’s three other largest groups, namely, Caucasians, Filipinos (Americans), and Japanese (Americans). Notably, the magnitude of this disparity—about 10？years lower than the longest lived group—has not changed over time. About 16% of deaths among Native Hawaiians in 2005 occurred before 45？years, which is at least two times higher than for any other ethnic group living in the state [4]. Mortality disparities are particularly significant when comparing Native Hawaiians with Japanese; in 2005, 60% of deaths among Japanese occurred at age 80+ years, compared to only 25%
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