This report examines the 10 leading causes of death among American Indians in South Dakota from 2004 to 2020. It analyzes data derived from death certificates submitted by local physicians and coroners. The report highlights the most prevalent causes of death, including heart disease, cancer, unintentional injuries, chronic liver disease, and diabetes, over the 17-year period. Additionally, it explores age-specific mortality patterns, revealing the leading causes of death in different age groups, such as unintentional injuries and suicide among children and young adults, chronic liver disease in the 40-49 age group, and the impact of COVID-19 on the 50-89 age group in 2020. The report also identifies heart disease as the primary cause of death in individuals aged 90 and above.