Mortality Trends Among Working-Age Whites: The Untold Story
http://tinyurl.com/grfw6rq
Abstract
Recent research has called attention to an unexpected rise in death rates among middle-aged, white Americans between 1999 and 2014. The full extent of the phenomenon may be underappreciated, however. If one assumes, based on historical trends, that mortality rates should have declined by 1.8 percent per year, then whites in 2014 had higher-than-expected mortality rates from age 19 to age 65. Furthermore, while increased substance abuse and suicides explain the elevated mortality rates for younger adults, middle-aged whites also seem to be experiencing stalled or rising mortality rates for most ailments and diseases. While a national phenomenon, middle-aged whites face much more adverse mortality trends in certain states and regions. The especially broad reach of these negative mortality trends suggests there is an urgent need for further investigation of its causes and potential remedies.
INTRODUCTION
At the end of 2015, Princeton University economists Anne Case and Angus Deaton published a startling finding: since 1999, death rates have been rising for non- Hispanic, white Americans between the ages of 45 and 54, reversing a decades-long decline.1 The authors largely attribute this reversal to rising rates of drug poisonings, suicides, and alcohol-related liver disease. They also note that over the same period, middle-aged whites reported worsening self-reported health status, greater levels of pain, increased difficulty with activities of daily living, and more mental health problems.
In January 2016, the New York Times followed up on Case and Deaton’s findings with an analysis showing that the rise in white mortality rates has not been confined to middle-aged adults but has occurred among younger adults—those 25 to 34—as well.2 The main culprit: increasing abuse of prescription opioids, such as oxycodone and hydrocodone, and heroin.
These findings have attracted substantial attention. Upon further examination, however, it becomes clear that the gap between expected and actual white mortality rates is wider than commonly recognized. Moreover, the gap is not adequately explained for the middle-aged by the common narrative of rising levels of substance abuse and suicide. And while it is a national phenomenon, the mortality crisis has struck some regions of the United States much more severely than others.
THE MORTALITY GAP
Between 1999 and 2014, mortality rates in the U.S. rose for white adults between the ages of 22 and 56, peaking at around age 30 and age 50 (Exhibit 1).3 In contrast, mortality rates for both younger and older white Americans declined over this period.
However, this perspective fails to adequately account for the well-founded presumption that, absent a health crisis, mortality rates for white Americans should have been declining during this time. In other words, white Americans are now facing a substantial “mortality gap.” Since 1968, death rates had declined by nearly 2 percent per year across most age groups as well as across races and ethnicities (Appendix Table 1).4 Other high-income countries also have experienced this broad-based decline, which for many even appeared to accelerate between 1998 and 2013 (Appendix Table 2).
Relative to this baseline of improvement, the mortality gap for white Americans becomes much more pronounced (Exhibit 2).5 It spans all the years of working life (ages 19–65) but is especially large at midlife. Compared with an expected decline of 1.8 percent annually, observed mortality rates in 2014 resulted in more than 100 excess deaths for every 100,000 middle-aged white adults.
THE CAUSES
Case and Deaton conclude that three causes of death account for the increase in midlife white mortality: accidental poisonings (mostly drug overdoses), suicides, and chronic liver diseases and cirrhosis associated with alcohol consumption. These three factors have risen in tandem, killing twice as many working-age whites in 2014 as in 1999.6
