The Death Rate Is Rising for Middle-Aged Whites
Addiction and mental-health issues largely drive a reversal of decades of longevity gains
By Betsy McKay
Nov. 2, 2015
White, middle-aged Americans are dying at a rising rate, a new study shows, a startling reversal that suggests addiction and mental-health issues are setting back decades of gains in longevity.
Suicide, alcohol abuse, drug overdoses and chronic liver diseases largely drove the rise, which occurred between 1999 and 2013, according to the report published Monday in the Proceedings of the National Academy of Sciences. Those causes of death offset declines in other major drivers of mortality in midlife, such as lung cancer, the study said.
The study “is going to change the game” for setting research priorities in public health, predicted Michael Eriksen, dean of Georgia State University’s School of Public Health, who wasn’t involved in the work. “Substance abuse and alcoholism are taking their toll in a way people haven’t acknowledged,” he said.
No other rich country has seen a similar reversal, and the trend is at odds with falling death rates for black and Hispanic Americans in that age group over the same period, said the authors, Anne Case and Angus Deaton, who are economics professors at Princeton University. Mr. Deaton won the Nobel Prize in economics this year.
The rise occurred primarily among men and women between 45 and 54 with no more than a high-school education. But deaths from those causes also rose for better-educated middle-aged whites as well as whites in other age groups, according to the study. Death rates are defined in the study as the number of deaths per 100,000 people for each age cohort.
Ms. Case and Mr. Deaton found that mortality rose half a percent annually for whites aged 45 to 54 between 1999 and 2013, after declining 2% a year on average between 1978 and 1998. Had mortality continued to decline at that rate, 488,500 deaths would have been avoided between 1999 and 2013, they said.
The study is based on data from the Centers for Disease Control and Prevention, individual death records and other sources.
Mortality for Hispanic Americans continued to fall an average of 1.8% a year during that period, while deaths for blacks slid an average of 2.6% a year-though blacks of this age group still have a higher mortality rate than whites. A narrowing gap in life expectancy between blacks and whites is due largely to the rising death rate among whites, Ms. Case and Mr. Deaton said.
James Smith, an expert in labor markets and demographic research with Rand Corp., called the study a “landmark paper.” He added, “I did not know things were getting this bad this fast.”
The authors warned that by the time white people in this age group are eligible for Medicare they could be in worse health than the current elderly population. That means they could require more expensive care.
Why middle-aged whites have been more affected than other groups isn’t entirely clear and needs more study, the authors and other experts said.
Ms. Case and Mr. Deaton found in health-survey data from the CDC that middle-aged whites have increasingly reported mental-health problems and difficulties dealing with daily life. One in three reported chronic pain between 2011 and 2013.
Those increases in mental-health and musculoskeletal problems may “explain some of the recent otherwise puzzling decrease in labor-force participation in the United States, particularly among women,” the authors said. Participation in the labor force has fallen since 2007, according to the Bureau of Labor Statistics.
Economic stress may play a role in substance abuse by middle-aged white people, according to the study.
Many people are reaching midlife short of a cornerstone of the American dream: making more money than their parents did. Average hourly wages in real terms were $19.18 in 1964 and $20.67 in 2014, according to Bureau of Labor Statistics data cited by the Pew Research Center. Median real household income for whites with a high-school education have fallen since the late 1990s, Ms. Case said.
Health and well-being should be measured along with income in debates about inequality, Mr. Deaton said. “You can’t just look at their incomes,” he said.
The findings illustrate the ways in which some people are responding to physical and mental pain, adversity and changing life situations, the researchers said. “What we see here is a group that’s in quite a lot of distress,” said Ms. Case, an expert in development and health economics.
The rising death rate is linked in part to the epidemic of prescription drug abuse. Whites have one of the higher rates of nonmedical use of prescription painkillers among ethnic groups, according to the Substance Abuse and Mental Health Services Administration.
The majority of those who died from overdosing on prescription painkillers between 1999 and 2013 were white, according to the CDC. People between 45 and 54 had the highest rate of such deaths of all age groups, at 10.6 per 100,000.
Suicide in 2013 was highest among whites and people ages 45 to 64, according to breakdowns by ethnicity and age. The U.S. suicide rate overall rose from 10.9 per 100,000 in 2005 to 12.6 per 100,000 in 2013, according to CDC data.
More research is needed to understand why chronic pain is so prevalent in middle-aged whites and how to address it with medications that don’t risk addiction, said Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health. Research also should be expanded into the higher suicide rate in this group, she said.
The study was funded by the National Institute on Aging, another arm of the NIH.