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Death rates rising for middle-aged white Americans

An analysis of surveys and databases found increases in morbidity and mortality in middle-aged white Americans, marking an upturn after decades of decline, according to data published in the Proceedings of the National Academy of Sciences.

Anne Case, an economist at Princeton University, and colleague reported that the rise was attributable to increases in suicides, drug and alcohol poisonings and liver diseases.

"Midlife increases in suicides and drug poisonings have been previously noted," Case and colleague wrote. "However, that these upward trends were persistent and large enough to drive up all-cause midlife mortality has, to our knowledge, been overlooked. Concurrent declines in self-reported health, mental health and ability to work, increased reports of pain, and deteriorating measures of liver function all point to increasing midlife distress."

The researchers used various tools to compile data on mortality and morbidity, including the CDC Wonder Compressed and Detailed Mortality files, death records, American Community Surveys, Current Population Surveys, the Human Mortality Database, National Health Interview Surveys and the National Health and Nutrition Examination Surveys.

"Between 1970 and 2013, a combination of behavioral change, prevention and treatment brought down mortality rates for those aged 45 to 54 by 44%," Case and colleague stated. "Parallel improvements were seen in other rich countries. Improvements in health also brought declines in morbidity, even among the increasingly long-lived elderly."

Researchers stated that from 1978 through 1998, the mortality rate for middle-aged white Americans declined by an average 2% each year. After 1998, unlike other rich countries, including France, Germany, the United Kingdom, Canada, Australia and Sweden, the mortality of whites in the United States rose by half a percent each year.

Case and colleagues noted that this rise was not seen in the other counties and it was only seen in white Americans.

The researchers found that three causes of death accounted for the increase in all-cause mortality: suicide, drug and alcohol poisonings and chronic liver diseases and cirrhosis.

Over a period from 1999 to 2013, the mortality rate of middle-aged white Americans rose by 33.9 per 100,000. The mortality rate of middle-aged black Americans fell by 214.8 per 100,000 and the mortality rate of middle-age Hispanic Americans fell by 63.6 per 100,000.

Data demonstrated that white Americans saw increases of 22.2, 9.5 and 5.3 per 100,000 for deaths by poisonings, intentional self-harm and chronic liver cirrhosis, respectively. Black Americans saw increases of 3.7 and 0.9 per 100,000 in poisonings and intentional self-harm and a decrease of 9.5 per 100,000 in chronic liver cirrhosis. Hispanic Americans saw increases of 4.3 and 0.2 per 100,000 in poisonings and intentional self-harm and a decrease of 3.5 per 100,000 in chronic liver cirrhosis.

Mortality increases were largest for white middle-age Americans who had a high school degree or less.

Case and colleague wrote that the cause of the turnaround remains unclear, but is partly caused by the increased availability of opioid prescriptions for pain.

"The epidemic of pain which the opioids were designed to treat is real enough, although the data here cannot establish whether the increase in opioid use or the increase in pain came first," they wrote. "Increased alcohol abuse and suicides are likely symptoms of the same underlying epidemic, and have increased alongside it, both temporally and spatially." – by Chelsea Frajerman Pardes

Disclosures: The authors report no relevant financial disclosures.