Explaining recent mortality trends among younger and middle-aged White Americans

Abstract

Background: Recent research has suggested that increases in mortality among middle-aged US Whites are being driven by suicides and poisonings from alcohol and drug use. Increases in these 'despair' deaths have been argued to reflect a cohort-based epidemic of pain and distress among middle-aged US Whites.

Methods: We examine trends in all-cause and cause-specific mortality rates among younger and middle-aged US White men and women between 1980 and 2014, using official US mortality data. We estimate trends in cause-specific mortality from suicides, alcohol-related deaths, drug-related deaths, 'metabolic diseases' (i.e. deaths from heart diseases, diabetes, obesity and/or hypertension), and residual deaths from extrinsic causes (i.e. causes external to the body). We examine variation in mortality trends by gender, age and cause of death, and decompose trends into period- and cohort-based variation.

Results: Trends in middle-aged US White mortality vary considerably by cause and gender. The relative contribution to overall mortality rates from drug-related deaths has increased dramatically since the early 1990s, but the contributions from suicide and alcohol-related deaths have remained stable. Rising mortality from drug-related deaths exhibit strong period-based patterns. Declines in deaths from metabolic diseases have slowed for middle-aged White men and have stalled for middle-aged White women, and exhibit strong cohort-based patterns.

Conclusions: We find little empirical support for the pain- and distress-based explanations for rising mortality in the US White population. Instead, recent mortality increases among younger and middle-aged US White men and women have likely been shaped by the US opiate epidemic and an expanding obesogenic environment.

Figure 1

Absolute changes in US White women’s (left) and men’s (right) age-standardized mortality rates, ages 45–54. Top row: 1999–2013. Middle and bottom rows: 1980–2014. Mortality rates are per 100 000 person-years.

Figure 2

Absolute Changes in US White women’s (left) and men’s (right) age-standardized mortality rates, ages 35–44 (bottom) and 25–34 (top), 1980–2014. Mortality rates are per 100 000 person-years.

Figure 3

Combined mortality rates for US White women (left) and men (right) aged 45–54 (bottom) and 35–44 (top), from drug-related deaths, alcohol-related deaths, suicides and metabolic diseases, 1980–2014. Mortality rates are per 100 000 person-years.

Figure 4

Period-based variation in drug-related mortality and cohort-based variation in metabolic disease mortality among White women and men (right), ages 35–54, 1980–2014. Estimates are 3-year moving averages, and gray areas indicate upper and lower bounds of the 95% confidence interval. Estimates are mortality rates per 100 000 person-years.