Trends in "Deaths of Despair" Among Working-Aged White and Black Americans, 1990-2017

Abstract

Life expectancy for US White men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in "deaths of despair" (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged White Americans. There has been less attention on Black mortality trends from these same causes, and whether the trends are similar or different by cohort and period. We complement existing research and contend that recent mortality trends in both the US Black and White populations most likely reflect period-based exposures to 1) the US opioid epidemic and 2) the Great Recession. We analyzed cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic Black and non-Hispanic White Americans, aged 20-64 years, over 1990-2017. We employed sex-, race-, and cause-of-death-stratified Poisson rate models and age-period-cohort models to compare mortality trends. Results indicate that rising "deaths of despair" for both Black and White Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both White and Black Americans changed during the Great Recession, despite some racial differences across cohorts.

Keywords: United States; age-period-cohort models; deaths of despair; midlife mortality; mortality trends; opioid; racial/ethnic trends.

Figure 1

Age-standardized mortality rates per 100,000 from drug-related mortality according to race and sex, United States, 1990–2017. A) Ages 20–34 years; B) ages 35–49; C) ages 50–64.

Figure 2

Women’s cohort- and period-based variation in “deaths of despair” mortality, United States, years 1990–2017 and cohorts 1926–1994. A) Black women, cohort; B) White women, cohort; C) Black women, period; D) White women, period. Estimates are mortality rates per 100,000 person-years.

Figure 3

Men’s cohort- and period- based variation in “deaths of despair” mortality, United States, years 1990–2017 and cohorts 1926–1994. A) Black men, cohort; B) White men, cohort; C) Black men, period; D) White men, period. Estimates are mortality rates per 100,000 person-years.