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

Area of Science:

• Public Health
• Epidemiology
• Demography

Background:

• Recent research suggests rising mortality in middle-aged US Whites is driven by suicides and substance abuse.
• These 'despair' deaths have been attributed to a cohort-based epidemic of pain and distress.

Purpose of the Study:

• To examine trends in all-cause and cause-specific mortality rates among younger and middle-aged US White men and women from 1980 to 2014.
• To investigate the roles of suicides, alcohol-related deaths, drug-related deaths, metabolic diseases, and extrinsic causes in mortality trends.
• To decompose mortality trends into period- and cohort-based variations by gender, age, and cause of death.

Main Methods:

• Analysis of official US mortality data from 1980 to 2014.
• Estimation of cause-specific mortality trends, including drug-related, alcohol-related, suicide, metabolic diseases, and extrinsic causes.
• Decomposition of mortality trends into period and cohort effects, stratified by gender and age.

Main Results:

• Mortality trends among middle-aged US Whites vary significantly by cause and gender.
• Drug-related deaths dramatically increased since the early 1990s, showing strong period-based patterns.
• Metabolic disease mortality declines have slowed or stalled, exhibiting strong cohort-based patterns.

Conclusions:

• Empirical evidence does not strongly support pain- and distress-based explanations for rising US White mortality.
• Recent mortality increases are more likely influenced by the US opiate epidemic and an expanding obesogenic environment.