Does despair drive increases in white mortality, or did the narrative get ahead of the data?

The aim of this study is to test the central claim of the "deaths of despair" theory: that rising despair among midlife white Americans has driven increases in all-cause mortality, particularly in those with low education. We analyzed time series of annual all-cause mortality rates per 100,000 (N=92,700 individuals) and despair (N=88,872 individuals) among US midlife (aged 45-54) adults from the CDC and NIH between 1999-2015. The association between changes in despair and changes in mortality rates were estimated via Bayesian autoregressive models with AR(1) errors. Race/ethnicity and education-specific estimates were obtained via marginal standardization. All-cause mortality increased by 7.49 per 100,000 only among midlife white adults, with a larger increase among those with low education (51.4 per 100,000). Despair prevalence did not increase exclusively among midlife white adults, increasing by 0.13% (-0.03%; 0.29%) and 0.12% (-0.27%; 0.51%) among white and Black midlife adults. The observed increases in despair among whites in midlife were not associated with increases in mortality rates (-0.12 per 100,000; 95%UI=-0.54; 0.29). These findings directly challenge the central claim of this theory and highlight the need to move beyond the white despair narrative to explain US mortality trends.