Shocking finding: Death rate increasing for middle-aged white Americans

'Something's clearly going wrong with this age group in America,' expert says

A new paper finds that after decades of decline, the mortality rate among middle-aged white Americans has been rising in recent years—unlike for other age groups, racial and ethnic groups, or even middle-aged whites in other countries.

The study, published Monday in the Proceedings of the National Academy of Sciences, comes from Princeton University economist Angus Deaton, who won the Noble Prize in economics last month for other research, and his wife and fellow Princeton economist Anne Case.

For their research, Case and Deaton examined mortality and health data from CDC and other sources. While the data used in the study has long been available, other experts say Deaton and Case were able to parse the information in ways that had not been pursued by other researchers.

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Study findings

Overall, the study found the all-cause mortality rate for white Americans ages 45 to 54 climbed from 381.5 per 100,000 in 1999 to 415.4 in 2013, an increase of about half a percent per year. By contrast, other developed nations studied—Australia, Canada, France, Germany, Sweden, and the United Kingdom—all saw mortality rates among whites decline.

All-cause mortality, ages 45-54

Source: Deaton/Case, PNAS, 11/2

And in the United States, the mortality rate for middle-aged Hispanics and blacks, and for younger and older individuals of non-white racial and ethnic groups, continued to decline between 1999 and 2013.

While middle-aged blacks continue to have a higher mortality rate in the U.S. than middle-aged whites—at about 582 per 100,000—the study found that the gap is closing. Middle-aged Hispanics have a mortality rate that is lower, at about 270 per 100,000, than middle-aged whites.

Behind the trend

Deaton says the increase in the mortality rate among whites was heavily concentrated among those who had received the least amount of education. "Those are the people who have really been hammered by the long-term economic malaise," he notes.

Deaton and Case also found that middle-aged white Americans have reported higher levels of chronic pain, mental health issues, and trouble with daily activities in recent years. That may partially explain another finding of the research, which is that much of the increasing death rate stems from suicides and deaths related to substance misuse.

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Deaton says "it certainly can't be helping" that these trends began in concert with broader availability of certain prescription painkillers. According to the Associated Press, research has shown whites are more likely to attempt suicide when faced with physical and mental hardships than other demographic groups.

Still, the findings came as a shock to the researchers. "Pretty quickly, we started falling off our chairs because of what we found," Deaton says, calling the increase in the morality rate among middle-aged white Americans an "extraordinary turnaround."

Case and Deaton estimated that the increase in mortality rate resulted in 488,500 additional deaths during the period they examined.

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Reaction

Experts say it is notable similar mortality trends were not found in other developed countries. "Something's clearly going wrong with this age group in America," warns John Haaga, the acting director of behavioral and social research at the National Institute on Aging, which funded the study.

In a commentary that accompanied the article, Dartmouth College economists Ellen Meara and Jonathan Skinner noted that whites have been hit particularly hard by the opiate-misuse epidemic and speculated it could be fueling the mortality trend. However, they said the exact cause is unclear.

Skinner told NPR's "Shots" that middle-aged white Americans may be having more difficulty dealing with the psychological aspects of struggling economically. "Their parents had done better economically and they had been doing pretty well. Then all of a sudden the financial floor dropped out from underneath them," he said.

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"For African-American and Hispanic households things had never been that optimistic and so perhaps the shock wasn't quite as great," Skinner hypothesized.

CDC Director Tom Frieden says the increase in the mortality rate among middle-aged white Americans is "deeply concerning" adding, "We shouldn't see death rates going up in any group in society" (Stobbe, AP/Sacramento Bee, 11/2; Kolata, New York Times, 11/2; Stein, "Shots," NPR, 11/2; Bernstein/Achenbach, Washington Post, 11/2).


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