The Centers for Disease Control (CDC) publish mortality data, “Multiple Cause of Death” files, for all deaths in the U.S. (beginning in 1969) based on death certificates filed in each US county. Deaths of middle-aged White Americans (ages 45-64) steadily declined through the 1980s. However, beginning in the 1990s there was a sharp up-surge in deaths from drug and alcohol poisoning, liver cirrhosis, and suicide among this demographic. These three causes of death together constitute the “deaths of despair” or DOD statistic.
In a 2015 publication, Case and Deaton identified an alarming trend in mortality rates for non-Hispanic White Americans in the 45-54 age group. Between 1978 and 1998, mortality rates declined by 2% per year on average for this group. After 1998, mortality for this group began rising by half a percent per year. This trend was surprising as it represented a reversal from the steadily declining mortality rate among all groups in the U.S. up to that point (1999). Further, the fact that this trend was not observed in other age groups or racial-ethnic minorities nor in other wealthy countries brought attention to this issue.
Education level was an important factor as the least educated in this group had the highest mortality rates. According to the authors, “this trend was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis” (p. 15078). In addition to declines in mortality, the authors point to related declines in other health outcomes among this group including mental and physical health, ability to work, and chronic pain.
In a follow-up article, Case and Deaton (2017) explored various explanations for the DOD trend among mid-life White Americans. For example, they refuted a purely economic explanation for higher DOD among this group. Instead, they proposed that the cumulative disadvantage of declining labor market opportunities combined with increasing “social dysfunctions” fostered by “the decline of marriage, social isolation, and detachment from the labor force” (p. 22) are the likely cause.
Citations: Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083.
https://pubmed.ncbi.nlm.nih.gov/26575631/
Case, A., & Deaton, A. (2017). Morality and morbidity in the 21st century. Brookings Papers on Economic Activity, 397-476.
https://pubmed.ncbi.nlm.nih.gov/29033460/
©Jennie Dilworth, Ph.D