Something
startling is happening to middle-aged white Americans. Unlike every
other age group, unlike every other racial and ethnic group, unlike
their counterparts in other rich countries, death rates in this group
have been rising, not falling.
That finding was reported Monday by two Princeton economists, Angus Deaton, who last month won the 2015 Nobel Memorial Prize in Economic Science,
and Anne Case. Analyzing health and mortality data from the Centers for
Disease Control and Prevention and from other sources, they concluded
that rising annual death rates among this group are being driven not by
the big killers like heart disease and diabetes but by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids.
The
analysis by Dr. Deaton and Dr. Case may offer the most rigorous
evidence to date of both the causes and implications of a development
that has been puzzling demographers in recent years: the declining
health and fortunes of poorly educated American whites. In middle age,
they are dying at such a high rate that they are increasing the death
rate for the entire group of middle-aged white Americans, Dr. Deaton and
Dr. Case found.
The
mortality rate for whites 45 to 54 years old with no more than a high
school education increased by 134 deaths per 100,000 people from 1999 to
2014.
“It
is difficult to find modern settings with survival losses of this
magnitude,” wrote two Dartmouth economists, Ellen Meara and Jonathan S.
Skinner, in a commentary to the Deaton-Case analysis to be published in Proceedings of the National Academy of Sciences.
“Wow,”
said Samuel Preston, a professor of sociology at the University of
Pennsylvania and an expert on mortality trends and the health of
populations, who was not involved in the research. “This is a vivid
indication that something is awry in these American households.”
Dr. Deaton had but one parallel. “Only H.I.V./AIDS in contemporary times has done anything like this,” he said.
In
contrast, the death rate for middle-aged blacks and Hispanics continued
to decline during the same period, as did death rates for younger and
older people of all races and ethnic groups.
Middle-aged
blacks still have a higher mortality rate than whites — 581 per
100,000, compared with 415 for whites — but the gap is closing, and the
rate for middle-aged Hispanics is far lower than for middle-aged whites
at 262 per 100,000.
David
M. Cutler, a Harvard health care economist, said that although it was
known that people were dying from causes like opioid addiction, the
thought was that those deaths were just blips in the health care
statistics and that over all everyone’s health was improving. The new
paper, he said, “shows those blips are more like incoming missiles.”
Dying in Middle Age
Death rates are rising for middle-aged white Americans,
while declining in other wealthy countries and among other races and
ethnicities. The rise appears to be driven by suicide, drugs and alcohol
abuse.
per 100,000 people aged 45–54
DEATHS
White
Americans
400
Hispanic
Americans
France
300
Germany
Britain
Canada
Australia
Sweden
200
INCREASING CAUSES OF DEATHS
Per 100,000 white Americans, 45–54
30
Suicide
20
100
Chronic liver
diseases and
cirrhosis
10
Alcohol and
drug poisoning
2000
2005
2010
’13
1990
1995
2000
2005
2010
’13
Dr.
Deaton and Dr. Case (who are husband and wife) say they stumbled on
their finding by accident, looking at a variety of national data sets on
mortality rates and federal surveys that asked people about their
levels of pain, disability and general ill health.
Dr.
Deaton was looking at statistics on suicide and happiness, skeptical
about whether states with a high happiness level have a low suicide
rate. (They do not, he discovered; in fact, the opposite is true.) Dr.
Case was interested in poor health, including chronic pain because she
has suffered for 12 years from disabling and untreatable lower back pain.
Dr.
Deaton noticed in national data sets that middle-aged whites were
committing suicide at an unprecedented rate and that the all-cause
mortality in this group was rising. But suicides alone, he and Dr. Case
realized, were not enough to push up overall death rates, so they began
looking at other causes of death. That led them to the discovery that
deaths from drug and alcohol poisoning also increased in this group.
They
concluded that taken together, suicides, drugs and alcohol explained
the overall increase in deaths. The effect was largely confined to
people with a high school education or less. In that group, death rates
rose by 22 percent while they actually fell for those with a college
education.
It
is not clear why only middle-aged whites had such a rise in their
mortality rates. Dr. Meara and Dr. Skinner, in their commentary,
considered a variety of explanations — including a pronounced racial
difference in the prescription of opioid drugs and their misuse, and a more pessimistic outlook among whites about their financial futures — but say they cannot fully account for the effect.
Dr.
Case, investigating indicators of poor health, discovered that
middle-aged people, unlike the young and unlike the elderly, were
reporting more pain in recent years than in the past. A third in this
group reported they had chronic joint pain over the years 2011 to 2013, and one in seven said they had sciatica. Those with the least education reported the most pain and the worst general health.
The
least educated also had the most financial distress, Dr. Meara and Dr.
Skinner noted in their commentary. In the period examined by Dr. Deaton
and Dr. Case, the inflation-adjusted income for households headed by a
high school graduate fell by 19 percent.
Dr.
Case found that the number of whites with mental illnesses and the
number reporting they had difficulty socializing increased in tandem.
Along with that, increasing numbers of middle-aged whites said they were
unable to work. She also saw matching increases in the numbers
reporting pain and the numbers reporting difficulty socializing,
difficulty shopping, difficulty walking for two blocks.
With
the pain and mental distress data, Dr. Deaton said, “we had the two
halves of the story.” Increases in mortality rates in middle-aged whites
rose in parallel with their increasing reports of pain, poor health and
distress, he explained. They provided a rationale for the increase in
deaths from substance abuse and suicides.
Dr.
Preston of the University of Pennsylvania noted that the National
Academy of Sciences had published two monographs reporting that the
United States had fallen behind other rich countries in improvements in
life expectancy. One was on mortality below age 50 and the other on
mortality above age 50. He coedited one of those reports. But, he said,
because of the age divisions, the researchers analyzing the data missed
what Dr. Deaton and Dr. Case found hiding in plain sight.
“We didn’t pick it up,” Dr. Preston said, referring to the increasing mortality rates among middle-aged whites.
Ronald
D. Lee, professor of economics, professor of demography and director of
the Center on Economics and Demography of Aging at the University of
California, Berkeley, was among those taken aback by what Dr. Deaton and
Dr. Case discovered.
“Seldom have I felt as affected by a paper,” he said. “It seems so sad.”
No comments:
Post a Comment