Thursday, March 30, 2017

Despair in White, Middle-Aged America

A fascinating new study by Anne Case and her husband, Nobel Prize winner Angus Deaton, looks at the rising level of morbidity and mortality among middle-aged white, non-Hispanic men and women in the United States.  This recent increase reverses decades of progress made as mortality rates for middle-aged Americans fell over the decades prior to the 1990s.  Here is a summary of their findings.

Let's open with a definition of mortality rate:

Mortality rate is the measure of the number of deaths in a population (in this study, per 100,000 people)  per unit of time (in this study, a year).

Here is a graphic which shows the mortality rates for middle-aged White, non-Hispanic persons of both genders between 1990 and 2013, comparing the American mortality rate (in bright red) to the mortality rates for six other wealthy, industrialized nations including France, Germany, the United Kingdom, Canada, Australia, Sweden as well as a comparison to U.S. Hispanics (in blue):

Things began to change in 1998; from 1978 to 1998, the mortality rate for American whites between the ages of 45 and 54 years fell by 2 percent per year on average, matching the decline rate in the other six nations.  After 1998, the mortality rates for the other six nations continued to decline at more-or-less the same rate as they did prior to 1998, however, as you can clearly see, the United States is a stand-alone.  White, non-Hispanic Americans actually saw their mortality rate rise by roughly one-half percent per year after 1998.  Additionally, the mortality reversal was confined to white non-Hispanics; Hispanic Americans between the ages of 45 and 54 years had mortality declines that continued to drop at 1.8 percent per year and black non-Hispanic Americans of the same age saw their mortality rate decline by 2.6 percent per year over the timeframe in the study.

Interestingly, the turnaround in mortality rates in Americans is confined to mid-life.  Mortality rates for white non-Hispanic Americans between the ages of 65 and 74 years continued to decline at 2 percent per year between 1999 and 2013, mirroring the declines seen by other racial and ethnic groups of the same age group.

Let's now look at a graphic which shows the rise in the three causes of death that account for this unprecedented mortality reversal in middle-aged Americans, comparing the three leading causes to mortality rates from lung cancer and diabetes, two other significant causes of death:

The change in all-cause mortality rates for middle-aged, white non-Hispanics is largest accounted for by an increasing death rate from external causes including increases in drug and alcohol poisonings and suicide.  This is a sharp change from earlier years when drug overdoses were concentrated among minority groups; in 2013, death rates from alcohol- and drug-induced causes for white non-Hispanic Americans exceeded those for black non-Hispanics by a significant 19 deaths per 100,000 population.

Let's look at the connection between educational attainment and mortality rate among Americans of all race/ethnic groups for ages between 45 and 54 as shown on this table:

Data shows that much of the decline in the mortality rate for middle-aged white non-Hispanic Americans was driven by increasing death rates for those with a high school education or less with all-cause mortality for this demographic rising by 134 per 100,000 between 1999 and 2013.  Those will a Bachelor's degree or higher saw their death rates fall by 57 per 100,000 over the same timeframe.  Over half of the increase in the mortality rate for Americans with a high school education or less was from al external causes with most of those dying from poisonings followed by intentional self-harm.

Let's look at the causes for this increased mortality among middle-aged, white Americans:

1.) increasing obesity - accounts for only a small fraction of the increase in mortality since there was an increase in mortality for both obese and non-obese Americans.

2.) heavy consumption of alcohol - there was a significant increase in alcohol consumption in this demographic (more than two drinks daily for men and one drink daily for women).

3.) increased availability of opioid prescription drugs used for pain management - the Centers for Disease Control estimate that for every prescription painkiller death in 2008, there were 10 treatment admissions for abuse, 32 emergency department visits for misuse or abuse and 130 people who were considered abusers or drug dependent.

4.) economic uncertainty - growth in real median earnings for this group of Americans has been slow, particularly for those with lower educational levels.  Here is a graph comparing the growth in real hourly wages for low, middle and high income Americans:

Here is a graph showing the slow growth in median wages for the second quartile of white male Americans between the ages of 25 and 54:

To summarize, the rising mortality rate for white, non-Hispanic Americans between the ages of 45 and 54 years has cost hundreds of thousands of lives.  Had the mortality rate continued to fall at the decline rate of 1.8 per cent per year seen during the period from 1979 to 1998 there would have been 488,500 fewer deaths, 54,000 in 2013 alone.  Here's a quote from one of the authors of the study, Angus Deaton:

"It’s not just their careers that have gone down the tubes, but their marriage prospects, their ability to raise children.  That’s the kind of thing that can lead people to despair.

In closing, please watch this short video interview with the authors:

Striving to be a middle class, middle-aged white American has rarely been a harder task in our lifetime.