In Reversal, Death Rates Rise For Middle-Aged Whites

Nov 2, 2015
Originally published on November 9, 2015 6:20 pm

A decades-long decline in the death rate of middle-aged white Americans has reversed in recent years, according to a surprising new analysis released Monday.

The cause of the reversal remains unclear. Researchers speculate it might be the result of the bad economy fueling a rise in suicides, plus overdoses from prescription painkillers and illegal drugs like heroin, and alcohol abuse.

"That could be just a volatile mix that could set off something like this," says Angus Deaton, a professor of economics at Princeton University who conducted the research with his wife, Anne Case, another Princeton economist.

Deaton was awarded the 2015 Nobel Prize in Economics for his work on poverty.

Overall, the U.S. mortality rate has been falling by about 2 percent a year since the 1970s.

But the upsurge in suicides and drug overdoses among middle-age whites, among other trends, prompted Deaton and Case to look more closely at this group. They analyzed data from CDC and other sources, including other countries.

"Pretty quickly we started falling off our chairs because of what we found," says Deaton, whose findings were published by the Proceedings of the National Academy of Sciences.

The mortality rate among whites ages 45 to 54 had increased by a half-percent a year from 381.5 per 100,000 in 1999 to 415.4 in 2013, the most recent year for which data are available, the researchers found.

Even so, the mortality rate for middle-aged African-Americans was higher: 581.9 per 100,000 in 2013. Hispanics fared better with a mortality rate of 269.6 per 100,000 in the same year.

"There was this extraordinary turnaround" among whites, Deaton says, likening the reversal to a large ship suddenly changing directions.

Based on the findings, Deaton and Case calculated that 488,500 Americans had died during that period who would have been alive if the trend hadn't reversed.

"We've been talking about this at various academic meetings and you look around the room and peoples' mouths are just hanging open," Deaton says.

"This is a deeply concerning trend," says Dr. Thomas Frieden, who heads the Centers for Disease Control and Prevention but wasn't involved in this research. "We shouldn't see death rates going up in any group in society."

The Princeton researchers analyzed data from other Western countries and didn't see the same trend.

"It's particularly important that they don't see it in other countries," says John Haaga, the acting director of behavioral and social research at the National Institute on Aging, which funded the research. "So something's clearly going wrong with this age group in America."

The trend appears to be being driven by increased mortality among those with the least amount of education.

"Those are the people who have really been hammered by the long-term economic malaise," Deaton says. "Their wages in real terms have been going down. So they get into middle age having their expectations just not met at all."

It remains unclear why the mortality rate only increased among whites and not African-Americans or Hispanics.

Deaton and others have a theory about the difference for whites.

"One possible explanation is that for whites 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," says Jon Skinner, a professor of economic and medicine at Dartmouth College who co-authored a commentary accompanying the article. "For African-American and Hispanic households things had never been that optimistic and so perhaps the shock wasn't quite as great."

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The death rate for middle-aged white Americans has been going up, and it's been happening for more than a decade. A new report detailing that trend came out today, and it shows that it's different than other Western countries including Germany, Britain, France, Canada. NPR health correspondent Rob Stein has been looking into the findings and what explains them.

ROB STEIN, BYLINE: Americans may have lots of problems, but for decades, there was one thing everyone thought was getting better pretty much across the board. Year after year, the death rate kept falling. Angus Deaton is a Nobel Prize-winning economist at Princeton who's been paying attention to this.

ANGUS DEATON: GDP and mortality and education are the sort of basic statistics for how the nation's doing.

STEIN: So Deaton and his wife, Anne Case, who is also a researcher at Princeton, decided to take a closer look at what was going on with the nation's death rate.

DEATON: Pretty quickly, we started falling off our chairs because of what we found.

STEIN: What they found was something dramatic had happened to one big group - white middle-aged Americans. Their death rate wasn't going down anymore. That stopped at least 14 years ago. Even worse, it's been creeping up every year since.

DEATON: There was this extraordinary turnaround, which is sort of something like - you would say the ship's been going in this direction for a very long time, and then all of a sudden, it just reverses and goes the other way. And when we saw this, that was the thing that sort of really thought, oh, my goodness, we have something here that we really haven't seen before.

STEIN: Instead of instead of going down 2 percent a year, the death rate was up half a percent every year. That means almost half a million Americans have died who would still be alive if the trend had not reversed.

DEATON: We've been talking about this at various academic meetings. And you look around the room, and people's mouths are just hanging open.

STEIN: When the researchers looked at other Western countries, they did not find the same trend. John Haaga is at the National Institute on Aging which funded the research.

JOHN HAAGA: Something's clearly going wrong with this age group in America.

STEIN: The big question is why? Well, a lot more middle-aged whites are committing suicide in the United States, and overdoses on prescription painkillers like OxyContin and illegal drugs like heroin have become epidemic. Here's Angus Deaton again.

DEATON: There's also accidental overdoses of alcohol, and there's big increases an cirrhosis, which is alcohol related.

STEIN: That raises another question. What's up with all that? One clue - the study found that those with the least education are suffering the most in this economy.

DEATON: Those are the people who have really been hammered by the long-term economic malaise. So they get into middle-age having their expectations just not met at all, and you introduce them to that - both legal and illegal drugs - and that could be just a very volatile mix.

STEIN: There's still another puzzle. Why is this happening only to whites? No one knows, but Jonathan Skinner, a professor of economics in medicine at Dartmouth, says there is a theory.

JONATHAN SKINNER: One possible explanation is that for whites, their parents had done better, and they had been doing pretty well. And all of a sudden, the financial floor dropped out from underneath them while for African-American and Hispanic households, things had never been that optimistic, and so perhaps the shock wasn't quite as great.

STEIN: Whatever the cause, other experts say the findings are sounding alarms. Tom Frieden heads the Centers for Disease Control and Prevention.

TOM FRIEDEN: This is a deeply concerning trend. We shouldn't see the death rates going up in any group in society. You never want for a group to be less healthy than a group that's come before it. That should not happen.

STEIN: Frieden says the CDC's trying to fight the epidemic of drug abuse and other problems causing white middle-aged Americans to lose ground. Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.