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HEALTH

DeathRatesRisingforMiddleAged
WhiteAmericans,StudyFinds
ByGINAKOLATA

NOV.2,2015

SomethingstartlingishappeningtomiddleagedwhiteAmericans.Unlike
everyotheragegroup,unlikeeveryotherracialandethnicgroup,unlike
theircounterpartsinotherrichcountries,deathratesinthisgrouphave
beenrising,notfalling.
ThatfindingwasreportedMondaybytwoPrincetoneconomists,
AngusDeaton,wholastmonthwonthe2015NobelPrizeforEconomic
Sciences,andAnneCase.Analyzinghealthandmortalitydatafromthe
CentersforDiseaseControlandPreventionandfromothersources,they
concludedthatrisingannualdeathratesamongthisgrouparebeingdriven
notbythebigkillerslikeheartdiseaseanddiabetesbutbyanepidemicof
suicidesandafflictionsstemmingfromsubstanceabuse:alcoholicliver
diseaseandoverdosesofheroinandprescriptionopioids.
TheanalysisbyDr.DeatonandDr.Casemayofferthemostrigorous
evidencetodateofboththecausesandimplicationsofadevelopmentthat
hasbeenpuzzlingdemographersinrecentyears:thedeclininghealthand
fortunesofpoorlyeducatedAmericanwhites.Inmiddleage,theyaredying
atsuchahighratethattheyareincreasingthedeathratefortheentire
groupofmiddleagedwhiteAmericans,Dr.DeatonandDr.Casefound.
Themortalityrateforwhites45to54yearsoldwithnomorethana
highschooleducationincreasedby134deathsper100,000peoplefrom

1999to2014.
Itisdifficulttofindmodernsettingswithsurvivallossesofthis
magnitude,wrotetwoDartmoutheconomists,EllenMearaandJonathan
S.Skinner,inacommentarytotheDeatonCaseanalysisthatwas
publishedinProceedingsoftheNationalAcademyofSciences.
Wow,saidSamuelPreston,aprofessorofsociologyattheUniversity
ofPennsylvaniaandanexpertonmortalitytrendsandthehealthof
populations,whowasnotinvolvedintheresearch.Thisisavivid
indicationthatsomethingisawryintheseAmericanhouseholds.
Dr.Deatonhadbutoneparallel.OnlyH.I.V./AIDSincontemporary
timeshasdoneanythinglikethis,hesaid.
Incontrast,thedeathrateformiddleagedblacksandHispanics
continuedtodeclineduringthesameperiod,asdiddeathratesforyounger
andolderpeopleofallracesandethnicgroups.
Middleagedblacksstillhaveahighermortalityratethanwhites581
per100,000,comparedwith415forwhitesbutthegapisclosing,andthe
rateformiddleagedHispanicsisfarlowerthanformiddleagedwhitesat
262per100,000.
DavidM.Cutler,aHarvardhealthcareeconomist,saidthatalthoughit
wasknownthatpeopleweredyingfromcauseslikeopioidaddiction,the
thoughtwasthatthosedeathswerejustblipsinthehealthcarestatistics
andthatoveralleveryoneshealthwasimproving.Thenewpaper,hesaid,
showsthoseblipsaremorelikeincomingmissiles.
Dr.DeatonandDr.Case(whoarehusbandandwife)saythey
stumbledontheirfindingbyaccident,lookingatavarietyofnationaldata
setsonmortalityratesandfederalsurveysthataskedpeopleabouttheir
levelsofpain,disability,andgeneralillhealth.
Dr.Deatonwaslookingatstatisticsonsuicideandhappiness,skeptical
aboutwhetherstateswithahighhappinesslevelhavealowsuiciderate

(theydont,hediscoveredinfacttheoppositeistrue.)Dr.Casewas
interestedinpoorhealth,includingchronicpainbecauseshehassuffered
for12yearsfromdisablinganduntreatablelowerbackpain.
Dr.Deatonnoticedinnationaldatasetsthatmiddleagedwhiteswere
committingsuicideatanunprecedentedrateandthattheallcause
mortalityinthisgroupwasrising.Butsuicidesalone,heandDr.Case
realized,werenotenoughtopushuptheoveralldeathratessotheybegan
lookingatothercausesofdeath.Thatledthemtothediscoverythatdeaths
fromdrugandalcoholpoisoningalsoincreasedinthisgroup.
Takentogether,theyconcludedthatsuicides,drugs,andalcohol
explainedtheoverallincreaseindeaths.Theeffectwaslargelyconfinedto
peoplewithahighschooleducationorless.Inthatgroup,deathratesrose
by22percentwhiletheyactuallyfellforthosewithacollegeeducation.
Itsnotclearwhyonlymiddleagedwhiteshadsuchariseintheir
mortalityrates.Dr.MearaandDr.Skinner,intheircommentary,
consideredavarietyofexplanationsincludingapronouncedracial
differenceintheprescriptionofopioiddrugsandtheirmisuse,andamore
pessimisticoutlookamongwhitesabouttheirfinancialfuturesbutsay
theycannotfullyaccountfortheeffect.
Dr.Case,investigatingindicatorsofpoorhealth,discoveredthat
middleagedpeople,unliketheyoungandunliketheelderly,werereporting
morepaininrecentyearsthaninthepast.Athirdinthisgroupreported
theyhadchronicjointpainovertheyears2011to2013andoneinseven
saidtheyhadsciatica.Thosewiththeleasteducationreportedthemost
painandtheworstgeneralhealth.
Theleasteducatedalsohadthemostfinancialdistress,Dr.Mearaand
Dr.Skinnernotedintheircommentary.IntheperiodexaminedbyDr.
DeatonandDr.Case,theinflationadjustedincomeforhouseholdsheaded
byahighschoolgraduatefellby19percent.
Dr.Casefoundthatthenumberofwhiteswithmentalillnessesandthe

numberreportingtheyhaddifficultysocializingincreasedintandem.Along
withthat,increasingnumbersofmiddleagedwhitessaidtheywereunable
towork.Shealsosawmatchingincreasesinthenumbersreportingpain
andthenumbersreportingdifficultysocializing,difficultyshopping,
difficultywalkingfortwoblocks.
Withthepainandmentaldistressdata,Dr.Deatonsaid,wehadthe
twohalvesofthestory.Increasesinmortalityratesinmiddleagedwhites
roseinparallelwiththeirincreasingreportsofpain,poorhealth,and
distress,heexplained.Theyprovidedarationalefortheincreaseindeaths
fromsubstanceabuseandsuicides.
Dr.PrestonoftheUniversityofPennsylvanianotedthattheNational
AcademyofScienceshaspublishedtwomonographsreportingthatthe
UnitedStateshadfallenbehindotherrichcountriesinimprovementsinlife
expectancy.Onewasonmortalitybelowage50andtheotheronmortality
aboveage50.Hecoeditedoneofthosereports.But,hesaid,becauseofthe
agedivisions,theresearchersanalyzingthedatamissedwhatDr.Deaton
andDr.Casefoundhidinginplainsight.
Wedidntpickitup,Dr.Prestonsaid,referringtotheincreasing
mortalityratesamongmiddleagedwhites.
RonaldD.Lee,professorofEconomics,professorofDemography,and
directoroftheCenteronEconomicsandDemographyofAgingatthe
UniversityofCaliforniaBerkeley,wasamongthosetakenabackbywhatDr.
DeatonandDr.Casediscovered.
SeldomhaveIfeltasaffectedbyapaper,hesaid.Itseemssosad.

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