Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century
Contributed by Angus Deaton, September 17, 2015 (sent for review August 22, 2015; reviewed by David Cutler, Jon Skinner, and David Weir)
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November 10, 2015
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Significance
Midlife increases in suicides and drug poisonings have been previously noted. However, that these upward trends were persistent and large enough to drive up all-cause midlife mortality has, to our knowledge, been overlooked. If the white mortality rate for ages 45−54 had held at their 1998 value, 96,000 deaths would have been avoided from 1999–2013, 7,000 in 2013 alone. If it had continued to decline at its previous (1979‒1998) rate, half a million deaths would have been avoided in the period 1999‒2013, comparable to lives lost in the US AIDS epidemic through mid-2015. Concurrent declines in self-reported health, mental health, and ability to work, increased reports of pain, and deteriorating measures of liver function all point to increasing midlife distress.
Abstract
This paper documents a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013. This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. The midlife mortality reversal was confined to white non-Hispanics; black non-Hispanics and Hispanics at midlife, and those aged 65 and above in every racial and ethnic group, continued to see mortality rates fall. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.
Acknowledgments
We thank David Cutler, Jonathan Skinner, and David Weir for helpful comments and discussions. A.C. acknowledges support from the National Institute on Aging under Grant P30 AG024361. A.D. acknowledges funding support from the National Institute on Aging through the National Bureau of Economic Research (Grants 5R01AG040629-02 and P01AG05842-14) and through Princeton’s Roybal Center for Translational Research on Aging (Grant P30 AG024928).
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Cover image: Pictured are gravity waves revealed by a thin layer of glowing atmosphere called airglow, as seen from the Tibetan Plateau. The orange colors come from excited hydroxyl radicals, and the green colors from oxygen light emissions. In the foreground are the Himalayas, and astronomy photographers capturing the night sky. Steven D. Miller and colleagues found that an instrument on the Suomi National Polar-orbiting Partnership satellite could detect nocturnal gravity waves near the mesopause, around 90 kilometers above sea level, through the observed modulation of airglow intensity by these waves. The authors identified cases of gravity waves launched in connection with events such as volcanic eruptions and strong thunderstorms. The results suggest a means to remotely observe gravity waves from space and at subkilometer spatial resolution. See the article by Miller et al. on pages E6728–E6735. Image courtesy of Dai Jianfeng (Chongqing University, Chongqing, China).
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Freely available online through the PNAS open access option.
Submission history
Published online: November 2, 2015
Published in issue: December 8, 2015
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Acknowledgments
We thank David Cutler, Jonathan Skinner, and David Weir for helpful comments and discussions. A.C. acknowledges support from the National Institute on Aging under Grant P30 AG024361. A.D. acknowledges funding support from the National Institute on Aging through the National Bureau of Economic Research (Grants 5R01AG040629-02 and P01AG05842-14) and through Princeton’s Roybal Center for Translational Research on Aging (Grant P30 AG024928).
Notes
See Commentary on page 15006.
Authors
Competing Interests
The authors declare no conflict of interest.
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