Death rates rising for poor, middle-aged whites

[litebright]

This is some crazy data. In the story, they compare the increasing deaths from suicide, drugs and alcohol among low-income whites to the impact of HIV/AIDS. It's that level of epidemic. 

From the NYT: 
www.nytimes.com/2015/11/03/health/death-rates-rising-for-middle-aged-white-americans-study-finds.html?_r=0


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.


Amanda Jordan with her son Brett Honor outside a meeting for people with addictions and their families in Plaistow, N.H. Her son Christopher died of an overdose.

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.

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.

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 that was 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.”

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.”

[ESF]

Damn.

Thanks for sharing. This seems very significant.

[pinkdutchtulips]

very few in xh's family (his mom's side) have lived to see 60 ... for all of the reasons listed above.

[ttt]

I feel like there is a connection here between the rise of Donald Trump-esque politics and this data. I feel like there is a general sense of despair, hopelessness, anger, bitterness, lack of direction among less educated white people, especially men. This is a group of people who have seen their incomes fall, their skills become obsolete or unimportant, their social standing and the feeling of "well at least I'm better than those blacks/Hispanics/xyz minority group" disintegrate, and so many of these poor towns become hollowed out as factories and industries left or collapsed. There's simply nothing left for a lot of these people to do, no more community, no more sense of pride or purpose. They've basically become unessential - the economy doesn't need them anymore, and they're slipping into the same ills that other 'discarded communities' like some low-income black neighborhoods are plagued with - drugs, violence, abject poverty, etc.

It's not surprising to me that these are the people who rally around a guy who promises to "make things better" and tells them that, hey, actually you ARE important, you ARE superior to all those blacks/Mexicans/women/liberals/smarty pants people with college educations. Their anger and discontentment are given legitimacy and given a conduit.

It is both tremendously sad and tremendously frightening to me.


As an aside, I'd be interested to see if there are any differences in gender here - are men or women more affected by this? Has one gender seen sharper increases in drug abuse, suicide, etc.?

[ESF]

One thing the article doesn't mention that I'd be interested in seeing more about is how this relates to the rise in people on disability support. I know when you see the numbers for that, it's pretty heavily spread across Appalachia and the South, where there are lots of poor, middle aged white people, who are increasingly marginalized.

[ttt]

Nov 3, 2015 13:35:05 GMT -5 ESF said:

One thing the article doesn't mention that I'd be interested in seeing more about is how this relates to the rise in people on disability support. I know when you see the numbers for that, it's pretty heavily spread across Appalachia and the South, where there are lots of poor, middle aged white people, who are increasingly marginalized.

I'd be interested in this too. Socialsecurity disability has essentially become a de facto permanent unemployment/welfare program in some of these areas. The government has realized that the factories and jobs are not coming back and instead of doing anything about it or trying to help people get jobs they just let the federal taxpayers support them.

[SallyJ]

Anecdote! Both of my parents more or less fit into this group. Grew up poor and remained poor, did not complete high school, lost jobs/significant financial distress, collected disability support, mental illness (mom), drug/alcohol abuse, and finally death by liver disease at age 54 (mom) and age 57 (dad). The things ttt says about the way they feel rings true based on the conversations I had with my parents, especially the end of life conversations. My mother could have chosen additional treatment that would have helped her live much longer, but she basically told me 'why, what's the point?'

This is alarming that it's happening in a more broad sense. I didn't realize it had reached 'epidemic size'.

[orriskitten]

My mom fit into the category, with a twist at the end. She had herniated discs in her back (had ongoing issues and was an EMT, struggling to make ends meet, and a new partner dropped a stretcher off of the ambulance with a 400lb patient on it and my mom stopped it from crashing to her ground at the expense of her back) that led to constant pain despite multiple surgeries. She had a childhood/teen history of drug abuse and a doctor gave her an rx for Vicodin. It was a long downward spiral.

But it wasn't typical side effects that led to her death. She was actually a strange case with a severe mitochondrial disorder, which led to complete hearing loss (like Rush Limbaugh who actually had cochlear implant surgery that inspired my mom's doctors to do the same for her), parkinsonisms and severe memory loss. No one could ever say why she got it, but our family is incredibly long lived and most doctors speculated it was drug related. The specialist we were going to right before my mom died was amazed because she had so many things but no family history and the symptoms were so sudden. In the end, the memory loss got her. She had come off them and went back on and forgot she had already taken some earlier. Accidental overdose.

Unfortunately, there is not enough research being done because it cannot be controlled. I genuinely wonder how many ailments may not be getting linked because you can't just blame everything on drugs.

Sorry for this getting into a long ramble. It's the 6 year anniversary of her death today and this just hit home.