If you pick up a newspaper and flip to the obituaries, you’ll mostly find the stories of long lives well-lived; of people with grandkids and great-grandkids, and veterans of wars fought long ago.
But if you’ve noticed more and more people on those pages whose lives were cut short long before old age, it’s not just your imagination.
Mortality rates are rising in Minnesota, caused by a combination of an aging population and a rise in so-called “deaths of despair.”
No age group has seen a larger increase in death rates than young adults, ages 25 to 34. Between 2010 and 2017, rates of death for this group rose by more than a third in Minnesota, according to data from the Centers for Disease Control.
The increase in deaths among young adults mirrors national trends, and represents the fastest increase in death rates of any age group in that time period.
That hasn’t escaped the notice of Dan Dahl, of Dahl Funeral Home in East Grand Forks and the former president of the Minnesota Funeral Directors Association.
“The older I get, the younger everyone else gets. I’m 59, and it used to be when I was 35, 35-year-olds didn’t die, it seemed like. It kind of sticks out now the older you get,” he said. “We’re not supposed to be burying our kids, our kids are supposed to be burying us.”
Public health officials have been troubled to see that after decades of gains in U.S. life expectancy, the number peaked in 2014, followed by three years of declines through 2017, the most recent year of data available.
Spikes in three causes of death are largely to blame: drug overdoses, alcohol-related liver disease, and suicide. Two economists who identified the trend, particularly among middle-aged white Americans, coined the term “deaths of despair.” They pointed at economic insecurity and income inequality as possible causes.
But deaths of despair aren’t limited to middle-aged Americans. While liver disease caused by drinking is degenerative and generally affects older people, accidental drug fatal overdose rates nearly tripled in Minnesota between 2010 and 2017 for the 25 to 34 age group, from 8.5 deaths per 100,000 people to 22.1 deaths per 100,000 people, according to the CDC.
That’s largely due to the changing nature of the opioid epidemic, said Jon Roesler, an epidemiologist supervisor at the Minnesota Department of Health.
In the late 1990s and early 2000s, when opioids were first widely available, epidemiologists began to see an increase in people dying from liver disease caused by opioids that contained acetaminophen.
“They’d get addicted to the opioid and then they’d get a cold and take NyQuil. Then they’d take some Tylenol, and pretty soon, especially if they had any problems with alcohol, (they’d have) hepatotoxicity,” or chemically-driven liver damage, Roesler said. “That was the character of the opioid epidemic.”
Many also died taking opioids with benzodiazepines, generally used to treat anxiety, which suppresses their breathing and heart rate.
“Then it continued to morph and it moved from prescription to street opioids,” Roesler said, including heroin and fentanyl. With that came a shift young adult age group.
Law enforcement and medical professionals are finding fentanyl, a powerful drug that can kill in tiny amounts, laced in all sorts of drugs, sometimes unbeknownst to the user, causing a rising number of drug overdoses in Minnesota.
Rise in suicides
Also on the upswing in the 25-to-34 age group in Minnesota is suicides. Between 2010 and 2017, the age group’s rate of death by suicide rose from 14.5 deaths per 100,000 people to 17.6 deaths per 100,000 people, the continuation of a more long-term increase since about 2001.
The causes behind this increase are less clear, and less age-specific. “In general, all ages have been affected by increases in suicides,” Roesler said. “It’s pretty much increased just about every year from 2000 to 2017. It’s just been kind of relentless.”
While suicide rates among 25- to 34-year-olds have increased, they’ve increased slower than for older age groups, Roesler said — and might, in fact, be proof that the state’s suicide prevention strategies, which began in 2000 and have focused on youth and young adults, are actually working.
“Maybe we actually have some evidence that all of our suicide prevention work is making a difference, even though rates have gone up, in an age group (where there’s been the most prevention activity), rates have gone up the least,” Roesler said.
Dahl, of the funeral home in East Grand Forks, thinks part of the increase in suicide and drug rates among young adults is that life is harder for young people now than it used to be — it’s tougher to make a living; more expensive to raise a family. There’s more pressure.
“I think a lot of them are moving toward the opioids and drug addictions to not necessarily hide it but hopefully alleviate it,” he said.
He sees more families being transparent about how their loved ones died, in the hope — he guesses — that others can be educated and more deaths can be prevented.
Roesler prefers to call deaths caused by suicide, drug overdose and alcohol “preventable deaths,” rather than “deaths of despair,” because with the right interventions, there is hope that these types of deaths can be prevented.
And preliminary numbers on deaths in 2018 in Minnesota suggest some progress in prevention, he noted. “I’m very hopeful that when the final numbers come out, we will be seeing a decline in drug overdose deaths and in suicide deaths as well,” Roesler said.