For the past 15 years, after decades of decline, the death rate for white middle-aged Americans — those aged 45 to 54 — has been steadily increasing, according to a study published Monday in the Proceedings of the National Academy of Sciences.
The findings are startling, for in other racial and ethnic groups and in all other age groups, deaths rates continued to improve in the United States during that same time period. Furthermore, no other wealthy country has experienced a similar turnaround in the death rate for its middle-aged adults, the study’s authors report.
Indeed, as a commentary accompanying the study points out, “It is difficult to find modern settings with survival losses of this magnitude.”
Exactly why white middle-aged Americans have experienced such a marked reversal in their death rate is not entirely clear, but the study suggests three main factors: substance abuse (alcohol, prescription opioids and heroin), suicide and chronic liver disease.
The study also found that the increase in the death rate among white middle-aged adults is occurring mostly among less educated Americans, those with a high school degree or less.
The study was conducted by two Princeton University economists, Angus Deaton, who received the 2015 Nobel Prize in economics earlier this fall, and Anne Case. For their analysis, Deaton and Case used data from the Centers for Disease Control and Prevention and other sources.
The data revealed that the overall mortality rate for all middle-aged Americans fell 44 percent between 1970 and 2013 — an average of 2 percent a year. Similar drops also occurred in other wealthy countries.
“These reductions … have made lives longer and better, and there is a general and well-based presumption that these improvements will continue,” Deaton and Case write.
But that is not what has happened for white Americans aged 45 to 54. After 1998, their death rate began to climb an average of half a percent a year, the analysis by Deaton and Case revealed. That reversal did not happen in any other wealthy country. Nor did it happen to Hispanic middle-aged Americans, whose death rate declined an average of 1.8 percent per year from 1998 to 2013, or to black Americans, whose rate declined an average of 2.6 percent per year during that same period.
The mortality rate for middle-aged black Americans is still higher (581.9 per 100,000), however, than for whites (415.4 per 100,000), but that gap is narrowing. Middle-aged Hispanic Americans have a significantly lower mortality rate than either their white or black peers — 269.6 per 100,000.
The factors driving the numbers
“This is a deeply concerning trend,” Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told NPR reporter Rob Stein. “We shouldn’t see death rates going up in any group in society.”
The trend is being driven, according to Deaton and Case, by alcohol and drug (mostly prescription pain killers and heroin) abuse, suicide and chronic liver diseases. Those diseases include cirrhosis, which is often, but not always, the result of alcohol abuse.
In fact, drug and alcohol poisonings overtook lung cancer in 2011 as the leading cause of death among white middle-aged Americans. Suicides are about to follow.
The study also found that middle-aged white adults are reporting a greater decline in physical and mental health and a greater increase in chronic pain than did previous generations at this age. In addition, these health problems are making it more difficult for them to work or to carry out daily living tasks.
Not better off than parents
Deaton and Case say the disturbing trends uncovered by their study may have their roots in the economic insecurity of the middle class that has been building up in the United States over the past few decades.
“After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents,” they write. “Growth in real median earnings has been slow for this group, especially those with only a high school education.”
Still, as the economists point out, other wealthy countries have experienced even slower growth in median earnings, “yet none have had the same mortality experience.”
Deaton and Case suggest one potential explanation for this difference: “The United States has moved primarily to defined-contribution pension plans with associated stock market risk, whereas, in Europe, defined-benefit pensions are still the norm. Future financial insecurity may weigh more heavily on US workers, if they perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans.”
Deaton and Case also say their findings may help explain some of “the recent but otherwise puzzling decrease in labor force participation in the United States, particularly among women,” as well as the recent large increases in Americans on disability.
‘A lost generation’
The reversal in the death rate among white middle-aged adults reported in this study is similar, Deaton and Case point out, to the slowdown in the death rate observed during the height of the AIDS crisis, which claimed 650,000 lives between 1981 and 2015.
The two economists estimate that 488,500 deaths would have been avoided in the U.S. if the mortality rate for white middle-aged adults had continued to fall rather than climb after 1998.
“A combination of behavioral change and drug therapy brought the US AIDS epidemic under control; age-adjusted deaths per 100,000 fell from 10.2 in 1990 to 2.1 in 2013,” Deaton and Case write. “However, public awareness of the enormity of the AIDS crisis was far greater than for the epidemic described here.”
“A serious concern is that those currently in midlife will age into Medicare in worse health than the currently elderly,” they add. “This is not automatic; if the epidemic is brought under control, its survivors may have a healthy old age. However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them.”
You can download and read the study in full on the PNAS website.