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Rising mortality rate among white, middle-aged Americans is fueled by ‘deaths of despair,’ say economists

REUTERS/Jessica Rinaldi
White, middle-aged Americans are dying at younger ages than their peers.

In 2015, two Princeton University economists, Anne Case and Angus Deaton, reported the startling finding that, after decades of decline, the death rate for white, middle-aged Americans — people aged 45 to 54 — had steadily climbed by about half a percent per year from 1999 to 2013.

During that same period, all other racial and ethnic groups in the United States, as well as all other age groups, saw their deaths rates continue to fall.

The reasons for the higher death rates among white, middle-aged Americans was not clear, but Case and Deaton suggested three main factors were likely involved: substance abuse (alcohol, prescription opioids and heroin), chronic liver disease (often caused by alcohol abuse) and suicide.

In a new paper published Thursday, the husband-and-wife team examined two additional years of data and reached the same troubling conclusion: white, middle-aged Americans are dying at younger ages than their peers. This time, however, the researchers were able get a better understanding of what’s behind the trend. 

“These deaths of despair have been accompanied by reduced labor force participation, reduced marriage rates, increases in reports of poor health and poor mental health,” Case told National Public Radio’s David Greene. “So we are beginning to thread a story in that it’s possible that [the trend is] consistent with the labor market collapsing for people with less than a college degree. In turn, those people are being less able to form stable marriages, and in turn that has effects on the kind of economic and social supports that people need in order to thrive.”

An educational divide

The educational divide shows up clearly in the numbers. For example, the overdose, suicide and alcohol-related death rate in 2015 for white men aged 50 to 54 was 196 per 100,000 for those with a high school degree or less, compared to 47 per 100,000 for those who had completed four years of college.

Both groups saw a troubling rise in their rates since 1999, but the increase was three times higher for those with a high school degree or less (130 percent versus 44 percent).

A similar educational divide can be seen among women. The overdose, suicide and alcohol-related death rate in 2015 for white women aged 50 to 54 was 115 per 100,000 for those with a high school degree or less, compared to 26 per 100,000 for those with a college degree.

In this case the increase since 1999 was more than five times higher (381 percent versus 70 percent) among the women with less education.

A racial divide

Case and Deaton say it’s not exactly clear why the death rate is rising for working-class whites but not for working-class Hispanics or blacks, groups who have also experienced income declines in recent years. But they propose some possible explanations in their paper. Many Hispanics are “markedly better” off than their parents or grandparents who were born abroad, which may give them a more positive perspective on their current economic status, Case and Deaton explain. They also point out that African Americans have experienced economic challenges and disadvantages for generations, and may, therefore, be more resilient than whites to changes in the labor market.

Shifts in the death rates of middle-aged whites and African-Americans certainly tell a dramatic story: In 1999, the death rate for whites aged 50 through 54 with a high school education or less was 30 percent lower than the death rate for similarly educated African-Americans in that age group. In 2015, the rate was 30 percent higher.

“What our data show is that the patterns of mortality and morbidity for white non-Hispanics without a college degree move together over lifetimes and birth cohorts, and that they move in tandem with other social dysfunctions, including the decline of marriage, social isolation, and detachment from the labor force,” Case and Deaton conclude.

“Ultimately, we see our story as about the collapse of the white, high school educated, working class after its heyday in the early 1970s, and the pathologies that accompany that decline,” they add.

FMI: Case and Deaton’s new paper was published Thursday in Brookings Papers on Economic Activity, which is published by the Brookings Institution. The paper can be read in full on that organization’s website.

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Comments (4)

  1. Submitted by Susan Lesch on 03/24/2017 - 12:12 pm.


    I think you probably meant to use some other word than “peer” which means “a person who is equal to another in abilities, qualifications, age, background, and social status.” Those are the people who are dying, and together they form a group (of peers who are all dying).

  2. Submitted by Joel Stegner on 03/24/2017 - 02:42 pm.

    Trump wants to make healthcare more expensive for that group?

    Why would he want to sharply increase premiums and cut mental health coverage for his voters?

  3. Submitted by Ilya Gutman on 03/24/2017 - 08:55 pm.

    I guess these are the people who need additional protection… Their problems, in part, are the result of being called names and insulted in the last 10-12 years…

  4. Submitted by jody rooney on 03/25/2017 - 03:44 pm.

    This should come as no surprise

    Societal expectations are that you should be able to make a good living with a high school education. That perhaps use to be true when shop, health, and business were part of a high school curriculum.

    Now that many of these have migrated to higher ed with the attendant costs and academic standards fewer people can follow that path.

    Unions have declined as has their recruitment and a living wage is less assured for a days work.

    Many lower skilled employers have convert full time jobs to part time jobs with no benefits so people can’t get ahead even with fair hourly wages.

    The expectations of that generation are a mismatch for the current market place.

    As a society we have made specialized education more expensive, tied critical services like health care to full time employment and allowed unions to be undercut at all opportunities. This is a new condition for white workers.

    I am not sure what the Trump comments were but as a business owner I strongly suspect he was part of the problem and took advantage of the this downward spiral of reducing wages and benefits in his businesses.

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