Healthify Blog

Rising Death Rate of Middle-Aged Whites, Part II

Last fall, a shocking study by Princeton economists Angus Deaton and Anne Case found that the death rates of middle-aged white Americans are rising, despite declining mortality rates for every other age group, racial and ethnic group, and middle-aged whites in other rich countries.
As another Heathify guest contributor emphasized at the time the report made national news, social determinants of health appeared to play a major role in the rising mortality rate for middle-aged white Americans. The overall increase in deaths was attributed to suicides and drug and alcohol abuse, and was largely confined to people with a high school education or less.
On Jan. 16,  the NYT published a similar finding about a slightly different demographic, discovering through an analysis of 60 million death certificates that young white Americans are also dying at higher rates due to drug overdoses. 
Poverty and stress – risk factors for the misuse of narcotics  – and other interrelated social factors such as lack of education, unemployment,  not having a support network and not being able to provide for one's children are what some experts have speculated have led to the higher mortality rates.
Now, a Jan. 29 study by the Commonwealth Fund is saying there's more to the story about middle-aged white Americans, placing emphasis on their "mortality gap" – how far off the mortality rate has been for the group from the rate's previously expected decline. 
"Compared with an expected decline of 1.8 percent annually, observed mortality rates in 2014 resulted in more than 100 excess deaths for every 100,000 middle-aged white adults," David Squires and David Blumenthal, the study's authors, wrote.
The authors said that they also found from digging into CDC data that substance abuse, suicides and liver disease don't fully explain why mortality rates of middle-aged white adults have failed to decline as expected. 
Heart disease, diabetes and respiratory disease also contributed to the problem.
"After rapidly declining between 1968 and 1998, mortality from heart disease essentially leveled off for this population between 1999 and 2014," they wrote. "This leveling-off in improvement was as important as the rise in drug overdoses in explaining the gap between observed and expected mortality among middle-aged whites."
Among the previously mentioned possible social causes for the mortality gap for middle-aged whites, the group was increasingly without health insurance until 2014, the authors said.
In a report on the study, The Atlantic added an important note to the mortality rate trends, saying that health outcomes for African Americans still lag behind those of white Americans in many areas because of historic racial injustice.
"African Americans die an average of four years younger than white Americans do, for example," author Olga Khazan wrote. 
The study's authors also noted that "The notion that changing social and economic forces are a possible explanation does not mean that white middle-aged adults are suddenly worse off than other groups, especially minorities."
While not being certain of the causes of higher mortality rates for white Americans, the aforementioned studies continue to highlight the importance of social determinants, which apply to everyone's health, regardless of race or age. 
In line with that emphasis, from Healthify's perspective, is the idea that poor health and even premature death can be avoided by connecting underserved people in a timely and efficient fashion to social programs that will help them in areas like housing and food.
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Topics: social determinants of health health disparities public health