Middle-aged white Americans are dying at faster rates, and nobody knows why

PNAS

After about a century of gains in US mortality rates, one group is now seeing a stark turnaround: middle-aged white people.

According to a new paper in Proceedings of the National Academy of Sciences, the all-cause mortality rate of white men and women ages 45 to 54 (the red line in the graph above) started climbing about half a percentage point per year in 1999 and has continued to rise ever since.

The turnaround is unique to this group: Other age, racial, and ethnic groups in the US have seen only declines in their mortality rates. Specifically, middle-aged Hispanic and black Americans have seen 1.8 percent and 2.6 percent decreases in their mortality rates per year, respectively. And middle-aged white people in other high-income countries have seen similar declines.

You can see the stark divide if you compare the graph's thick red line (middle-aged American white people) with the thick blue line (middle-aged US Hispanic people) and all the other lines representing middle-aged people in other high-income countries. The study authors, Princeton economists Angus Deaton and Anne Case, note that the trend is largely being driven by "increasing death rates for those with a high school degree or less."

The researchers aren't clear on exactly what explains the turnaround, but they think it's linked to "economic insecurity" and increasing reports of other serious health and social problems among white people, including drug and alcohol poisonings, suicide, and chronic liver disease and cirrhosis. Middle-aged white people have also reported increased suffering with chronic pain and a reliance on opioid painkillers — an epidemic that started in the late 1990s has been liked with terrible health and mortality outcomes.

"The epidemic of pain which the opioids were designed to treat is real enough, although the data here cannot establish whether the increase in opioid use or the increase in pain came first," the study authors write. Both trends increased rapidly after the mid-1990s, and the rising rates of alcohol abuse and suicides are probably "likely symptoms of the same underlying epidemic, and have increased alongside it, both temporally and spatially."

They add: "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."

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