Nobel winner Angus Deaton talks about the surprising study on white mortality he just co-authored

This week, a big, attention-grabbing study found there's been a dramatic increase in the mortality rate of middle-aged white Americans since 1999. The spike in deaths — coming after about a century of decline — is unique to this group. Other age, racial, and ethnic groups in the United States have seen their mortality rates go down. And no other high-income country is seeing a similar pattern.

One of the authors of the study is Angus Deaton, the Princeton economist who recently won the Nobel Prize in economics for his work on the intricacies of measuring human well-being. This latest article, he told Vox, has attracted more attention than just about anything else he's published in his decades-long career.

I talked to him to hear what he thinks about the findings in the paper, which he authored with his wife and fellow Princeton economist Anne Case.

1) Deaton isn't sure what's driving the increase in deaths — but he has some good guesses

PNAS

When Deaton and Case noticed the shocking rise in mortality rates among middle-aged white Americans, they started to search for explanations.

First, they ruled out an increase in deaths from chronic scourges such as heart disease, cancer, and diabetes — those numbers were all either stable or trending downward. Murder and accidents were also declining.

But then they noticed something strange: There had been a big increase in the suicide rate among middle-aged men and women. Deaton and Case also noted data showing an uptick in reliance on opioid painkillers — an epidemic that started in the late 1990s that has been linked with terrible health and mortality outcomes.

Was substance abuse at the root of this spike in deaths? "Poisonings were going up like crazy," Deaton noted. Most of the drug-related deaths in America are now caused by prescription medicines, and nearly three-quarters of those deaths are from opioid painkillers like OxyContin. Chronic liver diseases related to drug and alcohol use in this group were also on the rise.

"It’s like you’re doing a jigsaw where you can’t find the pieces. All of a sudden you find one piece and a whole bunch of things become clear," Deaton said.

2) Deaton thinks middle-aged white Americans have "lost the narrative of their lives"

But what's behind the substance abuse? One possible factor here: This demographic group has faced a rise in economic insecurity over the past decade, driven by things like the financial crisis and the collapse of manufacturing.

Still, it's difficult to put together a full story of what's going on. After all, if the recession or decline of manufacturing was the only factor, we might expect to see a similar uptick in mortality rates among middle-aged people in places such as Europe. But America seems to be unique in this regard.

"An anthropologist friend here says that [white, middle-age Americans] have lost the narrative of their lives — meaning something like a loss of hope, a loss of expectations of progress," he explained.

Though African Americans as a group are still worse off overall, Deaton added, their quality of life has improved over the past several decades. "And when Hispanics look back, they may look back to where they came from, or what their parents or grandparents had," he continued.

So Deaton says this particular group of middle-aged white Americans may have had higher expectations than others when it comes to steady employment and a bright future, and the stress of losing that could well be driving their deadly behaviors.

"The white non-Hispanics may be more susceptible to despair, and perhaps to the alcohol or drug 'solution,' especially those with less education," he said. "And then there is the availability of opioids and of heroin."

3) Poor, middle-aged white people are suffering most — but they're not alone

PNAS

Deaths from drugs, alcohol, and suicides have risen for all education groups, not just those at the bottom. Deaton calls that "the blockbuster finding."

Specifically, while the researchers found that the overall increase in the mortality rate was driven by "increasing death rates for those with a high school degree or less," they also found that people with all levels of education saw increases in deaths from suicide and poisonings.

4) The absolute mortality rate for African Americans is still highest — but it's falling much faster than the white mortality rate

In absolute numbers, other racial groups are still dying early at much higher numbers. Absolute mortality rates are still highest among black Americans, followed by white Americans, then Hispanics, and then Asian Americans.

But Deaton thinks this new study should change how people think about mortality in America. "Often in the scientific literature, people think of whites as the dominant group, with the lowest mortality rates. But in fact, whites don't do all that well. They do better than black Americans but not as well as Hispanics and Asian Americans."

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