Monday, November 2, 2015

US death rates rising among middle aged white people

 A few years ago, a study showed a shocking increase in mortality rates among white women with less than a high school eduation in the US. This finding seems to be echoed in this result for middle aged white men and women.
...death rates in this group have been rising, not falling.
That finding was reported Monday by two Princeton economists, Angus Deaton, who last month won the 2015 Nobel Memorial Prize in for Economic Science, and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, they concluded that rising annual death rates among this group are being driven not by the big killers like heart disease and diabetes but by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids.
That is, we have to enlarge out list of 'big killers'.
The mortality rate for whites 45 to 54 years old with no more than a high school education increased by 134 deaths per 100,000 people from 1999 to 2014.
“It is difficult to find modern settings with survival losses of this magnitude,” wrote two Dartmouth economists, Ellen Meara and Jonathan S. Skinner, in a commentary to the Deaton-Case analysis that was published in Proceedings of the National Academy of Sciences.
“Wow,” said Samuel Preston, a professor of sociology at the University of Pennsylvania and an expert on mortality trends and the health of populations, who was not involved in the research. “This is a vivid indication that something is awry in these American households.”
Dr. Deaton had but one parallel. “Only H.I.V./AIDS in contemporary times has done anything like this,” he said.
In contrast, the death rate for middle-aged blacks and Hispanics continued to decline during the same period, as did death rates for younger and older people of all races and ethnic groups.
 Middle-aged blacks still have a higher mortality rate than whites — 581 per 100,000, compared with 415 for whites — but the gap is closing, and the rate for middle-aged Hispanics is far lower than for middle-aged whites at 262 per 100,000.
David M. Cutler, a Harvard health care economist, said that although it was known that people were dying from causes like opioid addiction, the thought was that those deaths were just blips in the health care statistics and that overall everyone’s health was improving. The new paper, he said, “shows those blips are more like incoming missiles.”
Dr. Deaton and Dr. Case (who are husband and wife) say they stumbled on their finding by accident, looking at a variety of national data sets on mortality rates and federal surveys that asked people about their levels of pain, disability, and general ill health.
Dr. Deaton was looking at statistics on suicide and happiness, skeptical about whether states with a high happiness level have a low suicide rate (they don’t, he discovered — in fact the opposite is true.) Dr. Case was interested in poor health, including chronic pain because she has suffered for 12 years from disabling and untreatable lower back pain.
Dr. Deaton noticed in national data sets that middle-aged whites were committing suicide at an unprecedented rate and that the all-cause mortality in this group was rising. But suicides alone, he and Dr. Case realized, were not enough to push up the overall death rates so they began looking at other causes of death. That led them to the discovery that deaths from drug and alcohol poisoning also increased in this group.
Taken together, they concluded that suicides, drugs, and alcohol explained the overall increase in deaths. The effect was largely confined to people with a high school education or less. In that group, death rates rose by 22 percent while they actually fell for those with a college education. [my bolding]
This collapse of life expectancy  resembles  patterns in Russia after the fall of the USSR. Large numbers of people are economically and socially marginalized, increasing their immiseration, pain, and debility, and many die.
Dr. Case, investigating indicators of poor health, discovered that middle-aged people, unlike the young and unlike the elderly, were reporting more pain in recent years than in the past. A third in this group reported they had chronic joint pain over the years 2011 to 2013 and one in seven said they had sciatica. Those with the least education reported the most pain and the worst general health.
The least educated also had the most financial distress, Dr. Meara and Dr. Skinner noted in their commentary. In the period examined by Dr. Deaton and Dr. Case, the inflation adjusted income for households headed by a high school graduate fell by 19 percent.
Dr. Case found that the number of whites with mental illnesses and the number reporting they had difficulty socializing increased in tandem. Along with that, increasing numbers of middle-aged whites said they were unable to work. She also saw matching increases in the numbers reporting pain and the numbers reporting difficulty socializing, difficulty shopping, difficulty walking for two blocks.
With the pain and mental distress data, Dr. Deaton said, “we had the two halves of the story.” Increases in mortality rates in middle-aged whites rose in parallel with their increasing reports of pain, poor health, and distress, he explained. They provided a rationale for the increase in deaths from substance abuse and suicide.
This last is just a conjectured explanation, but one that seems plausible. Disrupting people's place in the social world by disrupting the economy in which they used to have a productive role can be lethal. The mechanisms of death differ, (vodka in Russia, opioids in the US) but the effects are the same.

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