While midlife mortality rates have been falling among all education classes in most developed countries, husband and wife researchers from Princeton University said in a new study released Thursday that "deaths of despair" — death by drugs, alcohol and suicide — have been surging among middle-aged white Americans who have a high school diploma or less.
In "Mortality and Morbidity in the 21st Century," Princeton University's Anne Case and her Nobel Prize winner husband, Angus Deaton, follow up on their groundbreaking 2015 paper that showed a shocking increase in midlife mortality among white Americans, examining patterns and contributing factors to the troubling trend.
Middle-aged white Americans with a high school diploma or less have experienced increasing midlife mortality since the late-1990s due to "deaths of despair" the study explains. A slowdown in progress against death from heart disease and cancer was also noted as a contributing factor.
"Increases in all-cause mortality continued unabated to 2015, with additional increases in drug overdoses, suicides, and alcoholic-related liver mortality, particularly among those with a high school degree or less. The decline in mortality from heart disease has slowed and, most recently, stopped, and this combined with the three other causes is responsible for the increase in all-cause mortality," the researchers explained in a summary of the study.
"Not only are educational differences in mortality among whites increasing, but mortality is rising for those without, and falling for those with, a college degree. This is true for non-Hispanic white men and women in all age groups from 25–29 through 60–64," they added.
In the meantime, mortality rates among blacks and Hispanics have continued to fall, the researchers explained.
"In 1999, the mortality rate of white non-Hispanics aged 50–54 with only a high school degree was 30 percent lower than the mortality rate of blacks in the same age group; by 2015, it was 30 percent higher. There are similar crossovers between white and black mortality in all age groups from 25–29 to 60–64," they said. And the trend was triggered by "deaths of despair."
Case and Deaton said they examined suggestions that the deaths among working class middle-aged whites were the result of poor incomes, but that factor could not comprehensively explain the phenomena.
"Many commentators have suggested that the poor mortality outcomes can be attributed to slowly growing, stagnant, and even declining incomes; we evaluate this possibility, but find that it cannot provide a comprehensive explanation. In particular, the income profiles for blacks and Hispanics, whose mortality has fallen, are no better than those for whites. Nor is there any evidence in the European data that mortality trends match income trends, in spite of sharply different patterns of median income across countries after the Great Recession," they said.
The researchers suggested instead that the poor mortality among middle-aged working class whites may have been triggered by the "progressively worsening labor market opportunities at the time of entry for whites with low levels of education."
"We propose a preliminary but plausible story in which cumulative disadvantage over life, in the labor market, in marriage and child outcomes, and in health, is triggered by progressively worsening labor market opportunities at the time of entry for whites with low levels of education," the researchers posited.
"This account, which fits much of the data, has the profoundly negative implication that policies, even ones that successfully improve earnings and jobs, or redistribute income, will take many years to reverse the mortality and morbidity increase, and that those in midlife now are likely to do much worse in old age than those currently older than 65," they added.
They suggested, however, that preventing the over-prescription of opioids could prove helpful in influencing mortality rates among the group.