Tuesday, November 3, 2015

qotd: High midlife mortality in US white, non-Hispanics

Proceedings of the National Academy of Sciences
Published online before print on November 2, 2015
Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century
By Anne Case and Angus Deaton


This paper documents a marked increase in the all-cause mortality of
middle-aged white non-Hispanic men and women in the United States
between 1999 and 2013. This change reversed decades of progress in
mortality and was unique to the United States; no other rich country saw
a similar turnaround. The midlife mortality reversal was confined to
white non-Hispanics; black non-Hispanics and Hispanics at midlife, and
those aged 65 and above in every racial and ethnic group, continued to
see mortality rates fall. This increase for whites was largely accounted
for by increasing death rates from drug and alcohol poisonings, suicide,
and chronic liver diseases and cirrhosis. Although all education groups
saw increases in mortality from suicide and poisonings, and an overall
increase in external cause mortality, those with less education saw the
most marked increases. Rising midlife mortality rates of white
non-Hispanics were paralleled by increases in midlife morbidity.
Self-reported declines in health, mental health, and ability to conduct
activities of daily living, and increases in chronic pain and inability
to work, as well as clinically measured deteriorations in liver
function, all point to growing distress in this population. We comment
on potential economic causes and consequences of this deterioration.

From the Discussion

Although the epidemic of pain, suicide, and drug overdoses preceded the
financial crisis, ties to economic insecurity are possible. After the
productivity slowdown in the early 1970s, and with widening income
inequality, many of the baby-boom generation are the first to find, in
midlife, that they will not be better off than were their parents.
Growth in real median earnings has been slow for this group, especially
those with only a high school education. However, the productivity
slowdown is common to many rich countries, some of which have seen even
slower growth in median earnings than the United States, yet none have
had the same mortality experience. The United States has moved primarily
to defined-contribution pension plans with associated stock market risk,
whereas, in Europe, defined-benefit pensions are still the norm. Future
financial insecurity may weigh more heavily on US workers, if they
perceive stock market risk harder to manage than earnings risk, or if
they have contributed inadequately to defined-contribution plans.

A serious concern is that those currently in midlife will age into
Medicare in worse health than the currently elderly. This is not
automatic; if the epidemic is brought under control, its survivors may
have a healthy old age. However, 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.


Midlife increases in suicides and drug poisonings have been previously
noted. However, that these upward trends were persistent and large
enough to drive up all-cause midlife mortality has, to our knowledge,
been overlooked. If the white mortality rate for ages 45−54 had held at
their 1998 value, 96,000 deaths would have been avoided from 1999–2013,
7,000 in 2013 alone. If it had continued to decline at its previous
(1979‒1998) rate, half a million deaths would have been avoided in the
period 1999‒2013, comparable to lives lost in the US AIDS epidemic
through mid-2015. Concurrent declines in self-reported health, mental
health, and ability to work, increased reports of pain, and
deteriorating measures of liver function all point to increasing midlife



Comment by Don McCanne

In recent years concerns have been raised about the increases in death
rates from prescription pain medications, but the magnitude of the
problem was not recognized until this landmark study was released
yesterday. Midlife deaths from poisonings with alcohol and drugs or from
suicide of white, non-Hispanic men and women in the United States have
skyrocketed since 1999. Morbidity likewise has increased in this group.

The intensity of the problem can be easily visualized by clicking on the
link above and looking at Figure 1. The mortality curve of US white
non-Hispanics, ages 45-54, is moving upward as the curves for US
Hispanics and for residents of six other wealthy industrialized nations
are continuing downward.

Although the other nations have more egalitarian, accessible and
affordable health care systems, that alone cannot explain the
differences since Hispanics in the United States have not seen this same
isolated increase in mortality.

The authors suggest that the decline in economic security that began in
the early 1970s may be an important factor. Not only have wages
stagnated, but retirement security has diminished with a shift from
defined benefit to defined contribution pension plans. Lack of higher
education has been especially associated with this phenomenon of higher
mid-life morbidity and mortality.

A single payer system would help by improving access to preventive
health, mental health, and drug treatment services. But we need to do
more. We need public policies that distribute the gains in productivity
to the workers rather than to the rentiers, plus tax policies that
reduce the injustices of income and wealth inequality. We need to ensure
adequate education opportunities for all, including industrial arts and
training for the service industries, along with assurances of adequate
incomes in those fields. In general, we need policies that serve the
social good.

To do that we need political leaders who are dedicated to the health and
welfare of the people and who would enact policies to ensure that. We
need to displace our current political leaders who have dedicated
themselves to supporting the military-industrial complex (through more
warfare), the medical-industrial complex (through prioritizing support
of insurers and pharmaceutical firms above the interests of patients),
and the rentiers of Wall Street who are redistributing wealth from the
masses to the magnates.

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