The authors talk about the increased availability of opioid painkillers, and the increased use of heroin within this…

The authors talk about the increased availability of opioid painkillers, and the increased use of heroin within this group, as a possible contributing factor, but it seems hard to ignore the ties between this rise and the collapse of the prospective economic futures of people in this group.

Originally shared by Yonatan Zunger

You may have seen this story circulating around the press: non-Hispanic whites in the US, aged 45-54, are dying at an alarming rate. I’m sad to say that, after going through the original research fairly carefully, they appear to have done a good job – the results are real, and telling.

First of all, a link: The research itself is available online at http://www.pnas.org/content/early/2015/10/29/1518393112.full.pdf?with-ds=yes . It’s a very readable paper, and if you’re comfortable with the scientific literature, I encourage you to read it. The Washington Post article (linked below) is probably the best general-public summary so far.

Second, let me summarize what the research did and found. They looked at records of mortality and morbidity (M&M for short; morbidity in this case means medical conditions which significantly affect one’s ability to function in daily life) from the Centers for Disease Control (CDC), which study these things carefully, and dug into the statistics. What they found is that for all groups in the developed world, M&M has been steadily decreasing – with one notable exception.

Note that this doesn’t mean that all groups have good M&M rates: for example, the rate for black, non-Hispanic adults in the US is much worse than the rate for white, non-Hispanic adults, but that rate in 2013 is much better (almost 50% better!) than it was in 1998. Improvements have been happening across the board.

The one marked exception was white, non-Hispanic adults with less than a Bachelor’s degree. For this group, three particular sources of death have been surging since 1998: suicide, drug and alcohol poisoning, and chronic liver disease and cirrhosis. This surge has affected all age groups, and appears to affect men and women equally; but it affects people with less than a high school diploma the most, people with a high school diploma or some college significantly, and people with a college degree or more very little.

For people aged 45-54 in particular, this surge has been so high as to completely counter all other improvements in mortality. The graph below shows the annual death rate for various groups for that age range.

The scale of this effect is tremendous, corresponding to roughly half a million excess deaths during this 15-year period. That’s on the same scale as the US death toll from the AIDS epidemic, which claimed 650,000 lives from 1981 to 2015. And like with epidemic diseases, for every one person who dies, many more are sickened and their lives are impaired.

And given what appears to be a very rigorous analysis of the data, I think we have to accept that this result is real. 

The authors talk about the increased availability of opioid painkillers, and the increased use of heroin within this group, as a possible contributing factor, but it seems hard to ignore the ties between this rise and the collapse of the prospective economic futures of people in this group.

If I had to look at this for unexpected patterns besides the blindingly obvious, a few things strike me:

* Its limitation to the non-Hispanic white population is interesting, because most things that go horribly wrong will also hit the black and Hispanic population as well. The one notable exception is when things are already bad for those populations and don’t get any worse.

Interestingly, that exception appears to apply to the recent economic downturn. I recently wrote a post about the effects of redlining and economic policy on people’s wealth (https://plus.google.com/+YonatanZunger/posts/Miuiu1caf3D), and one of the interesting things which showed up in the main data graph which drove that post (which that particular article didn’t spend too much time on) was how the Great Recession of 2007 had a huge effect on the net wealth of the white population, but very little on the Hispanic and black population. In no small part, that’s because the economic policies of previous decades left those populations with so little wealth (and so little housing wealth, in particular) that they had little left to lose in that recession. 

In fact, this sort of effect would synchronize well with the results of this new paper, since non-Hispanic white Americans with less than a college degree were (by all metrics) the ones most affected by the recent economic troubles: entire job sectors which this group dominated prior to this period, such as manufacturing, have essentially crashed and seem unlikely ever to recover, at least to the extent of providing quasi-middle-class existences to anyone.

* The gender balance of the effect was somewhat surprising to me. I would have guessed that a process like this would affect men more than women, as they are more likely to occupy the position of “breadwinner.” However, the effects of an economic crash will hit all of a family, and the male/female breadwinner ratio has been declining for decades, so apparently this is not a statistically significant difference.

* The extreme specificity of the causes of death which triggered this rise surprised me. I would expect that any rise in causes of death would be fairly broad, if nothing else because of the fraction of suicides misclassified as accidents or other causes of death. Apparently, this was not the case.

* Poisoning – that is, accidental or “intent undetermined” deaths from overdoses of alcohol, prescription, and illegal drugs – has surpassed lung cancer as a cause of death in this 45-54 group, and suicide is likely to do so within the next two or three years.

* Other things that you may expect to correlate with this shift in death rates, such as obesity, don’t. While people with a BMI over 30 have higher rates of all of the various morbidity and mortality types, they have seen the same rates of change as the greater population, and the change in rates of obesity itself contributed only a small amount to total health rate changes.

* Other countries in this study had similar economic problems, but none of them showed the same shift in M&M rates. The paper notes that these countries use different methods for retirement: defined-benefit pension plans, as opposed to the US, which has shifted largely to defined-contribution plans, which are much more vulnerable to stock market risk. While I think there isn’t enough data to strongly link these two (there are, after all, quite a few other differences between the countries), the reasons for these differences definitely bear further investigation.

So I don’t have any strong public policy recommendations here, except one: there is a real, severe, and lethal public health crisis spreading over the country, and we need to treat it as one. Further study is definitely needed to identify not simply the root cause, but the factors which make this so much more lethal for one group than for others. And we need to be ready to act seriously in order to stanch the bleeding.

https://www.washingtonpost.com/national/health-science/a-group-of-middle-aged-american-whites-is-dying-at-a-startling-rate/2015/11/02/47a63098-8172-11e5-8ba6-cec48b74b2a7_story.html//cdn.embedly.com/widgets/platform.js