All Cause Mortality Rate Takes Surprising Upward Turn For Middle Age
Whites
Historic Reversal
In Risk of Death Linked To Epidemic Of "Midlife Distress"
The report has stunned epidemiologists, says the
principal author. The root cause may be an epidemic of "midlife
distress" not unlike the AIDS epidemic in the toll being taken. In an
attention-grabbing and much discussed paper published in the
Proceedings of the National Academy of Sciences in late October,
Princeton University economists Anne
Case
and Angus Deaton
documented a unique reversal in the long term trend of declining
all-cause mortality rates across multiple age groups in the US and
selected other countries.
The
reversal occurred between 1999 and 2013 in the US, took place only in
white middle-aged persons 45-54, primarily in persons with less than a
high school education, and was not seen in six other rich
industrialized comparison countries. Rates among Hispanics and black
Americans continued to decline over the period studied.
Surprise Turn of
Events
Mortality rates had been falling at the rate of 2% per
year but the investigators appeared to have stumbled on the new
numbers showing that mortality actually rose by half a percent a year
in the midlife age group. Case, the senior author of the paper told
National Public Radio, “…to see this reversal was really stunning. And
it has been stunning to all of the medical people, the epidemiologists
that we have talked to as well.”
Deaths NOT Prevented
According to the paper, for those aged 45-54, if the
white mortality rate had held at its 1998 value, 96,000 deaths would
have been avoided from 1999 to 2013. If it had continued to fall at
its previous rate of decline of 1.8% per year, 488,500 deaths would
have been avoided in the period 1999-2013. The authors ruled out a
cohort effect for those born 1945 and 1965 and claim the turnaround
they describe is both historically and geographically unique in the
US, at least since 1950.
Causes of the Increase
Three causes of death, namely suicide, drug and alcohol
poisoning, and chronic liver diseases and cirrhosis accounted for most
of the increases in death rates. The patterns were similar for men and
women. Also, increases in these causes of death were accompanied by
increases in self-reported midlife morbidity such as pain,
psychological distress, difficulties with activities of daily living,
and alcohol use.
Role of Education
The reversal in mortality rates was attributable to
increases in rates among white persons with a high school degree or
less. Those with education less than a bachelor’s degree saw little
change and those with such a degree actually experienced decreases in
death rates.
In fact, all 5 year age groups between 30-34 and 60-64
had similar increases in mortality from the sum of drug and alcohol
poisoning, suicide, and chronic liver disease and cirrhosis between
1999 and 2013. What differentiates the midlife age group is not that
they were the only age group to experience increases in these causes
of death, but only that their increases were large enough in these
categories to bump up the all-cause mortality rate sufficiently to
reverse the long term declining trend.
Reactions To The
Findings
Commenting on the key features of the findings, namely
that they involve both men and women, they do not involve African
Americans and Hispanics, and they are not happening in other countries
similar to ours, Case told NPR “…all of those things stood out to us
as puzzle pieces that we have
to look into
further to figure out, what are the root causes of this?”
No Shortage Of
Speculation
The widespread coverage which this report elicited from
the media was replete with speculation about the reasons for the
reversal in declining death rates. Some of the increase may be
associated with an increase in the use of prescription painkillers the
authors report, however they also identified economic insecurity as a
result of the recent financial crisis as a contributing cause.
According to the authors, “…many of the baby boomer generation are the
first to find, in midlife, that they will not be better off than were
their parents.” They conclude on both an optimistic and pessimistic
note that “…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.”
To listen to media commentators speculate about this epidemic, visit:
Podcast
https://tinyurl.com/owsuhh5
Published paper
Rising morbidity and mortality in midlife among white
non-Hispanic Americans in the 21st century
https://tinyurl.com/pdl2mw6
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