Trend reversal and sharp increase of mortality of 45-54 year old, US white population

A new paper by Nobel winner Angus Deaton and his wife Anne Case points out a trend reversal and a sharp increase of mortality rates among 45-54 year old, non-Hispanic whites in the US between 1999 and 2013. This is highest among the less educated, less well-off population. It is the reversal of a previous trend and that is both perplexing and a little alarming. It suggests a deeper social malaise prevalent in this group.

A rather deadly – and morbid – case of “White Flight”.

Anne Case and Angus DeatonRising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century, PNAS, doi: 10.1073/pnas.1518393112

All-cause mortality, ages 45–54 for US White non-Hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE) Case & Deaton

All-cause mortality, ages 45–54 for US White non-Hispanics (USW), US Hispanics (USH), and six comparison countries: France (FRA), Germany (GER), the United Kingdom (UK), Canada (CAN), Australia (AUS), and Sweden (SWE)  – Case & 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.

The sharpest increase has been in “poisonings” which is essentially the use of drugs (including pain related opiates) and alcohol.

Mortality by cause, white non-Hispanics ages 45–54.

Mortality by cause, white non-Hispanics ages 45–54.

American Prospect comments:

Case and Deaton’s data indicate that the white midlife mortality reversal was due almost entirely to increased deaths among those with a high school degree or less. Mortality rates in that group rose by 134 per 100,000 between 1999 and 2013, while there was little change among those with some college, and death rates fell by 57 per 100,000 for those with a college degree or more.

Death rates from suicide and poisonings such as drug overdoses increased among middle-aged whites at all socioeconomic levels (as measured by education). But the increases were largest among those with the least education and more than sufficient in that group to wipe out progress in reducing other causes of death. Deaths from diabetes rose slightly but did not account for a significant part of the white midlife mortality reversal.

  ……. Among blacks, midlife mortality has been higher than among whites. But over the period 1999-2013, according to Case and Deaton, midlife mortality declined by more than 200 per 100,000 for blacks while it was rising for whites. As a result, the ratio of black to white mortality rates dropped from 2.09 in 1999 to 1.40 in 2013. Contrary to what many Americans may still believe, drug overdoses are no longer concentrated among minorities; in fact, among the 45-54 age group, drug-related deaths are now higher among whites. …..

American Prospect goes on to suggest that this might be a loss of hope among the white, middle-aged, less educated population, which is part of the malaise which is showing up politically as support for Trump and Carson.

The declining health of middle-aged white Americans may also shed light on the intensity of the political reaction taking place on the right today. The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. ……  The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change. Much of that support is now going to Republican candidates, notably Donald Trump. Whether Democrats can compete effectively for that support on the basis of substantive economic and social policies will crucially affect the country’s political future.

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