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“Explaining recent mortality trends among younger and middle-aged White Americans”

Kevin Lewis sends along this paper by Ryan Masters, Andrea Tilstra, and Daniel Simon, who write:

Recent research has suggested that increases in mortality among middle-aged US Whites are being driven by suicides and poisonings from alcohol and drug use. Increases in these ‘despair’ deaths have been argued to reflect a cohort-based epidemic of pain and distress among middle-aged US Whites.

We examine trends in all-cause and cause-specific mortality rates among younger and middle-aged US White men and women between 1980 and 2014, using official US mortality data. . . .

Trends in middle-aged US White mortality vary considerably by cause and gender. The relative contribution to overall mortality rates from drug-related deaths has increased dramatically since the early 1990s, but the contributions from suicide and alcohol-related deaths have remained stable. Rising mortality from drug-related deaths exhibit strong period-based patterns. Declines in deaths from metabolic diseases have slowed for middle-aged White men and have stalled for middle-aged White women, and exhibit strong cohort-based patterns.

We find little empirical support for the pain- and distress-based explanations for rising mortality in the US White population. Instead, recent mortality increases among younger and middle-aged US White men and women have likely been shaped by the US opiate epidemic and an expanding obesogenic environment.

I don’t have anything to add on this topic right now—my own work with Auerbach (also see here) broke down mortality rates by age, sex, ethnicity, and state but not by cause of death.

I’m just sharing this new article in support of the point I’ve made several times, that when we’re looking at trends in disease and mortality, it makes sense to listen more to demographers, who should be the real experts on these topics.


  1. jrc says:

    ” We find little empirical support for the pain- and distress-based explanations for rising mortality in the US White population. Instead, recent mortality increases among younger and middle-aged US White men and women have likely been shaped by the US opiate epidemic and an expanding obesogenic environment.”

    Just to be clear, the argument is: This isn’t a pain and distress thing, it is an opiate and food abuse thing?

    I didn’t bother trying to get through the gate, so I am making no comments about anything in this paper beyond the above question relating specifically to the argument as presented in those two sentences. Because opiate overdose and unhealthy eating behaviors both strike me as at least partly about pain and distress. I mean, opiates are literally for pain.

    • Andrew says:


      I actually found that last paragraph a bit confusing and was thinking of not including it in the excerpt. To me, the key paragraph is the one that comes before.

      I should also emphasize that I did not read the paper—actually, the link I have only gave the abstract. I was posting based on the general principle that we should be hearing more about these things from demographers; I was not commenting on the paper itself.

    • N says:

      Even so, overall misery levels may not have changed, if coping mechanisms and general regard for social or even legal consequences of drug use and obesity (“obesogenic environment”) have.

    • We find little evidence for a recklessness theory of increased deaths among 17 year old men, instead it seems clear that the main causes of death are a motorcycle use and hang-gliding epidemic….

    • Alex says:

      Just going by the snippet, it sounds like the argument is that if it was pain and distress (presumably they mean mental pain?) you would also expect increases in suicide and alcohol-related deaths, but they don’t see that. So at the least the pain and distress argument might need to include some reasons for why people are eating/pill-popping themselves to death instead of drinking or doing it directly.

    • gdanning says:

      My rather limited understanding of the opioid issue is that people use opioids because 1) doing so is enjoyable; or 2) they are addicted as a result of prior prescription use. So, I have been skeptical of the claim that the rise in opioid-related deaths is a symptom of rising “distress.” It is just as likely the result of 1) a decrease in the black market price of opioids; and 2) over-prescription. So, I don’t see anything necessarily inconsistent about the argument that the authors make.

      • Trevor Butterworth says:

        One of the hardest problems in teasing out the opioid problem is that the CDC (at least the last time I looked) didn’t separate out opioid use from other drug use in mortality reports. During the previous opioid scare, one research paper found that, overwhelmingly, those recorded as od’ing from opioids had other drugs in their system too. The media largely—entirely, I think— ignored this study in favor of the idea that accidental addiction due to reckless pharma marketing was the cause of the overdose “epidemic.” The question of whether polypharma users were simply abusing opioids because they were available was ignored. While accidental addiction is not impossible (and the pain research community have a good idea for the psychological triggers behind such addiction), the research has not shown mass iatrogenic addiction. What did correlate strongly 15 years ago with a surge in hospital admissions fr opioid abuse was the media’s lurid stories of hillybilly heroin during sweeps week, which helpfully showed how to defuse the time release mechanism on OxyContin.

      • Harald Korneliussen says:

        Opioid use isn’t exactly enjoyable. Recreational users typically don’t enjoy the first time. If you got something without knowing it or expecting it, you would probably feel ill first and foremost. Prescription abusers are another matter, because of course they really do help with pain.

  2. Martha (Smith) says:

    Then there’s this:

    Recent Increases in the U.S. Maternal Mortality Rate: Disentangling Trends From Measurement Issues,

    The lead author is a demographer.

    I haven’t read the article, but the title sounds like they’re looking at something that needs to be considered. (The study has gotten a lot of attention in Texas.)

  3. Martha (Smith) says:

    Since you didn’t provide a cat picture, here is an interesting page (including several cat pictures) on an ongoing study of cat communication:

    ““We want to find out to what extent domestic cats are influenced by the language and dialect that humans use to speak to them, because it seems that cats use slightly different dialects in the sounds they produce”, says Associate Professor of Phonetics Susanne Schötz.”

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