Pundits continue to push the white-men-are-dying story, even though the real change is occurring among women.

From the New York Times book review:

Over the last century, Americans’ life expectancy at birth has risen from 49 to 77. Yet in recent years, that rise has faltered. Among white people age 45-54 — or a time many view as the prime of life — deaths have risen. Especially vulnerable are white men without a four-year bachelor’s degree. Curiously, midlife deaths have not climbed in other rich countries, nor, for the most part, have they risen for American Hispanics or blacks.

And, now, the data:

See here for a link to lots more graphs.

If you want to talk about trends in death rates for middle-aged whites, it’s women, not men, whose death rates have been going up. But pundits just loooove talking about the problems of white men.

That said, the absolute death rate remains higher among men than women:

And I haven’t looked at the data from the past few years. So the story is complicated. Still, I think the whole blue-collar blues thing is overplayed.

From the New Yorker:

As Case and Deaton recount in their new book, “Deaths of Despair and the Future of Capitalism” (Princeton), they dug deeper into national vital statistics and compared rates of suicide with those of other causes of mortality. “To our astonishment, it was not only suicide that was rising among middle-aged whites; it was all deaths,” they write. . . . working-age white men and women without college degrees were dying from suicide, drug overdoses, and alcohol-related liver disease at such rates that, for three consecutive years, life expectancy for the U.S. population as a whole had fallen. . . .

Case and Deaton argue that the problem arises from the cumulative effect of a long economic stagnation and the way we as a nation have dealt with it. For the first few decades after the Second World War, per-capita U.S. economic growth averaged between two and three per cent a year. In the nineties, however, it dipped below two per cent. In the early two-thousands, it was less than one per cent. This past decade, it remained below 1.5 per cent.

Though their earnings still lag behind those of the white working class, life for this generation of people of color is better than it was for the last. Not so for whites without a college education. Among the men, median wages have not only flattened; they have declined since 1979. . . .

Again with the men! But, again, at least at the time when Case and Deaton published their influential paper, the death rates for middle-aged white men was declining in this country. It was only the women whose death rates were still increasing.

But this doesn’t fit the decline-of-the-white-male story, so nobody talks about it.

50 thoughts on “Pundits continue to push the white-men-are-dying story, even though the real change is occurring among women.

  1. The review is punishably poorly done, and the author should be sentenced to only reviewing The Berenstain Bears. More interesting to me is C&D’s continuing focus on men, even though the data suggest something big happening with women. My guess is that their focus reflects a kind of intellectual stubbornness and loathing of admitting error. You don’t often win Nobel prizes by saying “Oops, guess I missed that one.” Is there a word/phrase for that tendency to stick to a conclusion even in the face of factual correction? And don’t say “human nature.”

  2. Andrew –

    The article:

    > Though their earnings still lag behind those of the white working class, life for this generation of people of color is better than it was for the last. Not so for whites without a college education. Among the men, median wages have not only flattened; they have declined since 1979. . . .

    You:

    > Again with the men! But, again, at least at the time when Case and Deaton published their influential paper, the death rates for middle-aged white men was declining in this country. It was only the women whose death rates were still increasing.

    Presumably, declines in wages among white men could have an effect on health outcomes in white women (via drones in household income). I would expect any such effect to be paralleled in health outcomes among white men, although it wouldn’t necessarily have to be (women could conceivably feel the effect of declines in household income more than men).

    At any rate – there seems to be a bit of a category jump?

  3. Has anyone other than an economist tried to explain the mortality trends, like an epidemiologist. It seems to me that the more likely explanation for a change in the mortality rate is some more directly health related like smoking. Smoking has a big effect on mortality. I don’t like these stories someone finds a trend in the economy and a trend in health or mortality and we are suppose to imagine a connection. There are a lot of steps in between that are missing. It is conceivable that an economic decline could result in positive health benefits as well. There is no reason to connect these two trends without figuring out the intervening links of the chain.

    • Steve –

      > I don’t like these stories someone finds a trend in the economy and a trend in health or mortality and we are suppose to imagine a connection.

      Not to defend the reasoning in this particular case, but my understanding is that there’s pretty strong support for a link between SES and health outcomes – even if the associated causal mechanism might be complex with a variety of potential moderators/mediators (like smoking).

    • ” like an epidemiologist. ”

      I’ll be your armchair epidemiologist: Women are suffering from an epidemic of rising employment. More stress at the very least, but probably rising exposure to harmful environments on the job. Men, on the other hand, are working less and having shorter working lives, and thus experiencing an epidemic of longer healthier lives.

    • Yes.

      Declining Life Expectancy in the United States: Missing the Trees for the Forest
      Annual Review of Public Health
      Vol. 42:381-403

      Abstract
      In recent years, life expectancy in the United States has stagnated, followed by three consecutive years of decline. The decline is small in absolute terms but is unprecedented and has generated considerable research interest and theorizing about potential causes. Recent trends show that the decline has affected nearly all race/ethnic and gender groups, and the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer’s disease. A slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further. Although a popular explanation for the decline is the cumulative decline in living standards across generations, recent trends suggest that distinct mechanisms for specific causes of death are more plausible explanations. Interventions to stem the increase in overdose deaths, reduce access to mechanisms that contribute to violent deaths, and decrease cardiovascular risk over the life course are urgently needed to improve mortality in the United States.

      https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-082619-104231

      • Nick:

        Thanks. Good article and it wasn’t behind a paywall. In the article, the authors point to the opiod crisis and increase in alcohol (among other things) which could contribute both to increases in accidental poisonings and the spread of Hep C, which would explain the increase in liver cancer. Also, I believe opiods could contribute to certain types of heart disease. This should spark a completely different discussion from the “white men are in despair.” The FDA made a policy decision to let these opiods on the market. Then the Supreme Court gutted the FDA’s ability to regulate drug advertising. Perdue ran ads where actors on opiods were driving around and performing tasks that would not be safe for them to do. Then, no one monitored the fact that there were simply too many opiod perscriptions being filled to possibly meet the legitimate demand because we actually have no real mechanism to monitor that. I am still amazed that the opiod crisis did not recieve the attention it needed to and still hasn’t. But, let’s talk about how white men are the real victims.

        • I honestly wonder if the opioid crisis was worsened by trying to crack down on prescription opioids and the push for a new oxycontin formula (approved in 2010) that made it less amenable to abuse. You had a gradual but substantial rise in overdose deaths from prescription opioids (mostly driven by the increased use in prescription opioids) in the early aughts (then plateauing after that). Then in 2010 (when the new formulation of oxy was approved (note I’m not making a causal claim, but it is coincidental)), you start seeing a dramatic rise in heroin overdose deaths (almost reaching the same number of deaths as from prescriptions). Then, starting in 2013, deaths from synthetic opioids sky-rocket, quickly becoming (by far) the main method of overdose deaths. (https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates)

          This doesn’t really fit the “prescriptions opioids are the main factor or cause of epidemic”. They contributed to the problem for sure, but from what I’ve read, the evidence of prescriptions being the gateway to heroin and synthetic opioids is pretty weak.

          If the “prescriptions lead to heroin and synthetic use” were the story of most opioid deaths (note, I do not think it is), then it might be better just to facilitate prescription usage. The number of prescription opioid deaths mostly rose in the aughts due to increased usage. The death rate of prescription users (deaths of prescription users/number of prescription users) is much lower than that of heroin and synthetic. You’d have fewer deaths by giving those users prescriptions.

      • One thing that people keep missing in all these kinds of discussions is the impact of immigration.

        According to Wikipedia the percentage of foreign born residents in the US has nearly tripled since 1970, from 4.7% in 1970 to 13.5% in 2018, while the source of immigration shifted from 68% European in 1970 to 13% European in 2018. From Latin American and Asia the trend is the exact opposite. In 2018 78% of foreign born US residents were from Latin America and Asia.

        Where I live there are large numbers of immigrants from both Latin America and Asia. It’s impossible not to notice their frequently small stature, which probably results from nutritional limitations in their home country as children. It would be very surprising if this population had the same average lifespan as an American-born resident of any nationality or race.

        Like the women in the work force and cleaning up of industry, the 2000s is about the right time for this wave of immigration to start impacting US lifespans.

        Lots of handwaving there, for sure, but seems plausible at the very least.

        • “a quick Google returned this”

          I don’t buy it. How ’bout that? :) I’m not married to my off-the-cuff theory but as even the authors note in the article, it’s a very surprising result, so one study just ain’t gonna cut it.

          Note a little bug from the study:

          “Age misreporting is always a concern with any data source, including both vital statistics and survey-based estimates. ”

          They use a population model to estimate the effects of age misreporting and conclude “These estimates suggest that our death rates are not greatly affected by age misreporting”. I don’t claim to know anything about those population models, but there’s no way of knowing for sure if people are giving accurate ages.

          As I recall there was a pretty major discussion here a while back about age verification for centenarians in the Mediterranean casting doubt on the supposed long lifespans there.

        • While many immigrants are from poor countries where they have poor diets and poor education, Americans are also notably unhealthy, so it is also plausible that immigrants would live longer

          But do you find this:

          “If American immigrants were a country, they would be among the world leaders in longevity.”

          more plausible? :) To me this is not quite ridiculous but it’s **extremely surprising**. How do immigrants, 75% whom come from some of the world’s poorest countries, self select to become the “world leaders in longevity”? Particularly when many of these groups have a number of characteristics that are associated with shorter lives (low education) and were demonstrably negatively impacted by their unwillingness to follow medical advice during the pandemic?

        • I wasn’t making a broader claim about whether immigrants have lower, similar, or longer lifespans than non-immigrants. I just think the differences couldn’t be so extreme as to account for a large part of the short-term changes in mean life expectancy. If a large fraction of recent immigrants died within a decade of arrival I’m pretty sure I would have heard about it.

        • ” just think the differences couldn’t be so extreme…”

          OK. I have no data. I can’t really refute that.

          “If a large fraction of recent immigrants died within a decade of arrival”

          But this doesn’t have to happen. Immigration from poor countries starts rising in the early 1970s. People don’t have to die within a decade of arrival – they just have to live a few years less or a decade less or whatever. The impacts we’re discussing here don’t emerge until 2005 as the “collective age” of immigrants gains some sort of critical mass.

          I agree though it might not be as likely as I thought at first.

        • “I just think the differences couldn’t be so extreme as to account for a large part of the short-term changes in mean life expectancy.”

          After reading this paper more carefully the paper is claiming the exact opposite of your statement: that immigration accounts for a substantial portion of the short term changes in life expectancy. They claim that, because of the rising **increase** in life expectancy of immigrants, the overall **decrease** in life expectancy of Americans is much smaller than it would have been otherwise. Quite the opposite of my prior. Not that I accept this at face value. But the paper does explore some alternative verification of the headline result.

          However I don’t quite get the approach. There’s an obvious problem comparing life expectancy at birth: since most immigrants didn’t emigrate at birth, the immigrant population would by definition have survivorship bias. It seems that the obvious approach would be to simply compare the lifespan of immigrants who emigrated in Year X at Age Y to the lifespan of Americans of the age in the same year. That’s not what they do. They recalculate to lifespan at age 1.

  4. In fairness, I think you have to notice that the quotes from both the NYT and the New Yorker primarily talk about middle-aged white people as a whole, with only a single sentence in each zeroing in on white men.

    I would be very interested to see data broken down by educational level. My guess (and it is just a guess) is that the death rate among middle-aged white men with no college has been steadily increasing, and it’s not visible in the data here because it’s balanced by a decrease in the death rate among those who are college-educated. That’s certainly the main story you hear in the media–not “white men are dying,” but “blue-collar white men are dying.”

    What really mystifies me is why the death rate for middle-aged white men as a whole reached a peak around 2005, and then started going down. It certainly wasn’t because of the economy getting better. The Affordable Care Act wasn’t implemented until some years later, so that can’t be the reason. What happened right in 2005?

    • You have to view this data through a cohort perspective. The factors that influence the rate of death at any given time could be decades old because illnesses from smoking, job related hazards (e.g., asbestos) or other factors could take decades to play out. Since many job related hazards began to be mitigated, and industrial production in the US cleaned up substantially, from the 1960s-1990s, its sensible that the older generations of men in the early 2000s started to see a benefit in life expectancy. At the same time, while the net hazards were reduced, the dramatic increase in women in the work force from the 1960s-1990s could also explain the rising death rate of women by the early 2000s.

      I think a lot of this attribution to specific events is way over done given how terribly fuzzy the data are. The larger events that affected all of society are more likely to play a significant role in broad long term trends, even if it does make the analysis difficult if not impossible.

  5. I looked at some suicide rate data recently (a year ago or so) and recall it being the case that suicide rates are rising among older white men. It was something like older white men had the overall highest suicide rate among any age/race group. It might have been the 70+ age group though. I can’t recall how it compared with suicide rates for white women of the same age group though. Of course suicide is a very specific cause of death that is that is only a small part of the data included in the above post I presume.

    The real standout I found was that suicide rates for teens was skyrocketing, and especially for black female teens. Suicide rates were very low for teens compared to older folks (and lowest for young blacks I think), but the relative increase was quite extreme, something like a tripling of suicide rate among young black females, whereas it was like a 10% increase for older white males. These numbers could be totally off, but illustrate the qualitative finding that I recall (which again could be wrong).

  6. Jim says, “I think a lot of this attribution to specific events is way over done given how terribly fuzzy the data are. The larger events that affected all of society are more likely to play a significant role in broad long term trends, even if it does make the analysis difficult if not impossible.”

    +1

    Although the article that Nick sent does seem to suggest that the opiod crisis play some large factor in these trends. I guess that would fall under your “larger events” category.

    • It is not just painkillers. Over/under-dosing blood pressure medication was also a major contributor, along with suicide (possibly related to anti-depressant/anxiety use).

      There should be a discussion about why 80 million people in the US are on blood pressure medication when it is only supposedly benefiting ~1 million out of that 80: https://www.thennt.com/nnt/anti-hypertensives-to-prevent-death-heart-attacks-and-strokes/

      Anti-depressant/anxiety drugs are a whole other story, I have personally seen those destroy someone’s life (inability to successfully work or have social relationships) within months.

      • Anoneuoid –

        > Anti-depressant/anxiety drugs are a whole other story, I have personally seen those destroy someone’s life (inability to successfully work or have social relationships) within months.

        What leads you to be so certain and absolute about the causality?

        • Because within a week the known side effects began, namely loss of bladder control. Then all of sudden bizarre hallucinations/paranoia began about people they hadn’t seen for years at work harassing them. Then the rage started.

          None of this ever happened even the slightest bit before being prescribed these pills, and it became a huge issue starting immediately after they were taking daily doses of psychotropic drugs with those symptoms as well-known effects.

        • Did this person stop taking the meds? If not, why not? If so, were these permanent impairments after the meds stopped? Seems if the problems started so quickly and dramatically it would be odd if the person remained on these meds beyond even that week? Was this person in touch with a prescribing doctor who was monitoring for side effects?

        • Despite my immediate and strongest best efforts, they did not. Because they became addicted.

          Sorry, you will just have to experience it for yourself I guess.

        • I realize this is a sidebar and apologize to Andrew in advance. I will stipulate that virtually none of the extant treatments for depression are great, and acknowledge that your acquaintance’s situation is unfortunate and I am sorry to hear about it, but I have a number of problems with extrapolating from this anecdote.

          First, discontinuing SSRIs is not like getting off heroin or benzodiazepines or alcohol, or even cigarettes. The physical and mental effects suck but most people can work through them without even taking a day off. And then when you’re fully off, there’s no pleasurable sensation to chase, so the temptation to start again is not very high unless they were actually helping you cope with your depression. Although there are elements that meet the technical definition of addiction, it is more like a caffeine addiction than most other addictions we talk about. So it is weird for someone not to quit if SSRIs are ruining their life.

          Second, any competent doctor would discontinue you immediately and try something else if you reported those kinds of symptoms. So this person either has an incompetent doctor or is not being honest about their symptoms. Neither of these is really the fault of the drug.

          Third, the thing that kills most people with depression when depression figures into the death, which seems to be how we got onto this topic, is untreated depression leading to suicide. Preventing suicidal ideation, and thus attempts, is a pretty significant benefit of antidepressants, and they clearly do for many people.

          All of that said, SSRI/SNRIs are much better at putting a floor on the depths of depression than curing it, and they don’t even manage that for a large proportion of the people who try them. We need to be actively pursuing a far wider range of treatment avenues, including TMS, ECT, psychedelics, etc, rather than continue to develop slight tweaks on the SSRI formula. To some extent I think the medical community has come around to this realization.

        • 1) Sounds like what was said about opioids, eventually it was realized there was a crisis. How did they miss it for so long?

          2) What if you take an antidepressant and a benzodiazepine at the same time?

          3) This:

          Second, any competent doctor would discontinue you immediately and try something else if you reported those kinds of symptoms. So this person either has an incompetent doctor or is not being honest about their symptoms. Neither of these is really the fault of the drug.

          Not everyone is always going to comply with the protocol used in the RCT, failing to account for that is also an issue with the “poisonings” from blood pressure medications mentioned above. This is a well known issue, so anyone ignoring it when recommending a drug is indeed to blame for the results.

        • Anoneuoid –

          > Sorry, you will just have to experience it for yourself I guess.

          That seems like a rather odd statement. Since you’re discussing anecdotes, I know quite a few people who have tried antidepressants. Quite a few feel that they’ve been helped. A few feel that they had no benefit. Not a single one felt they were in any way harmed by seeing if they worked.

          I happen to have a fairly intensive experience related to other psychotropic drugs, in that I cared for many years for a schizophrenic brother. For many years he was “non-compliant” with taking medications, and as a result have a very unstable life at the edges of society even with a strong support group. When I became his primary caretaker, I had a somewhat ambivalent attitude about his psychotropic mediations. I might take him to the hospital where they were dispensed and drop him off to get them, not knowing for sure if he actually went in and stayed in long enough to get medicated. That changed one day when he came up to me with a knife held to his wrist and told me that god wanted his blood.

          From that point forward, I would take him to a clinic and sit with him in the waiting room along with other people waiting to receive their psychotropic meds. I still had some ambivalence. I have read articles about how even schizophrenics do better long term without medications when in their society, their communities assume a kind of collective responsibility for supporting people with mental illness. Not only do they do better on average in terms of the manifestation of their mental illness, they also, obviously, aren’t going to suffer from the often serious side-effects of the medications. In some societies, people who are like those we consider psychotic can just live lives as someone who is woven into the fabric of society as unique individuals. That’s great.

          But those questions of what happens in other societies has somewhat limited application to our society. In addition to my brother, I have known other people who seem to have significantly better life outcomes in association with using psychotropic medications.

          Anyway, sorry for the ramble – but thus idea that I’ll just “have to experience it [my]self” woefully uniformed and oddly condescending. Your experiences are not unique. Nor are they the only kinds of experiences one might have. And of course, the very idea of dealing with this issue through the lens of anecdote is extremely problematic anyway. Not to say that anecdote is irrelevant. But it should be placed in full context – which from what you’ve said in this thread it appears you’ve failed to do.

        • Anyway, sorry for the ramble – but thus idea that I’ll just “have to experience it [my]self” woefully uniformed and oddly condescending. Your experiences are not unique. Nor are they the only kinds of experiences one might have.

          Mental illness is awful in every way, and I have dealt with multiple people who have destroyed all their social relatinoships because of it without any prescribed drug at all. So I do not mean to diminish your experience in any way.

          However, it has nothing to do with the topic at hand which is that in some people taking anti-depressant/anxiety medications increases the chance of bad things happening which is known to lead to suicide.

          On average it may even not increase this, but it definitely happens and that risk should be accounted for.

          The much bigger issue is the blood pressure medications.

        • Anoneuoid –

          > Mental illness is awful in every way, and I have dealt with multiple people who have destroyed all their social relatinoships because of it without any prescribed drug at all. So I do not mean to diminish your experience in any way.

          I have to say the phrasing of “people who have destroyed all their social relationships because of [mental illness]” strikes me as a bit strange. Almost as if you think there was some kind of volition involved. I don’t look at it as people destroying their relationships because of mental illness, but mental illness ruining people’s relationships. Or maybe I”m making too much of semantics.

          But actually, my brother’s mental illness was very closely connected to him developing a huge community of people who had extremely strong connections to him. He used to hang out at a high end coffee shop in Rittenhouse Square in Philly and became a kind of artist in residence there. He had a huge slew of people who have very deep relationships with him (and collected his work, some collecting into the thousands), and it wasn’t at all that his mental illness impeded those relationship but in many ways it enriched those relationships. Not to say that it can’t work in the reverse fashion, of course.

          > However, it has nothing to do with the topic at hand

          Let me bring you back to this statement of yours —

          > …and it became a huge issue starting immediately after they were taking daily doses of psychotropic drugs with those symptoms as well-known effects.

          Which it seemed to me was more of a reference to psychotropic drugs more generally and which is what I was responding to when talking about my brother.

          > which is that in some people taking anti-depressant/anxiety medications increases the chance of bad things happening which is known to lead to suicide.

          Yes, bad things can happen as a result of people taking antidepressants. And there seems to be some evidence that antidepressants may result in a net overall increase in suicides, among certain cohorts of people in particular. Sure, that’s a real issue. But you don’t mention the uncertainty which seems to me to be an agenda-driven way of dealing with the situation. As is referencing personal anecdote without any balance.

          > On average it may even not increase this, but it definitely happens and that risk should be accounted for.

          We agree that it should be accounted for. I’m glad that now, you mention that you’re not sure that antidepressants increase the risk for negative outcome in balance to the benefits.

          > The much bigger issue is the blood pressure medications.

          I have no knowledge about that. I’ll check out your link. I’ll also mention that I benefit from blood pressure medications.

      • Case and Deaton were studying “deaths of despair”: deaths from suicide, alcoholism and drug overdose. And this kind of death has undeniably become more common among middle aged white men without a college degree over the last 20 years.

  7. “. . . the real change is occurring among women” [headline]

    Andrew:

    Would your commitment to this claim change if you combined the graphs of regional data, rather than putting them side by side — or, at least, equalized the scales of the vertical axes? The clearest “real change” does indeed seem to have occurred among southern women: a steady increase to about 50 more deaths per 100K. The second-clearest increase seems to be among southern men: say, 40 per 100K over the time period, which is not a whole lot less real, is it?

    (The minimum value on the regional men’s graph is higher than the maximum on the women’s graph, so maybe the review’s statement, “Especially vulnerable are white men without a four-year bachelor’s degree,” isn’t entirely implausible. Gratuitous, maybe, or tendentious, but implausible?)

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