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. 2015 Dec 8;112(49):15078-83.
doi: 10.1073/pnas.1518393112. Epub 2015 Nov 2.

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

Anne Case  1 , Angus Deaton  1
Affiliations

Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century

Anne Case et al. Proc Natl Acad Sci U S A. .

Abstract

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. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population. We comment on potential economic causes and consequences of this deterioration.

Keywords: US white non-Hispanics; midlife mortality; morbidity.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
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).
Fig. 2.
Fig. 2.
Mortality by cause, white non-Hispanics ages 45–54.
Fig. 3.
Fig. 3.
Census region-level suicide and poisoning mortality rates 1999–2013. Census regions are Northeast (blue), Midwest (red), South (black), and West (green).
Fig. 4.
Fig. 4.
Mortality by poisoning, suicide, chronic liver disease, and cirrhosis, white non-Hispanics by 5-y age group.
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