The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999-2015

Am J Public Health. 2017 Oct;107(10):1541-1547. doi: 10.2105/AJPH.2017.303941. Epub 2017 Aug 17.


Objectives: To evaluate trends in premature death rates by cause of death, age, race, and urbanization level in the United States.

Methods: We calculated cause-specific death rates using the Compressed Mortality File, National Center for Health Statistics data for adults aged 25 to 64 years in 2 time periods: 1999 to 2001 and 2013 to 2015. We defined 48 subpopulations by 10-year age groups, race/ethnicity, and county urbanization level (large urban, suburban, small or medium metropolitan, and rural).

Results: The age-adjusted premature death rates for all adults declined by 8% between 1999 to 2001 and 2013 to 2015, with decreases in 39 of the 48 subpopulations. Most decreases in death rates were attributable to HIV, cardiovascular disease, and cancer. All 9 subpopulations with increased death rates were non-Hispanic Whites, largely outside large urban areas. Most increases in death rates were attributable to suicide, poisoning, and liver disease.

Conclusions: The unfavorable recent trends in premature death rate among non-Hispanic Whites outside large urban areas were primarily caused by self-destructive health behaviors likely related to underlying social and economic factors in these communities.

MeSH terms

  • Adult
  • Age Distribution
  • Cardiovascular Diseases / ethnology
  • Cause of Death*
  • Female
  • HIV Infections / ethnology
  • Humans
  • Liver Diseases / ethnology
  • Male
  • Middle Aged
  • Mortality, Premature / ethnology*
  • Neoplasms / ethnology
  • Poisoning / ethnology
  • Racial Groups
  • Residence Characteristics / statistics & numerical data*
  • Suicide / statistics & numerical data
  • United States
  • White People / statistics & numerical data*