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

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Anne Case and Angus Deaton in PNAS, from a little while ago:

There has been a remarkable long-term decline in mortality rates in the United States, a decline in which middle-aged and older adults have fully participated (13). Between 1970 and 2013, a combination of behavioral change, prevention, and treatment (4, 5) brought down mortality rates for those aged 45–54 by 44%. Parallel improvements were seen in other rich countries (2). Improvements in health also brought declines in morbidity, even among the increasingly long-lived elderly (69).

These reductions in mortality and morbidity have made lives longer and better, and there is a general and well-based presumption that these improvements will continue. This paper raises questions about that presumption for white Americans in midlife, even as mortality and morbidity continue to fall among the elderly.

This paper documents a marked deterioration in the morbidity and mortality of middle-aged white non-Hispanics in the United States after 1998. General deterioration in midlife morbidity among whites has received limited comment (10, 11), but the increase in all-cause midlife mortality that we describe has not been previously highlighted. For example, it does not appear in the regular mortality and health reports issued by the CDC (12), perhaps because its documentation requires disaggregation by age and race. Beyond that, the extent to which the episode is unusual requires historical context, as well as comparison with other rich countries over the same period.

Increasing mortality in middle-aged whites was matched by increasing morbidity. When seen side by side with the mortality increase, declines in self-reported health and mental health, increased reports of pain, and greater difficulties with daily living show increasing distress among whites in midlife after the late 1990s. We comment on potential economic causes and consequences of this deterioration.

More here.