Increasing Midlife Mortality and Morbidity in White Americans in the 21st Century

Project Outcomes Statement

The starting point for this research was our previous (2015) discovery that, after nearly a century of falling mortality, the death rate among white non-Hispanics in midlife (45-54) had stopped declining and begun to rise. The project has been concerned with understanding why this happened, and with extending and qualifying the results.

When we first looked at midlife white mortality, two important facts emerged: the rising deaths were almost entirely among people without a four-year college degree, and that the fastest growing causes of death were from drug overdoses, suicides, and alcoholic liver disease. It later became clear that the decline in deaths from cardiovascular disease, which had been the most important force for mortality decline in the last quarter of the 20th century, had slowed or stopped in the 21st, particularly among those without a college degree. Suicide rates, which have been falling throughout the world, were rising in the US, primarily among those without a college degree, itself an astonishing finding, given a more than century-long literature that argued that education was positively associated with suicide. We came to call these deaths, from overdose, suicide, and alcoholic liver disease “deaths of despair,” a term that has entered the professional and popular vocabulary.

We put forward the Durkheimian explanation that the American economy and society are no longer delivering for working-class Americans. Globalization, automation, and the effects of an egregiously expensive healthcare system have progressively destroyed the supports of working-class life in America. We also documented a whole “tangle of pathologies” including rising pain, rising loneliness, falling marriage rates, falling wages, falling labor force participation, and falling religious participation. These pathologies are all structured by education so that the BA degree is effectively a certificate of exemption. After about 2013, the deaths, long confined to white non-Hispanics, spread to the Black and Hispanic communities; our book gives an account of the delay and of the history.