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Proceedings of the National Academy of Sciences www.pnas.org

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

1. Anne Case 1 and
2. Angus Deaton 1

1. Contributed by Angus Deaton, September 17, 2015 (sent for review August 22, 2015; reviewed by David Cutler, Jon Skinner, and David Weir)

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## Significance

Midlife increases in suicides and drug poisonings have been previously noted. However, that these upward trends were persistent and large enough to drive up all-cause midlife mortality has, to our knowledge, been overlooked. If the white mortality rate for ages 45−54 had held at their 1998 value, 96,000 deaths would have been avoided from 1999–2013, 7,000 in 2013 alone. If it had continued to decline at its previous (1979‒1998) rate, half a million deaths would have been avoided in the period 1999‒2013, comparable to lives lost in the US AIDS epidemic through mid-2015. Concurrent declines in self-reported health, mental health, and ability to work, increased reports of pain, and deteriorating measures of liver function all point to increasing midlife distress.

## 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.

- midlife mortality
- morbidity
- US white non-Hispanics

## Footnotes

- ↵1To whom correspondence may be addressed. Email: accase@princeton.edu or Deaton@princeton.edu.

- Author contributions: A.C. and A.D. designed research, performed research, analyzed data, and wrote the paper.

- Reviewers: D.C., Harvard University; J.S., Dartmouth College; and D.W., Institute for Social Research.

- The authors declare no conflict of interest.

- See Commentary on page 15006.

- This article contains supporting information online at www.pnas.org/lookup/suppl/doi:10.1073/pnas.1518393112/-/DCSupplemental.

Freely available online through the PNAS open access option.

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## Related Letters

Letter - Social Sciences - Social Sciences:

- Christopher H. Schmid

Increased mortality for white middle-aged Americans not fully explained by causes suggested PNAS 2016 113 (7) E814; published ahead of print February 8, 2016, doi:10.1073/pnas.1522239113

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Letter - Social Sciences - Social Sciences:

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## Author Response

Letter - Social Sciences - Social Sciences:

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Reply to Schmid, Snyder, and Gelman and Auerbach: Correlates of the increase in white non-Hispanic midlife mortality in the 21st century PNAS 2016 113 (7) E818-E819; published ahead of print February 8, 2016, doi:10.1073/pnas.1524312113

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## Related Commentary

Commentary - Social Sciences - Social Sciences:

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Losing ground at midlife in America PNAS 2015 112 (49) 15006-15007; published ahead of print November 10, 2015, doi:10.1073/pnas.1519763112

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