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March 24, 2017

Why the mortality rate for white, working-class adults keeps rising

Daily Briefing

A lack of steady, well-paying jobs and increased social dysfunction has driven growth in so-called "deaths of despair" among middle-aged white U.S. residents, according to draft paper published Thursday by the Brookings Institution.

Princeton University researchers Anne Case and Angus Deaton completed the research as a follow-up to a 2015 study they conducted that found mortality rates among middle-aged white U.S. residents were increasing. For their new research, Case and Deaton examined more than 15 data sets including death certificates, government health statistics, and numerous economic indicators.


The researchers found that midlife mortality rates have declined among all education classes in most of the developed world, but have increased among white U.S. residents with a high school education or less since the late 1990s.

For instance, the researchers found that, in 2015, the mortality rate among white U.S. residents between ages 50 and 54 with at least high school educations was 30 percent higher than the mortality rate among blacks in the same age range—a significant increase from 1999, when the mortality rate among that demographic of whites was 30 percent lower than the mortality rate among blacks.

According to the researchers, the increase in mortality rates is driven by growth in deaths of despair—deaths resulting from alcohol-related liver diseases, drugs, and suicides. The increase is also driven by a decrease in progress made on reducing deaths related to cancer and heart disease, and an increase in deaths related to other chronic diseases, such as diabetes. The researchers found that deaths of despair increased among both men and women and in both urban and rural areas throughout the country.

The researchers said deaths of despair rose in tandem with a notable deterioration in individuals' economic and social wellbeing. Specifically, the researchers wrote that declining job opportunities—including less upward mobility and a slowdown in rising wages—have occurred alongside of declines in marriage and an increase in social isolation, which could contribute to less stable lifestyles. As a whole, those changes could be leading to more mental and physical health problems, the researchers found, which in turn could spur individuals to use alcohol or drugs or attempt suicide.

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According to Case, "This doesn't seem to be about current income. It seems to be about accumulating despair."

The researchers wrote that there has been a gradual "collapse of the white, high school-educated working class after its heyday in the early 1970s." Deaton said individuals who "entered the labor market in the '70s on down" had comparably "worse" employment and income prospects, which "affected their marriage prospects" and caused some to have "children out of wedlock." Middle-aged white U.S. residents without college degrees also have reported more pain, all of which contribute to deaths of despair, Deaton said.

Overall, the researchers surmised that life prospects for middle-aged white U.S. residents without college degrees have stagnated, and such individuals therefore believe they are performing worse than their parents both professionally and personally. The researchers said that belief is different from those held by individuals of other races, who could feel a sense of hope about the progress their races have seen in recent years.

But Case and Deaton said more research is needed to prove their findings, which they called "preliminary but plausible." Still, Deaton cautioned that the trend could have long-term effects on U.S. policies. "As these people move into old age, they're going to be sick, and that has disastrous consequences for Medicare and Social Security policy," he said (Boddy, "Shots," NPR, 3/23; McKay, Wall Street Journal, 3/23; Brookings Institution release, 3/23; Belluz, Vox, 3/23).

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