The Untold Story: Why Middle-Aged White People Are Dying At Higher Rates

Decades of progress towards healthier, longer lives appear to have stalled for middle-aged, white adults who live in the U.S., particularly in the South. Since 1999, these Americans have been dying more and more frequently, reversing a decades-long trend towards fewer deaths. This reversal — largely unprecedented in modern American history — was first identified in 2015 by economists Anne Case and Angus Deaton. It is limited to white Americans — death rates for black and Hispanic Americans, and for citizens of other wealthy countries, have continued to decline.

So, what is happening?

Primarily attributing the rising death rates to an increase in suicides and substance abuse, Case and Deaton laid the foundation for additional research on the troubling trend. The New York Times picked up the mantle, reporting that white adults aged 25 to 34 are also dying younger — mainly due to higher rates of suicide and substance abuse.

But for middle-aged whites, there is more to the story.

For whites ages 45 to 54, we at The Commonwealth Fund found that the problem of higher-than-expected deaths rates is more complex than initially indicated. Yes, deaths from suicide and substance abuse were up. But, more importantly, we discovered that progress against other common killers for this population — like heart disease, diabetes, and respiratory illnesses — had either stopped or reversed as well.

This is startling because we should still be making progress against these illnesses. Our medical knowledge and technology has only improved. People should be dying at lower rates from diseases that we increasingly know how to prevent and treat, and they are not.

What this adds up to is a “mortality gap” — the difference between expected and actual death rates. Take heart disease for example. Between 1968 and 1998, heart disease deaths among middle-aged whites declined fast. But, between 1999 and 2014, they essentially leveled off. This “leveling off” is just as responsible for the mortality gap as the increase in drug overdoses.

This trend is pervasive.

A mortality gap between the actual death rate and the expected death rate appears in every single state in the nation. But some states fare worse than others — in Alabama, Arkansas, Kentucky, Tennessee, Oklahoma, Mississippi, and West Virginia, actual 2014 death rates were 60 to 76 percent higher than expected. And in West Virginia, death rates for middle-aged whites are at levels not seen since 1980.

“Why has progress stopped?” is the obvious question.

While we can only speculate, it is likely that factors outside of the health care system are involved. The early 21st century has been challenging for many middle-aged white Americans. Since 2000, their incomes have declined, fewer are employed, and fewer are married. Social commentators of different political leanings have documented these changes and ascribed many to the same underlying causes: fewer economic opportunities for those without a college degree; greater social isolation and distrust; weakened community organizations like churches or local clubs; and the splintering of society along class, geographic, and cultural lines.

“What can we do to fix this?” is the next question.

Given the breadth and complexity of the problem, there will be no quick or easy answer. However, one thing is clear: We should continue to work to ensure that everyone has access to affordable health insurance and health care — especially in states that have not expanded their Medicaid programs to include all low-income adults.

While we do not expect that this is a problem that health insurance alone can solve, we know that health insurance is important.

Research has left little doubt that access to coverage means: being more likely to have a regular doctor; receiving timely preventive care services; having better managed chronic health conditions; improved health status, particularly among people with chronic health problems; greater workforce participation; and longer life expectancy.

It’s time to reverse these trends.

It is worth noting that while the mortality gap between actual and expected death rates is worst at middle age, it affects whites from all ages between 19 and 65 — a full 39 percent of the U.S. population. In addition, while black Americans’ death rates have continued to fall, they remain far more likely to die in middle-age than whites.

The troubling death trends for this group of Americans underscores the need to study how changes in their lives have so profoundly altered their health trajectory — and what steps we can take to get them back on track.