Deaths of Despair

Are Middle-Agers Giving Up?

A Brookings Institute study by Anne Case and Angus Deaton described an increase in "deaths of despair," or deaths caused by suicide, drug addiction, alcohol poisoning, and liver disease. Their two reports, published in 2015 and 2017, pointed to an increase in mortality rates among white Americans, particularly those with a high school degree or less. This was particularly evident among middle-aged Americans aged 45-54. In other countries and other demographics, the average mortality rate is decreasing.¹

These studies have garnered some criticism.² However, when assessed in tandem with data from the Centers for Disease Control and Prevention (CDC) on overdose deaths (predominantly from opioid painkillers and heroin), they point to a disturbing trend among Americans to self-medicate their mental distress, often to the point of lethality.

How & How Many

• Between 1999 and 2015 approximately 600,000 Americans died from suicide.

• Suicide rates were declining until 2000, but from then through 2015 they have been increasing over all urban and rural locations.³

• In 2015, 33,000 people died as a result of opioid overdose. That is about 91 people every day.⁴ The rates were highest among white non-Hispanics and American Indians, including Alaskan Natives.

• From 2010 to 2015, heroin-related deaths tripled, with 12,989 people dying from heroin in 2015. Three out of four new heroin users started by taking prescription pain medicine.⁵

• Deaths from synthetic opioid use went up from 5,544 people in 2014 to 9,580 people in 2015, an increase of 73 percent.⁶

• In 2013, of the 22,000 people who died from drug overdoses, 31 percent had been using benzodiazepines, such as Valium and Xanax.⁷

Other Notable Statistics

—Place

• Approximately 15 percent of the U.S. population, or 46 million Americans, live in rural areas.⁸

• The state with the two highest mortality rates due to overdose are West Virginia, with 41.5 deaths per 100,000 people, and New Hampshire, with 34.3 per 100,000.⁹

• Since the 1980s, the suicide rate among farmers has been notably higher than average. In 2010, the suicide rate for farmers was 0.95 per 100,000, compared to less than 0.19 per 100,000 for all other occupations.¹⁰

• Between 1999 and 2015, the four southern states of Alabama, Kentucky, Tennessee, and Mississippi had some of the steepest increases in mortality rates at 1.6 percent per year for white non-Hispanics aged 50-54.¹¹

—Education

• Chronic pain, which often correlates with lower levels of mental health, is higher among people with less education. People without a high-school diploma are 4.5 times more likely to have chronic pain than people with a graduate degree.¹²

• Case and Deaton found that the highest increases in mortality from all types of deaths of despair in the U.S. were among non-Hispanic whites with a high-school diploma or less.¹³

—Sex:

• Between 1999 and 2010, 48,000 women have died as a result of a prescription painkiller overdose.¹⁴

• While more men than women die of drug overdoses, women aged 45 and older tend to abuse opioids at higher rates than men.¹⁵

• Since 1999, the number of women who have died due to an overdose of prescription pain medicine has increased by 400 percent. Among men, such deaths have increased by 265 percent.¹⁶

—Race:

• Hispanics have generally had lower mortality rates than other whites, and African Americans have generally had higher mortality rates and shorter life expectancies than whites. Today, mortality rates for both whites and blacks with a high-school education or less are about the same. This is due to mortality rates among whites having increased while the rates among blacks have decreased.¹⁷

• The increases in "deaths of despair" that have occurred among whites have not been observed among blacks and Hispanics.¹⁸

• Before 1980, some 50 percent of new users of heroin were white. Since 2005, about 90 percent of new users of heroin have been white.¹⁹

Global Comparison

• From 1999 to 2015, among both men and women aged 50-54, mortality rates dropped in the U.K., Ireland, Canada, Australia, France, Germany, Sweden, Switzerland, Denmark, Netherlands, Spain, Italy, and Japan. The average drop in mortality rate for these countries was 1.9 percent. Among American white non-Hispanics of the same age group, mortality rates increased by 0.5 percent each year.²⁰

Notes
1. Anne Case and Sir Angus Deaton, "Mortality and morbidity in the 21st century," Brookings Institute Study (Mar. 23, 2017): brookings.edu/bpea-articles/mortality-and-morbidity-in-the-21st-century.
2. Malcolm Harris, "The death of the white working class has been greatly exaggerated," Pacific Standard (Mar. 28, 2017): https://psmag.com/news/the-death-of-the-white-working-class-has-been-greatly-exaggerated.
3. "Trends in Suicide by Level of Urbanization—United States, 1999-2015," CDC Morbidity and Mortality Weekly Report (Mar. 17, 2017): cdc.gov/mmwr/volumes/66/wr/mm6610a2.htm.
4. CDC, "Opioid Overdose: Understanding the Epidemic": cdc.gov/drugoverdose/epidemic/index.html.
5. NIH, "Prescription opioid use is a risk factor for heroin use" (2015): drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use.
6. CDC, note 4.
7. Leah Samuel, "More than just an opioid crisis: deaths from anti-anxiety drugs are on the rise, too," STAT News (Feb. 18, 2016): statnews.com/2016/02/18/benzodiazepines-overdose-deaths.
8. Diana Phillips, "Rural Americans at Higher Risk for Five Leading Causes of Death," Medscape (Jan. 12, 2017): http://www.medscape.com/viewarticle/874405.
9. Margaret Talbot, "The Addicts Next Door," The New Yorker (June 5, 2017): newyorker.com/magazine/2017/06/05/the-addicts-next-door.
10. "Farmers at higher risk for suicide than other occupations, study says," UPI (June 21, 2017): upi.com/Health_News/2017/06/21/Farmers-at-higher-risk-for-suicide-than-other-occupations-study-says/5671498062419.
11. Case and Deaton, note 1.
12. Sarah Frostenson, "More Americans say they're in pain. It's a fascinating and disturbing medical mystery," Vox (Mar. 15, 2017): vox.com/science-and-health/2017/3/15/14903130/more-americans-pain-opioids-disturbing-medical-mystery.
13. Case and Deaton, note 1.
14. CDC, "Vital Signs" (July 2013): cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/index.html.
15. Blue Cross Blue Shield, The Health of America Report (June 29, 2017): bcbs.com/the-health-of-america/reports/americas-opioid-epidemic-and-its-effect-on-the-nations-commercially-insured.
16. CDC, "Vital Signs," note 14.
17. NPR interview with Case and Deaton (Mar. 23, 2017): org/sections/health-shots/2017/03/23/521083335/the-forces-driving-middle-aged-white-peoples-deaths-of-despair
18. Case and Deaton, note 1.
19. Talbot, note 9.
20. Case and Deaton, note 1.