An Alarming Mortality and Morbidity Trend Among Middle-Aged White Non-Hispanic Americans Suggests Implications for Ability to Work

Despite strides in medical care, mortality/morbidity is rising among this important demographic due to drugs, alcohol, suicide, liver disease and cirrhosis

According to a study recently released by two Princeton University economists, the broadly observed long-term decline in mortality rates among men and women in the United States has been conspicuously absent within one American demographic—middle-aged, white non-Hispanics [see “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century”, by Anne Case, Ph.D. and Angus Deaton, Ph.D., published in the Proceedings of the National Academy of Sciences]. The study suggests that the increase in mortality among the identified segment of America’s population is largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, chronic liver diseases and cirrhosis. The researchers also observed a similar increase in morbidity among middle-aged white non-Hispanics, particularly since 1990. The researchers posit that in recent decades middle-aged Whites, particularly those with limited education, have experienced significant increases in stress and the researchers identify several potential economic causes related to the loss of overall health in the middle-aged subject group. The study has important implications for the workers’ compensation world, suggesting that, among other things, while recent attention has been focused on a number of common co-morbidities—e.g., obesity, heart disease and diabetes—middle-aged Whites are susceptible to an even broader range of co-morbid conditions that can negatively affect recovery from injury and delay successful return to work.

Overview of the Study

Case and Deaton, who happen to be married, analyzed health and mortality data from various sources, including that provided by the Centers for Disease Control and Prevention [see, e.g., http://www.cdc.gov/nchs/products/life_tables.htm#life]. Their study included data not only from the U.S., but also from six other rich industrialized nations: France, Germany, the United Kingdom, Canada, Australia, and Sweden.

According to the study, from 1978 to 1998, the mortality rate for middle-aged white non-Hispanics (“the subject group”) in the U.S. (aged 45–54) fell approximately two percent per year, a declining rate that matched the statistics in the other developed counties. After 1998, that two percent annual decline in death rates continued in the other rich, industrialized countries, but not in the United States. Here, the downward trend began to reverse. Moreover, the reversal was isolated within the subject group. Although the mortality rate among Hispanic Americans and black, non-Hispanics in this country is greater than that experienced by the subject group, the rate continued to decline in Hispanics and Blacks. The researchers posit that the narrowing of the mortality rate ratio between Whites and Blacks is largely driven by increased mortality within the subject group.

The study also indicates that the negative trend in mortality is specific to midlife; it cannot be explained by a simple cohort effect—e.g., that Americans born between 1945 and 1965 might just have higher mortality rates than those born before or after that period. For the subject group, prior to midlife, no high mortality rate was observed.

Suicide, Drug and Alcohol Poisoning, Chronic Liver Diseases and Cirrhosis

The researchers identified three causes of death that appear to explain the reversal in death rates among the subject group:

> Suicide

> Drug and Alcohol Poisoning

> Chronic Liver Diseases and Cirrhosis

Within the subject group, beginning in 1998, all three causes increased year-over-year. The researchers noted that earlier studies had generally observed increases in suicides and drug poisonings during midlife, but the Allen-Deaton study is the first to indicate that the upward trend in these three causes of death has been sufficient to drive up all-cause midlife death rates for the subject group.

Increase in Mortality Rate Seen Particularly in Those With Limited Education

The researchers observed that the negative trend in the mortality rate among the subject group was particularly pronounced for those with a high school degree or less. Those with some college saw little change in mortality in the period after 1998. Those with a college degree showed modestly declining mortality rates. While all three educational groups saw increases in mortality due to suicide and drug poisonings, it was most pronounced among those who had no college at all.

Similar Increases Seen in Self-Reported Midlife Morbidity

Cash and Deaton also observed concomitant increases in midlife morbidity within the subject group. Examining statistics regarding self-assessed health status, pain, psychological distress, difficulties with ordinary, daily activities, and alcohol use within the subject group, the researchers observed a significant decline in the fraction of persons reporting excellent or very good health and a similar increase in those reporting poor health. The subject group also reported increases in level of pain experienced. Particularly significant, say the researchers, is the increase in the number of persons within the subject group who self-reported serious psychological distress.

The researchers echo concern noted by many others regarding the American “epidemic of pain,” with its consequences, including increased opioid use and abuse, dependence upon alcohol, and other social disorders. Pain is a significant risk factor for suicide. The researchers observe that increased alcohol abuse and suicides appear to be symptoms of the same sort of underlying epidemic.

Cash and Deaton report that a feeling of economic insecurity appears closely tied to the self-reporting levels of poor health, pain, alcohol abuse and other difficulties among those in the subject group. The researchers repeat the point made by social scientists: that many baby-boomers have been the first to find—generally during midlife—“that they will not be better off than were their parents.” In recent years, growth in income has been slow within the subject group, especially those with limited education.

The researchers observed an important difference between retirement plans in the United States and those of the other six developed countries. In the U.S., more and more retirement schemes are defined-contribution plans that are subject to the risks of the stock market, whereas in the other developed countries, most retirements are funded by defined-benefit plans, which are not so subject to the vicissitudes of the market. That important difference may weigh heavily on middle-aged white non-Hispanics, say Cash and Deaton.

Cash and Deaton point to another alarming issue: the convergence of morbidity conditions during midlife—pain, alcohol and drug abuse, liver disorders and cirrhosis—have important implications for Medicare.  It isn’t just that large numbers within the study group feel they will not be better off than their parents financially; they are likely to enter their Medicare years in poorer health than those currently served by the Medicare system.  Increased costs in caring for those within the study group will be borne by society as a whole. As pointed out in other studies, health care in the latter years is increasingly expensive.

Deaton, by the way, was awarded the 2015 Nobel Memorial Prize in Economic Science In September for his long career in Economics. Among Deaton’s other work in recent years was a collaboration with the psychologist Daniel Kahneman, a fellow Princeton professor and a previous Economics laureate, on work showing that happiness increases with income, but only up to about $75,000 a year.

Implications for the Workers’ Compensation World

Cash and Deaton do not directly discuss any implications their research has for those of us within the current world of workers’ compensation law and policy. They do posit that their findings might help explain the recent large increase in growth of Americans drawing Social Security Disability benefits. They add that the increased morbidity they have identified may also explain at least some of the “otherwise puzzling decrease in labor force participation,” particularly among women.

The researchers do seem to have identified a number of additional co-morbid conditions that should concern employers, insurers, and employees alike. For example, they repeat the mantra that the obesity “epidemic” has appropriately made diabetes a cause of major concern, particularly for those within the midlife years. As widely observed, generally the employer takes the employee as it finds him or her: all too often with increased levels of obesity and the risk (or existence) of diabetes. Yet the Cash and Deaton note that the rate of death from diabetes has not increased in recent years. While this doesn’t, of course, mean that diabetes is under control, it does seem to show that, with regard to this specific co-morbidity, Americans are holding their own.

Yet the study appears also to show that such is not the case with other important co-morbid conditions, particularly those conditions affecting the subject group. Problems with opioids, drug overdoses, excessive drinking, and suicides continue to be all too common, particularly among those who are only semi-skilled and poorly educated. Rehabilitation and retraining programs, while expensive, may be more cost effective than allowing the trends observed by Cash and Deaton to continue to spiral downward.

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