National Academies Press: OpenBook
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R1
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R2
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R3
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R4
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R5
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R6
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R7
Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R8
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R9
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R10
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R11
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R12
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R13
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R14
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R15
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R16
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R17
Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R18
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R19
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
×
Page R20

Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Prepublication Copy Uncorrected Proofs HIGH AND RISING MORTALITY RATES AMONG WORKING-AGE ADULTS Kathleen Mullan Harris, Malay Majmundar, and Tara Becker, Editors Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities Committee on Population Committee on National Statistics Division of Behavioral and Social Sciences and Education A Consensus Study Report of

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by contracts between the National Academy of Sciences and the National Institute on Aging of the National Institutes of Health (HHSN263201800029I/HHSN26300036), and the Robert Wood Johnson Foundation (#75873). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project. International Standard Book Number-13: 978-0-309-XXXXX-X International Standard Book Number-10: 0-309-XXXXX-X Digital Object Identifier: https://doi.org/10.17226/25976 Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2021 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. (2021). High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. https://doi.org/10.17226/25976.

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

COMMITTEE ON RISING MIDLIFE MORTALITY RATES AND SOCIOECONOMIC DISPARITIES KATHLEEN MULLAN HARRIS (Chair), Department of Sociology, University of North Carolina at Chapel Hill MICHAEL E. CHERNEW, Department of Health Care Policy, Harvard Medical School DAVID M. CUTLER, Department of Economics, Harvard University ANA V. DIEZ ROUX, Dornsife School of Public Health, Drexel University IRMA T. ELO, Department of Sociology, Population Studies Center, University of Pennsylvania DARRELL J. GASKIN, Bloomberg School of Public Health, Johns Hopkins University ROBERT A. HUMMER, Department of Sociology, University of North Carolina at Chapel Hill RYAN K. MASTERS, Department of Sociology, University of Colorado Population Center, Institute of Behavioral Science, University of Colorado Boulder SHANNON M. MONNAT, Department of Sociology and Lerner Center for Public Health Promotion, Syracuse University BHRAMAR MUKHERJEE, School of Public Health, University of Michigan ROBERT B. WALLACE, College of Public Health, University of Iowa STEVEN H. WOOLF, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine Staff MALAY K. MAJMUNDAR, Study Director TARA BECKER, Program Officer ELLIE GRIMES, Senior Program Assistant MARY GHITELMAN, Senior Program Assistant v Prepublication copy, uncorrected proofs

COMMITTEE ON POPULATION KATHLEEN MULLAN HARRIS (Chair), Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill DEBORAH BALK, Marxe School of Public and International Affairs and CUNY Institute for Demographic Research, Baruch College of the City University of New York NANCY BIRDSALL, Center for Global Development (President Emeritus), Washington, DC ANN K. BLANC, Social and Behavioral Science Research, Population Council, New York, NY COURTNEY C. COILE, Department of Economics, Wellesley College VICKI A. FREEDMAN, Institute for Social Research, University of Michigan DANA A. GLEI, Research Consultant, Georgetown University ROBERT A. HUMMER, Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill HEDWIG (HEDY) LEE, Department of Sociology, Washington University in St. Louis JENNIFER J. MANLY, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University EMILIO A. PARRADO, Department of Sociology and Population Studies Center, University of Pennsylvania ANNE R. PEBLEY, Department of Community Health Sciences, Department of Sociology, California Center for Population Research, Bixby Center on Population and Reproductive Health, University of California, Los Angeles ISABEL V. SAWHILL, The Brookings Institution, Washington, DC REBECA WONG, Health Disparities, University of Texas Medical Branch at Galveston MALAY K. MAJMUNDAR, Director vi Prepublication copy, uncorrected proofs

COMMITTEE ON NATIONAL STATISTICS ROBERT M. GROVES (Chair), Office of the Provost, Georgetown University LAWRENCE D. BOBO, Department of Sociology, Harvard University ANNE C. CASE, Woodrow Wilson School of Public and International Affairs, Princeton University MICK P. COUPER, Institute for Social Research, University of Michigan JANET M. CURRIE, Woodrow Wilson School of Public and International Affairs, Princeton University DIANA FARRELL, JPMorgan Chase Institute, Washington, DC ROBERT GOERGE, Chapin Hall at The University of Chicago ERICA L. GROSHEN, The ILR School, Cornell University HILARY HOYNES, Goldman School of Public Policy, University of California, Berkeley DANIEL KIFER, The Pennsylvania State University SHARON LOHR, School of Mathematical and Statistical Sciences, Arizona State University, Emerita JEROME P. REITER, Duke University JUDITH A. SELTZER, University of California, Los Angeles C. MATTHEW SNIPP, School of the Humanities and Sciences, Stanford University ELIZABETH A. STUART, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health JEANNETTE WING, Data Science Institute, Columbia University BRIAN A. HARRIS-KOJETIN, Director CONSTANCE F. CITRO, Senior Scholar vii Prepublication copy, uncorrected proofs

viii Prepublication copy, uncorrected proofs

Preface and Acknowledgments The year 2017 marked the third year in a row that life expectancy in the United States had fallen, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918–1919). Already ranked relatively low in life expectancy (26th) in 2015 among the 35 countries that make up the Organisation for Economic Co-operation and Development (OECD), the United States would lose even more ground in its global position in national health and well-being. Research had already uncovered some troubling mortality trends and disparities before 2015 and was focused on the search for explanations. Early findings pointed to rising mortality rates among middle-aged White adults, although the trends soon revealed that younger adults were also at risk, as were other racial and ethnic groups, such that premature mortality in the working ages of 25–64 was becoming more common in the United States than in prior years and in comparison with its international peers. In this context, in 2018 the National Institute on Aging and the Robert Wood Johnson Foundation requested that the National Academies of Sciences, Engineering, and Medicine undertake a study on high and rising rates of midlife mortality and concomitant widening social differentials. In response to that request, the National Academies appointed the Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities (under the standing Committee on Population) to carry out the task. Twelve scholars representing a broad array of disciplines— including demography, economics, epidemiology, medicine, public health, sociology, and biostatistics—were included on the committee, which met six times in person over a 2-year period. This report presents a considerable body of information. The committee decided to conduct its own analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data to establish its members’ collective understanding of the main drivers of the rising trend and disparities in working-age mortality in the United States. Findings from the committee’s analysis are presented in Part I of this report. The committee then conducted a comprehensive review of the research on rising working-age mortality to evaluate evidence on what had changed in American society to bring about the change in mortality rates and how the patterns of change differed for population subgroups. Findings on the explanations for the rise in working-age mortality are presented in Part II of the report. The committee’s work was arduous because the amount of data was massive; the problem was complex; and the unique trends by age, sex, race/ethnicity, and geography multiplied that complexity. In this report, the committee attempts to communicate these complexities while at the same time identifying the main drivers of high and rising working-age mortality based on current research and their implications for the future. The committee was also very deliberate and conscientious in its recommendations for further data collection, research, and policy. This study would not have been possible without the contributions of many people. Special thanks go to the members of the study committee, who dedicated extensive time, thought, and energy to this task. Committee members conducted extensive analysis in generating Part I of the report, often enlisting their students and research assistants to help. Julene Cooney (Syracuse University), Nick Graetz (University of Pennsylvania), Jermaine Heath (Harvard ix Prepublication copy, uncorrected proofs

Medical School), Fitore Hyseni (Syracuse University), Jeron Impreso (Harvard Medical School), Sammer Marzouk (Harvard University), Harrison Mintz (Harvard Medical School), Rohan Shah (Harvard Medical School), and Yue Sun (Syracuse University) assisted the committee in analyzing mortality trends and assessing selected research literatures. Thanks are also due to Anna Mueller (Indiana University Bloomington), who provided valuable guidance to the committee on suicide deaths. The committee received useful information and insights from presentations by outside experts at open sessions of committee meetings. We thank Erika Blacksher (University of Washington), Anne Case (Princeton University), Andrew Cherlin (The Johns Hopkins University), Carol Graham (Brookings Institution), Christopher Ruhm (University of Virginia), Jennifer Silva (Indiana University Bloomington), and Kathleen Frydl. Several staff members of the National Academies made significant contributions to the report. Ellie Grimes and Mary Ghitelman made sure that the committee meetings ran smoothly, assisted in preparing the manuscript, and otherwise provided key administrative and logistical support; Kirsten Sampson Snyder managed the report review process; Yvonne Wise managed the report production process; and Brian Harris-Kojetin, director of the Committee on National Statistics, provided valuable guidance and oversight. We also thank Rona Briere for skillful editing. This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: Andrew J. Cherlin, Department of Sociology, Johns Hopkins University; Sandro Galea, School of Public Health, Boston University; Mark D. Hayward, Population Research Center, University of Texas at Austin; Ichiro Kawachi, Department of Social and Behavioral Sciences, Harvard School of Public Health; Peter Muennig, Mailman School of Public Health, Columbia University; Samuel H. Preston, Population Studies Center, University of Pennsylvania; Albert L. Siu, Mount Sinai Medical Center; and Frank A. Sloan, Economics Department and Center for Health Policy, Law and Management, Duke University. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Bradford Gray, Urban Institute, and Eileen Crimmins, University of Southern California. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. Kathleen Mullan Harris, Chair Malay K. Majmundar, Study Director Tara Becker, Program Officer Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities x Prepublication copy, uncorrected proofs

Contents Summary Part I 1 Introduction 1-1 Individual and Societal Implications of Rising Mortality among Working-Age Adults Searching for Explanations Charge to the Study Committee Impact of the COVID-19 Pandemic on Working-Age Mortality Study Methods and Limitations of the Evidence Base Organization of the Report 2 U.S. Mortality in an International Context 2-1 Life Expectancy at Birth in the United States versus Peer Countries The U.S. Mortality Disadvantage by Age International Differences in Life Expectancy Decomposed by Age U.S. Mortality Relative to International Peers by Age International Trends in Working-Age Mortality U.S. Mortality by Cause of Death in International Perspective Summary ANNEX 2-1 International Trends Methodology Source of International Trend Comparison Data Data for the Sixteen Peer Countries Data for the United States Analytic Strategy Life Expectancy at Birth Arriaga Age Decomposition of Differences in Life Expectancy Ratio of Age-Specific Mortality in the United States to That in the Peer Countries The Probability of Death between Ages 25 and 64 3 U.S. Trends in All-Cause Mortality among Work-Age Adults 3-1 Trends in All-Cause Mortality by Sex and Age Trends in All-Cause Mortality by Sex, Age, and Race/Ethnicity Trends in Mortality by Socioeconomic Status Geographic Differences in Mortality Trends Trends in All-Cause Mortality by Metropolitan Area Type Trends in All-Cause Mortality across U.S. Regions and States Trends in All-Cause Mortality across U.S. Counties Summary of Geographic Trends in Mortality Summary ANNEX 3-1 Morality Trends among U.S. Asians/Pacific Islanders and American Indians/Alaska Natives Mortality Trends among U.S. Asians and Pacific Islanders Mortality Trends among American Indians/Alaska Natives xi Prepublication copy, uncorrected proofs

Changes in High/Low-Mortality Counties by Metropolitan Status 4 U.S. Trends in Cause-Specific Mortality among Working-Age Adults 4-1 Trends in U.S. Working-Age Mortality by Cause of Death Non-Hispanic White Adults Working-Age Non-Hispanic Black Adults Hispanic Adults Disparities in Cause-Specific Mortality by Socioeconomic Status Cause-Specific Mortality Trends by Metropolitan Status Temporal Patterns in Cause-Specific Mortality Trends Summary ANNEX 4-1 Trends in Cause-Specific Mortality among American Indians and Alaskan Natives 5 U.S. Mortality Data: Data Quality, Methodology, and Recommendations 5-1 The U.S. National Vital Statistics System (NVSS) and the Construction of Mortality Rates Limitations and Quality of Mortality Data Limitations of Death Certificate Data and Use of Linked Mortality Data Quality and Accuracy of Death Certificate Data Estimation of Mortality Rates in This Report Recommendations Part II 6 A Framework for Developing Explanations of Working-Aged Mortality Trends 6-1 A Conceptual Framework for U.S. Working-Age Mortality Macro-Level Upstream Factors in Working-Age Mortality Meso-Level Factors Individual-Level Factors The Role of Life-Course Stage Considerations in Developing Explanations for Trends in Working-Age Mortality Single versus Multiple Explanations Interactions or Synergies and Dynamic Relations among Factors Socioeconomic Inequality at All Levels Differences across Social Groups Levels versus Trends Time Lags Attention to Period and Cohort Effects Summary ANNEX 6-1 Period- and Cohort-Based Examination of Trends in U.S. Working-Age Mortality Drug-Related Death Rates among U.S. Black and White Men Death Rates from Cardiometabolic Diseases among U.S. White Men and Women Death Rates from Alcohol Use among U.S. Black and White Men and Women xii Prepublication copy, uncorrected proofs

7 Opioids, Other Drugs, and Alcohol 7-1 Trends in Mortality Due to Drug Poisoning and Alcohol Drug Poisoning Mortality Alcohol-Induced Mortality Summary of Trends in Mortality from Drugs and Alcohol Explanations for the Rise in Working-Age Mortality from Drug Poisoning and Alcohol- Induced Causes Supply-Side Explanations Demand-Side Explanations Summary Implications for Research and Policy 8 Suicide 8-1 Trends in Suicide Economic Factors Social Engagement, Religious Participation, and Social Support Access to Lethal Means Mental, Emotional, and Physical Health Summary Implications for Research and Policy 9 Cardiometabolic Diseases 9-1 Trends in Cardiometabolic Mortality Endocrine, Nutritional, and Metabolic Diseases Hypertensive Heart Disease Ischemic Heart Disease and Other Circulatory System Diseases Summary of Trends Explanations for the Trends in Cardiometabolic Mortality Rising Rates of Obesity Diminishing Returns of Medical Advances Social, Economic, and Cultural Change Summary Implications for Research and Policy 10 The Relationship between Economic Factors and Mortality 10-1 Conceptual Challenges Association between Economic Deprivation and Worse, and Rising, Mortality Job Loss and Deaths of Despair Trade/Import Competition and Mortality Lack of a Strong Association between Economic Fluctuations and Increased Mortality Association between Income Inequality and Mortality Implications for Research and Policy Part III 11 Implications for Policy and Research 11-1 xiii Prepublication copy, uncorrected proofs

A Framework for the Categorization of Policy and Research Implications Medical Science and Health Care Access and Delivery Background Implications for Policy and Research Public Health Background Implications for Policy and Research Social and Economic Policies Background Implications for Research and Policy Lessons from the COVID-19 Pandemic Conclusion REFERENCES APPENDIXES A Mortality Data Analyses: Review Process and Detailed Mortality Rate Tables B Meeting Agendas C Biographical Sketches xiv Prepublication copy, uncorrected proofs

Boxes, Figures, and Tables BOXES 3-1 Trends in Mortality among Asians and Pacific Islanders 3-2 Trends in Mortality among American Indians and Alaska Natives (AI/AN) 4-1 Trends in Cause-Specific Mortality among American Indians and Alaskan Natives (AI/AN) 4-2 Trends in Cause-Specific Mortality among Asians and Pacific Islanders FIGURES 2-1 Female and male life expectancy at birth in the United States and peer countries, 1950– 2016 2-2 Contributions of age-specific mortality differences between the United States and peer countries to overall life expectancy (LE) differences 2-3 Ratio of the probability of death in United States to the average probability of death in peer countries, by age group and year 2-4 Age-adjusted probability of dying between ages 25 and 64 in the United States and in peer countries, 1950–2016 (top), and the relative standing of the United States and peer countries with respect to working age mortality risk (bottom) 3-1 All-cause mortality rates by sex and 10-year age group, 1990–2017 3-2 All-cause mortality rates (deaths per 100,000 population) by sex, age group, and race/ethnicity, 1990–2017 B3-1 All-cause mortality rates for Asian/Pacific Islander males and females aged 25–64, 1990– 2017 B3-2 Ratio of all-cause mortality rates among non-Hispanic American Indians/Alaska Natives to those among non-Hispanic Whites, Contract Health Service Delivery counties, 1999– 2009 3-3 All-cause mortality rates by race/ethnicity, sex, age group, and metropolitan status, 1990– 2017 3-4 All-cause mortality rates (deaths per 100,000 population) by U.S. Census Region and State, 1990–1992 and 2015–2017 3-5a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Males aged 25–44 3-5b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S county: Males aged 25–44 3-6a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Males aged 45–64 3-6b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Males aged 45–64 3-7a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Females aged 25–44 3-7b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Females aged 25–44 3-8a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Females aged 45–64 3-8b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Females aged 45–64 xv Prepublication copy, uncorrected proofs

A3-1 Locations of Contract Health Service Delivery counties across the United States A3-2 Life expectancy at birth for males and females by race/ethnicity, 2007–2009 A3-3 Percentage of U.S. counties in top and bottom sex- and age-specific county mortality rate quintiles, 1990–1992 and 2015–2017, by metropolitan status A3-4 Distribution of U.S. population in counties with highest and lowest mortality rates, 1990– 1992 and 2015–2017, based on 1990–1992 county mortality rate quintiles, by sex and age 4-1 Decomposition of changes in cause-specific mortality rates (deaths per 100,000 population) by time period: Males 4-2 Decomposition of change in cause-specific mortality rates (deaths per 100,000 population), by time period: Females 4-3 Percentage of mental and behavioral disorder–related deaths due to alcohol, drugs, and all other causes, ages 25–64, 1990–2017 A4-1 Leading causes of death in CHDSA in 1999–2009 6-1 Conceptual framework: A life course multilevel model of factors involved in high and rising mortality among working-age adults A6-1 DGP1 Mx by birth cohort A6-2 DGP2 Mx by birth cohort A6-3 DGP3 Mx by birth cohort A6-4 DGP1 Mx by period A6-5 DGP2 Mx by period A6-6 DGP3 Mx by period A6-7 Drug-related mortality rates by five-year age group, 25–29 to 60–64, between 1990 and 2017, U.S. Black and White men A6-8   Drug-related mortality rates for U.S. Black and White men aged 55–59 and 60–64 versus 25–54 average, 1990–2017 A6-9 Mortality rates for cardiometabolic diseases by five-year age group, 40–44 to 60–64, between 1990 and 2017, U.S. White men and women A6-10 Alcohol-related mortality rate by five-year age group, 40–44 to 60–64, between 1990 and 2017, U.S. Black and White women and men 7-1 Mortality rates among U.S. working-age adults (aged 25–64) (deaths per 100,000 population) from drug poisoning by sex, age, and race/ethnicity 7-2 Drug poisoning mortality rates (deaths per 100,000 population) for U.S. working-age males and females (aged 25–64) by metropolitan status, 1990–1993 through 2015–2017 7-3 Drug poisoning mortality rates (deaths per 100,000 population) for U.S. working-age males and females (aged 25–64) by region and state, 1990–1992 and 2015–2017 7-4 Percentage of all fatal drug poisonings among U.S. working-age adults (aged 25–64) that involved opioids, by sex, 1999–2018 7-5 Drug poisonings involving opioids among U.S. working-age adults (aged 25–64) by sex, 1990–2018 7-6 Specific drug involvement in drug poisonings among U.S. working-age adults (aged 25– 64) by sex, 1999–2018 7-7 Mortality rates (deaths per 100,000 population) for U.S. working-age adults for alcohol- induced causes by sex, age, and race/ethnicity 7-8 Alcohol-induced mortality rates (deaths per 100,000 population) for U.S. working-age males and females (aged 25–64) by region and state, 1990–1992 and 2015–2017 7-9 Percentage change in per capita ethanol consumption by beverage type, United States, xvi Prepublication copy, uncorrected proofs

1977–2016 7-10 Prescription opioid sales and deaths, 1999–2013 8-1 Suicide rates per 100,000 population among U.S. working-age adults (aged 25–64), 1990–2017, by sex, age, and race/ethnicity 8-2 Suicide rates per 100,000 population among U.S. working-age males and females (aged 25–64), 1990–1993 through 2015–2017, by metropolitan status 8-3 Suicide rates per 100,000 population among U.S. working-age males and females (aged 25–64), 1990–1992 and 2015–2017, by region and state 8-4 Number of suicides among U.S. working-age non-Hispanic Whites (aged 25–64), 1990– 2017, by type and gender 9-1 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (aged 25–64), 1990– 2017, by sex, age, and race/ethnicity 9-2 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (aged 25–64), 1990–1993 through 2015–2017, by metropolitan status 9-3 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (aged 25–44), 1990–1992 and 2015–2017, by region and state 9-4 Mortality rates (deaths per 100,0000 population) from hypertensive heart disease among U.S. working-age males and females (aged 25–64), 1990–2017, by sex, age, and race/ethnicity 9-5 Mortality rates (deaths per 100,000 population) from hypertensive heart disease among U.S. working age males and females (aged 25–64), 1990–1993 through 2015–2017, by metropolitan status 9-6 Mortality rates (deaths per 100,000 population) from hypertensive heart disease among U.S. working-age males and females (aged 25–44), 1990–1992 and 2015–2017, by region and state 9-7 Mortality rates (deaths per 100,000 population) from ischemic heart disease and other circulatory system diseases among U.S. working-age males and females (aged 25–64), 1990–2017, by sex, age, and race/ethnicity 9-8 Mortality rate (deaths per 100,000 population) from ischemic heart disease and other diseases of the circulatory system among U.S. working-age males and females (aged 25– 64), 1990–1993 through 2015–2017, by metropolitan status 9-9 Mortality rates (deaths per 100,000 population) from ischemic heart disease and other diseases of the circulatory system among U.S. working-age males and females (aged 25– 44), 1990–1992 and 2015–2017, by region and state 9-10 Obesity rates by income measured as percentage of poverty in each respective period, among U.S. adults, 1960–2016 (obesity defined as body mass index [BMI] >30) 9-11 Obesity prevalence by educational attainment for men and women, 2011–2014 (obesity defined as body mass index [BMI] >30) 9-12 CVD death rates in U.S. and selected peer countries 1999-2017 9-13 Trends in smoking by education among adults aged 20-74, 1974–2016 xvii Prepublication copy, uncorrected proofs

TABLES 2-1 Age-Standardized Mortality Rates (Deaths per 100,000 Population) for All Causes of Death and Specific Causes of Death in the United States and Peer Countries, 2000, 2008, and 2015 A2-1 Availability of Mortality Data for the 16 Peer Countries 4-1 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Non-Hispanic White Adults Aged 25–64 4-2 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Non-Hispanic Black Adults Aged 25–64 4-3 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Hispanic Adults Aged 25–64 4-4 Summary of Findings: Cause-Specific Mortality among Working-Age Adults, 1990– 2017 A4-1 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non- Hispanic White Adults A4-2 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non- Hispanic Black Adults A4-3 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Hispanic Adults 5-1 Assignment to 20 Cause-of-Death Categories 5-2 ICD-9 and ICD-10 Codes for Drug- and Alcohol-Related Deaths due to Mental and Behavioral Disorders A6-1 Simulated Data Used in Figures 2–7 11-1 Recommendations and Policy Conclusions A-1 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 25– 44 A-2 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 25– 44 A-3 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 25–44 A-4 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 25–44 A-5 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 25–44 A-6 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 25–44 A-7 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 45– 54 A-8 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 45– 54 A-9 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 45–54 A-10 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 45–54 A-11 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 45–54 xviii Prepublication copy, uncorrected proofs

A-12 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 45–54 A-13 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 55– 64 A-14 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 55– 64 A-15 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 55–64 A-16 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 55–64 A-17 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 55–64 A-18 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 55–64 A-19 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 25– 64 Living in Large Central Metropolitan Areas A-20 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 25– 64 Living in Large Fringe Metropolitan Areas A-21 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 25– 64 Living in Small/Medium Metropolitan Areas A-22 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Males Ages 25– 64 Living in Nonmetropolitan Areas A-23 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 25– 64 Living in Large Central Metropolitan Areas A-24 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 25– 64 Living in Large Fringe Metropolitan Areas A-25 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 25– 64 Living in Small/Medium Metropolitan Areas A-26 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Males Ages 25– 64 Living in Nonmetropolitan Areas A-27 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 25–64 Living in Large Central Metropolitan Areas A-28 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 25–64 Living in Large Fringe Metropolitan Areas A-29 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 25–64 Living in Small/Medium Metropolitan Areas A-30 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Males Ages 25–64 Living in Nonmetropolitan Areas A-31 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Large Central Metropolitan Areas A-32 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Large Fringe Metropolitan Areas A-33 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Small/Medium Metropolitan Areas A-34 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Nonmetropolitan Areas A-35 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Large Central Metropolitan Areas xix Prepublication copy, uncorrected proofs

A-36 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Large Fringe Metropolitan Areas A-37 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Small/Medium Metropolitan Areas A-38 Cause-Specific Mortality Rates (Deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Nonmetropolitan Areas A-39 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 25–64 Living in Large Central Metropolitan Areas A-40 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 25–64 Living in Large Fringe Metropolitan Areas A-41 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 25–64 Living in Small/Medium Metropolitan Areas A-42 Cause-Specific Mortality Rates (Deaths/100,000): Hispanic Females Ages 25–64 Living in Nonmetropolitan Areas xx Prepublication copy, uncorrected proofs

Next: Summary »
High and Rising Mortality Rates Among Working-Age Adults Get This Book
×
Buy Prepub | $99.00 Buy Paperback | $90.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The past century has witnessed remarkable advances in life expectancy in the United States and throughout the world. In 2010, however, progress in life expectancy in the United States began to stall, despite continuing to increase in other high-income countries. Alarmingly, U.S. life expectancy fell between 2014 and 2015 and continued to decline through 2017, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918-1919). The recent decline in U.S. life expectancy appears to have been the product of two trends: (1) an increase in mortality among middle-aged and younger adults, defined as those aged 25-64 years (i.e., "working age"), which began in the 1990s for several specific causes of death (e.g., drug- and alcohol-related causes and suicide); and (2) a slowing of declines in working-age mortality due to other causes of death (mainly cardiovascular diseases) after 2010.

High and Rising Mortality Rates among Working Age Adults highlights the crisis of rising premature mortality that threatens the future of the nation's families, communities, and national wellbeing. This report identifies the key drivers of increasing death rates and disparities in working-age mortality over the period 1990 to 2017; elucidates modifiable risk factors that could alleviate poor health in the working-age population, as well as widening health inequalities; identifies key knowledge gaps and make recommendations for future research and data collection to fill those gaps; and explores potential policy implications. After a comprehensive analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data, this report then looks upstream to the macrostructural factors (e.g., public policies, macroeconomic trends, social and economic inequality, technology) and social determinants (e.g., socioeconomic status, environment, social networks) that may affect the health of working-age Americans in multiple ways and through multiple pathways.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  6. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  7. ×

    View our suggested citation for this chapter.

    « Back Next »
  8. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!