To Understand Climbing Death Rates Among Whites, Look To Women Of Childbearing Age

http://healthaffairs.org/blog/2015/11/10/to-understand-climbing-death-rates-among-whites-look-to-women-of-childbearing-age/

Laudan Aron, Lisa Dubay, Elaine Waxman, and Steven Martin
Nov. 10, 215

The news that mortality is increasing among middle-aged white Americans spread like wildfire last week (see here and here and here) thanks to a study by Anne Case and Angus Deaton, who recently won the Nobel Prize in Economics. As researchers who study the social determinants of health, we were very pleased to see such widespread interest in this urgent national problem. Unfortunately, there are a couple of pieces of the puzzle that we think the Case and Deaton study missed.

By not looking at men and women separately, Case and Deaton failed to see that rising mortality is especially pronounced among women. The authors parenthetically note that “patterns are similar for men and women when analyzed separately,” but several recent studies have shown otherwise.

Two studies from the National Academy of Sciences (NAS) and the Institute of Medicine (one of which was directed by the first author of this post) have shown that Americans are slipping behind other high-income countries when it comes to mortality and survival, and that this “US health disadvantage” has been growing particularly among women. Another study by researchers at the University of Wisconsin–Madison shows that in the decade between 1992-96 and 2002-06, female mortality rates increased in 42.8 percent of US counties. Only 3.4 percent of counties, by comparison, saw an increase in male mortality rates.

Furthermore, our own analysis of the same data used by Case and Deaton shows that the average increase in age-specific mortality rates for whites age 45-54 was more than three times higher for women than men. More specifically, between 1999 and 2013, age-specific mortality rates for US white women age 45-54 increased by 26.8 deaths per 100,000 population, while the corresponding increase for men was 7.7 deaths.

By lumping women and men together, the study also missed the important point that the increases in mortality are affecting women of reproductive and childrearing ages, a finding that has huge implications for children, families, and communities.

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Case and Deaton identify suicide, drug and alcohol poisoning, and chronic liver diseases and cirrhosis as the main causes behind the rising mortality rates among white Americans in mid-life. Our recent analysis of causes of death among American women confirmed increasing death rates among non-Hispanic white women ages 15 to 54 specifically. Like Case and Deaton, we found accidental poisonings (linked to prescription opioid and heroin use) and suicides to be among the biggest drivers of this increase.

Accidental poisonings increased more than all the other causes combined, but they still explain only half of the total increase in deaths among white women at these ages. In addition to suicide, obesity- and smoking-related diseases are driving these mortality increases. Our findings clearly point to the need for a stronger public health focus on the misuse of prescription opioid drugs, as well as more prevention and treatment of tobacco, alcohol, and other drug use; mental illness; and obesity-related illnesses.

Finally, Case and Deaton’s discussion of their findings is too narrow in our view. Men and women have different experiences in the labor market, different responsibilities for caring for children and aging parents, and different economic realities. Improving the conditions of life that shape the health of women and their families and social networks and that are contributing to the “epidemic of pain” is critical. Many systemic and environmental factors are likely at work behind these mortality trends, including unstable and low-paying jobs, a fraying social safety net, and other stressors. When life conditions undermine health or one’s ability to make healthy choices, we all suffer.
[We have a weaker safety net than at least some of these other countries.]

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Men and women have different experiences in the labor market, different responsibilities for caring for children and aging parents, and different economic realities. Improving the conditions of life that shape the health of women and their families and social networks and that are contributing to the “epidemic of pain” is critical. Many systemic and environmental factors are likely at work behind these mortality trends, including unstable and low-paying jobs, a fraying social safety net, and other stressors. When life conditions undermine health or one’s ability to make healthy choices, we all suffer.

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