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Substance Abuse, Suicide Killing More White, Middle-Aged Americans: Report

Experts cite despair, especially among the least educated

By Karen Pallarito
HealthDay Reporter

MONDAY, Nov. 2, 2015 (HealthDay News) -- A largely unnoticed "epidemic" is killing white, middle-aged Americans in growing numbers, a new analysis reveals.

Princeton University researchers report that the overall death rate of white adults in midlife has risen sharply over the past 15 years, largely because of drug and alcohol overdoses, suicide, chronic liver disease and cirrhosis of the liver. The tally is on par with the nation's AIDS deaths, they added.

"We sort of fell off our chairs when we saw that in the data, because that's just not what's happening elsewhere," said study author Anne Case, a professor of economics and public affairs.

No other industrialized nation has experienced a similar deterioration in health during the timeframe studied -- 1999 to 2013, the researchers said in background notes. Meanwhile, death rates of U.S. Hispanics and blacks continue to plummet.

Results of the analysis, funded by the U.S. National Institute on Aging, were published online Nov. 2 in the Proceedings of the National Academy of Sciences.

The study raises important questions about the future of white Americans in their 40s and 50s as they approach old age in worse health than the preceding generation.

"It happened very quietly," Case said. "The despair is really there. It's just that the focus has not been on it."

Dr. Wilson Compton, deputy director of the U.S. National Institute on Drug Abuse, said the analysis provides the first evidence that behavioral issues, such as misuse of alcohol and narcotic painkillers, are affecting the overall death rate for an entire group of people often considered exempt from such issues.

"Pretty startling," he said.

Aaron White, senior scientific advisor to the director of the U.S. National Institute on Alcohol Abuse and Alcoholism, called the results "very alarming."

"Now there are more people 45 to 54 dying from alcohol and drug poisonings than from lung cancer," he said.

Using data from multiple sources, Case and study co-author Angus Deaton, a professor of economics and international affairs at Princeton, connected rising death rates to factors such as increasing reports of pain, growing psychological distress, more alcohol poisonings and greater availability of prescription painkillers such as OxyContin and Vicodin.

Adults with the least education (a high school degree or less) experienced the sharpest increase in death rates -- up 22 percent, the study found.

The turnabout in the health of middle-aged whites comes after two decades of life-extending health improvements.

Between 1978 and 1998, the death rate for white, middle-aged Americans fell 2 percent a year, on average, mirroring rates in other rich nations, including France, Germany, Great Britain and Sweden, the study found.

After 1998, death rates in other rich nations continued to decline. But in the United States, deaths of whites began climbing by half a percent a year through 2013, the study found.

Deaths related to drug and alcohol poisoning, suicide, chronic liver disease and cirrhosis rose for every age group studied. Liver disease and cirrhosis are linked to alcohol abuse. The difference is that the number of deaths in the midlife group was substantial enough to bend the overall mortality rate.

Why only whites, and least-educated whites in particular?

Dr. Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco, said one possible explanation is despair.

"Perhaps they perceived that the deck was stacked against them, with widening inequality, not only in wealth, but in the most basic opportunities to give them a fighting change of upward mobility," she said. "People of color never had that hope."

Whatever the underlying causes may be, the toll on human health is remarkable.

If the 1998 death rate of whites had held steady, 96,000 lives would have been saved between 1999 and 2013, the authors estimated.

And if the death rate had continued its descent at the same pace established in the prior two decades, nearly a half million deaths would have been avoided from 1999 to 2013.

That's comparable to the number of U.S. lives lost to AIDS through mid-2015, the study authors pointed out.

Physicians are "the canaries in the cage" for some of these causes of death, because they are the most likely to spot someone who's drinking too heavily or misusing medications, White said.

"We need to take these data and arm physicians with the numbers so that they can help their patients," he said.

But Braveman said, "This health issue will not be solved by medical care; it will require changes in social policy."

More information

See the U.S. National Institute on Drug Abuse for more about addiction.

SOURCES: Anne Case, Ph.D., professor, economics and public affairs, Princeton University, Princeton, N.J.; Wilson Compton, M.D., deputy director, U.S. National Institute on Drug Abuse, Aaron White, Ph.D., senior scientific advisor to the director, U.S. National Institute on Alcohol Abuse and Alcoholism, Bethesda, Md.; Paula Braveman, M.D., professor, family and community medicine, and director, Center on Social Disparities in Health, University of California, San Francisco; Nov. 2, 2015, JAMA Internal Medicine, online

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