Trends in U.S. Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences

Monnat S. M. (2020). Trends in U.S. Working-Age non-Hispanic White Mortality: Rural-Urban and Within-Rural Differences. Population research and policy review, 1–30. Advance online publication. https://doi.org/10.1007/s11113-020-09607-6

  • “After decades of lower or comparable mortality rates in rural than in urban areas of the U.S., numerous studies have documented a rural mortality penalty that started in the 1990s and has grown since the mid-2000s. The widening of the gap appears to be especially pronounced among non-Hispanic (NH) whites. However, the rural U.S. is not monolithic, and some rural places have experienced much larger mortality rate increases than others over the past 30 years.”
  • “Drawing on restricted mortality files from the National Vital Statistics System (NVSS), I examine metro versus nonmetro and intra-nonmetro (divisional and economic dependency) all-cause and cause-specific mortality trends among working-age (25-64) NH white males and females, 1990-2018. Results show that the nonmetro mortality penalty is wide and growing and is pervasive across multiple disease and injury categories. Trends for females are particularly concerning.”
  • “High and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, systemic failures across a variety of institutions and policies have contributed to rural America’s troubling mortality trends generally and within-rural disparities more specifically.”

Trends in “Deaths of Despair” Among Working-Aged White and Black Americans, 1990-2017

Tilstra, A. M., Simon, D. H., & Masters, R. K. (2021). Trends in “Deaths of Despair” Among Working-Aged White and Black Americans, 1990-2017. American journal of epidemiology, 190(9), 1751–1759. https://doi.org/10.1093/aje/kwab088

  • ”Life expectancy for US White men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in “deaths of despair” (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged White Americans. There has been less attention on Black mortality trends from these same causes, and whether the trends are similar or different by cohort and period.”
  • “We complement existing research and contend that recent mortality trends in both the US Black and White populations most likely reflect period-based exposures to 1) the US opioid epidemic and 2) the Great Recession. We analyzed cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic Black and non-Hispanic White Americans, aged 20-64 years, over 1990-2017.”
  • ”Results indicate that rising “deaths of despair” for both Black and White Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both White and Black Americans changed during the Great Recession, despite some racial differences across cohorts.”

Invited Commentary: Do Small Cause-of-Death Correlations Throw Into Question the Notion of a Collective “Deaths of Despair” Phenomenon?

Siddiqi, A., & Sod-Erdene, O. (2021). Invited Commentary: Do Small Cause-of-Death Correlations Throw Into Question the Notion of a Collective “Deaths of Despair” Phenomenon?. American journal of epidemiology, 190(6), 1172–1174. https://doi.org/10.1093/aje/kwab016

  • “Since the turn of the 21st century, during which White mortality has been rising, there has been a sharp increase in only 3 causes of death: drug use, alcohol use, and suicide. Because all 3 of these causes conjure notions of anguish and hopelessness, they have been conceptualized as a collective “deaths of despair” phenomenon.”
  • “Simon and Masters (Am J Epidemiol. 2021;190(6)1169-1171) challenge this conceptualization by asking whether these 3 causes are empirically associated with each other. Their analyses produce small correlations, which lead them to call into question that the 3 causes are part of a unified phenomenon. We contest their work on several grounds.”
  • “We argue that the best answer to the authors’ important question comes from assessing whether there is a common, despair-based causal mechanism underlying all 3 of them.”

The Contribution of Occupation-Specific Factors to the Deaths of Despair, Massachusetts, 2005-2015

Hawkins, D., Punnett, L., Davis, L., & Kriebel, D. (2021). The Contribution of Occupation-Specific Factors to the Deaths of Despair, Massachusetts, 2005-2015. Annals of work exposures and health, 65(7), 819–832. https://doi.org/10.1093/annweh/wxab017

  • “ In the USA, deaths from poisonings (especially opioids), suicides, and alcoholic liver disease, collectively referred to as ‘deaths of despair’, have been increasing rapidly over the past two decades. The risk of deaths from these causes is known to be higher among certain occupations. It may be that specific exposures and experiences of workers in these occupations explain these differences in risk. This study sought to determine whether differences in the risk of deaths of despair were associated with rate of occupational injuries and illnesses, job insecurity, and temporal changes in employment in non-standard work arrangements.”
  • “Results: Workers in occupations with higher injury and illnesses rates and more job insecurity had higher rates of deaths of despair, especially opioid-related deaths. Rates of deaths of despair increased most rapidly for occupations with increasing prevalence of workers employed in non-standard work arrangements.”

Can Labor Market Policies Reduce Deaths of Despair?

Dow, W. H., Godøy, A., Lowenstein, C., & Reich, M. (2020). Can Labor Market Policies Reduce Deaths of Despair?. Journal of health economics, 74, 102372. https://doi.org/10.1016/j.jhealeco.2020.102372

  • “Do minimum wages and the earned income tax credit (EITC) mitigate rising “deaths of despair?” We leverage state variation in these policies over time to estimate event study and difference-in-differences models of deaths due to drug overdose, suicide, and alcohol-related causes.”
  • “Our causal models find no significant effects on drug or alcohol-related mortality, but do find significant reductions in non-drug suicides. A 10 percent minimum wage increase reduces non-drug suicides among low-educated adults by 2.7 percent, and the comparable EITC figure is 3.0 percent. Placebo tests and event-study models support our causal research design.”
  • “Increasing both policies by 10 percent would likely prevent a combined total of more than 700 suicides each year.”

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NAMI Montana has a resource guide for every county in Montana. Check it out at https://namimt.org/montana-county-mental-health-resource-guides/

The Treatment Scout website helps people find effective inpatient and residential care. It can also help you explore other intensive care options for mental health, addiction, etc. Find out more at http://www.treatmentscout.com/