1 -Understanding Recent Trends in Mortality and Morbidity

项目摘要/摘要 项目1--了解死亡率和发病率的最新趋势 该项目的目标是了解美国中年男性健康状况的恶化 女性，特别是在非西班牙裔白人中--最近才被曝光。在经历了30年的衰落之后， 自1998年以来，年龄在45-54岁的非西班牙裔白人的全因死亡率一直在上升。涨幅 是由药物和酒精中毒、自杀以及肝硬变和酒精性肝病引起的。如果是白色的 1998年后，非西班牙裔美国人的死亡率继续以每年1.8%的速度下降-- 在过去的20年里，白人的死亡人数有所下降-通过 2013年，这一数字相当于美国累计的艾滋病死亡人数。没有相应的变化 非西班牙裔黑人或西班牙裔美国人的死亡率下降。在同一年龄段，发病率 在一系列指标中，非西班牙裔白人的比例有所上升，包括自我报告的身体状况和 精神健康，慢性疼痛，日常生活活动能力，包括工作，自我报告的沉重 饮酒，以及临床测量的肝功能。与中年组相比，死亡率和发病率 对于65岁及以上的人，情况继续改善。 该项目将深入了解这些总体统计数据，按地点、年龄、性别、 职业和教育群体，按种族和族裔，以及通过与其他 富裕国家。它还将试图了解中年健康下降背后的原因。确实有 两个广泛的具体目标：(1)为美国和其他富裕国家建立一个公共用途数据库，这将是 足够丰富，足以为美国记录中年死亡的地理分布，并将死亡率和 疾病模式，跨越空间和时间，到收入、贫困、不平等、就业、 失业、教育和职业，并在国际上研究 美国和其他富裕国家之间的死亡率和发病率模式；以及(2)使用空间和 对这些数据进行时间排序，以考虑一系列假设和可能的决定因素，包括 (一)经济机会减少，特别是对那些只有高中学历或受教育程度较低的人来说；(二) 阿片类药物供应显著增加前后疼痛和发病率增加；(3) 关于疼痛和其他发病率报告的职业结构，以及(4)教育本身，关于调节死亡率 与职业和收入无关的发病率。我们将检验关于经济的假设 繁荣、痛苦和其他发病率、阿片类药物的可获得性增加、职业和教育有助于解释 美国与其他富裕国家之间的差异，以及种族和民族之间的差异 在美国国内。

PROJECT SUMMARY/ABSTRACT Project 1 – Understanding Recent Trends in Mortality and Morbidity The goal of this project is to understand the deterioration in health among middle-aged American men and women, especially among white non-Hispanics – only recently brought to light. After three decades of decline, all-cause mortality rates for white non-Hispanics aged 45–54 have been on the rise since 1998. The increase has been driven by drug and alcohol poisonings, suicides, and cirrhosis and alcoholic liver disease. If white non-Hispanic mortality rates had continued to decline at 1.8 percent a year after 1998 – the average rate of decline for whites in the previous two decades – about 500,000 deaths would have been avoided through 2013, a number comparable to cumulative AIDS deaths in the U.S. There has been no corresponding change in the rate of mortality decline for non-Hispanic blacks or for Hispanics. In the same age group, morbidity among white non-Hispanics has increased for a range of measures, including self-reported physical and mental health, chronic pain, ability to conduct activities of daily living, including work, self-reports of heavy drinking, and clinically measured liver function. In contrast to the midlife group, mortality and morbidity have continued to improve for those aged 65 and above. The project will drill down into these overall statistics, disaggregating by location, by age, by sex, by occupational and educational groups, and by race and ethnicity, as well as by making comparisons with other wealthy countries. It will also attempt to understand the causes behind the decline in midlife health. There are two broad Specific Aims: (1) to build a public use database for the U.S. and for other rich countries that will be rich enough to document, for the U.S., the geographical distribution of midlife deaths and to link mortality and morbidity patterns, across space and time, to patterns of income, poverty, inequality, employment, unemployment, education and occupation and, internationally, to study the differences and similarities in mortality and morbidity patterns between the U.S. and other rich countries; and (2) to use the spatial and temporal ordering of those data to consider a range of hypotheses and possible determining factors, including (i) diminishing economic opportunity, especially for those with only a high school degree or less education, (ii) increases in pain and morbidity, before and after the marked increase in opioid availability, (iii) changes in occupational structure on reports of pain and other morbidity, and (iv) education itself, in conditioning mortality and morbidity independent of occupation and income. We will test whether hypotheses on economic prosperity, pain and other morbidity, increased availability of opioids, occupation, and education help to explain the differences between the US and other rich countries, and differences between racial and ethnic groups within the U.S.