1 -Understanding Recent Trends in Mortality and Morbidity

项目总结/摘要 项目1 -了解死亡率和死亡率的最新趋势 该项目的目标是了解美国中年男性健康状况的恶化， 妇女，特别是非西班牙裔的白色妇女，直到最近才被曝光。在经历了三十年的衰落之后， 自1998年以来，45-54岁的非西班牙裔白色人的全因死亡率一直在上升。增加 由药物和酒精中毒、自杀、肝硬化和酒精性肝病引起。如果是白色 非西班牙裔的死亡率在1998年后以每年1.8%的速度继续下降， 在过去的20年里，白人的死亡人数下降-大约50万人的死亡本来可以避免， 2013年，这个数字相当于美国累计艾滋病死亡人数。 非西班牙裔黑人或西班牙裔美国人的死亡率下降。在同一年龄组中， 在白色非西班牙裔中，一系列措施增加了，包括自我报告的身体和 心理健康，慢性疼痛，进行日常生活活动的能力，包括工作，自我报告的沉重 饮酒和临床检测的肝功能与中年组相比，死亡率和发病率 65岁及以上人士的情况持续改善。 该项目将深入研究这些总体统计数据，按地点、年龄、性别、 职业和教育群体，并按种族和族裔，以及与其他 富裕的国家。它还将试图了解中年健康下降背后的原因。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使用的数据库， 丰富到足以记录，对于美国来说，中年死亡的地理分布，并将死亡率与 发病率模式，跨越空间和时间，收入模式，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;（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 (i)经济机会减少，特别是对于那些只有高中学历或教育程度较低的人，（ii） 在阿片类药物供应显著增加之前和之后，疼痛和发病率增加，（iii） 职业结构对疼痛和其他疾病的报告，和（iv）教育本身，在条件死亡率 发病率与职业和收入无关。我们将检验关于经济学的假设是否 繁荣，疼痛和其他疾病，阿片类药物的可用性增加，职业和教育有助于解释 美国和其他富裕国家之间的差异，以及种族和民族之间的差异， 在美国境内

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.