Increasing Midlife Mortality and Morbidity in White Americans in the 21st Century

其他项目信息-项目概要/摘要 本项目的目标是了解未被充分认识和研究的健康恶化， 中年美国男性和女性，特别是非西班牙裔的白色人。全因死亡率 45-54岁的非西班牙裔白色人在经历了30年的下降后，自1998年以来一直在上升。涨幅 由药物和酒精中毒（意外和意图未确定），自杀和肝硬化驱动 和慢性肝病如果白色非西班牙裔的死亡率继续以每年1.8%的速度下降， 在1998年之后--这是前20年白人死亡率下降的平均速度--大约有50万人死亡， 在2013年，这些病例都被避免了，这个数字相当于美国累计的艾滋病死亡人数。出现 非西班牙裔黑人或西班牙裔美国人的死亡率下降率没有相应的变化。在同一 年龄组，发病率之间的白色非西班牙裔增加了一系列的措施，包括自我， 报告的身心健康、慢性疼痛、进行日常生活活动（包括工作）的能力， 酗酒的自我报告和临床肝功能检测与中年组相比， 65岁及以上人士的死亡率和发病率持续改善。该项目将深入研究 这些总体统计数据，按地点、年龄、教育群体、种族和族裔分列， 以及与其他富裕国家进行比较。它还将试图了解 中年健康状况下降的原因有六个具体目标：（1）记录地理分布情况 美国各地额外的中年死亡人数，并将整个空间的死亡率和发病率模式与 收入、贫困、不平等、就业、失业和教育的空间格局，（2）比较 富裕国家的死亡率和发病率模式，（3）调查 美国中年死亡率和发病率的变化，试图了解为什么非白人和西班牙裔 （4）了解死亡率和发病率教育的同时陡峭化 梯度，（5）调查发病率和死亡率之间的联系，特别是疼痛的作用， 在阿片类药物的处方中很重要，这本身就是自杀的风险因素，以及（6） 调查这一假设，即长期不利的经济变化，为那些目前在中年， 特别是那些教育程度低的人， and mortality.该项目的长期目标是了解一个重要的和不寻常的逆转， 发病率和死亡率的正常进展下降，并能够更好地预测它是否是一个暂时的 这一现象是否仅限于这一年龄组，或者是否可能蔓延到其他年龄组，特别是 老人我们的方法是观察人口学和经济学的标准方法。大部分工作都是 关注记录官方数据和全国性调查中的模式，并利用空间模式， 时间和团体来测试一系列假设，特别是健康状况不佳和经济压力之间的联系。

OTHER PROJECT INFORMATION – Project Summary/Abstract The goal of this project is to understand the underappreciated and understudied deterioration in health among middle-aged American men and women, especially among white non-Hispanics. All-cause mortality rates for white non-Hispanics aged 45–54, after three decades of decline, have been rising since 1998. The increase has been driven by drug and alcohol poisonings (accidental and intent undetermined), by suicides, and by cirrhosis and chronic 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 US. 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 educational group, and by race and ethnicity, as well as by making comparisons with other wealthy countries. It will also attempt to understand the reasons behind the decline in midlife health. There are six specific aims: (1) to document the geographical distribution of the additional midlife deaths across the US and to link mortality and morbidity patterns across space to spatial patterns of income, poverty, inequality, employment, unemployment, and education, (2) to compare mortality and morbidity patterns across rich countries, (3) to investigate the racial and ethnic dimensions of midlife mortality and morbidity change in the US, to try to understand why non-whites and Hispanics have been largely exempt, (4) to understand the concurrent steepening in mortality and morbidity education gradients, (5) to investigate the links between morbidity and mortality, and particularly the role of pain, which has been important in the prescription of opioids, and which is itself a risk factor for suicide, and (6) to investigate the hypothesis that long-term unfavorable economic changes for those currently in midlife, particularly those with low educational attainment, have played a role in precipitating increases in morbidity and mortality. The long-term aim of the project is to understand an important and unusual reversal in the normal progress of morbidity and mortality decline, and to be better able to predict whether it is a temporary phenomenon confined to this age group, or whether it is likely to spread into other age groups, particularly the elderly. Our methods are the standard ones of observational demography and economics. Much of the work is concerned with documenting patterns in official data and nationwide surveys, and using patterns across space, time, and groups to test a range of hypotheses, particularly the links between ill health and economic stress.