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

其他项目信息-项目摘要/摘要 这个项目的目标是了解人们对健康状况的认识不足和研究不足。 美国中年男女，尤指非西班牙裔白人。全因死亡率 45-54岁的非西班牙裔白人在经历了30年的下降后，自1998年以来一直在上升。这一增长已经 由药物和酒精中毒(意外和意图不明)、自杀和肝硬变驱动 和慢性肝病。如果非西班牙裔白人死亡率继续以每年1.8%的速度下降 在1998年--过去20年白人的平均下降速度--之后，大约50万人将死亡 到2013年，已经避免了这一数字，这一数字相当于美国累计的艾滋病死亡人数。已经有了 非西班牙裔黑人或西班牙裔美国人的死亡率没有相应的变化。在相同的 在年龄组中，非西班牙裔白人的发病率在一系列措施中有所增加，包括自我 报告的身心健康、慢性疼痛、进行日常生活活动的能力，包括工作， 自我报告大量饮酒，并临床测量肝功能。与中年群体相比， 65岁及以上人群的死亡率和发病率继续改善。该项目将向下挖掘 纳入这些总体统计数据，按地点、年龄、受教育群体以及种族和民族分列， 以及通过与其他富裕国家进行比较。它还将试图了解原因 在中年健康下降的背后。有六个具体目标：(1)记录地理分布 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、失业和教育的空间模式，(2)比较 富裕国家的死亡率和发病率模式，(3)调查#年的种族和民族层面 美国中年死亡率和发病率的变化，试图理解为什么非白人和西班牙裔美国人 在很大程度上被豁免，(4)了解死亡率和发病率同时急剧上升的教育 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， 在阿片类药物处方中很重要，这本身就是自杀的危险因素，以及(6) 调查这样一种假设，即长期的不利经济变化对目前处于中年的人来说是不利的， 尤其是那些受教育程度较低的人，在促进发病率上升方面发挥了作用 和死亡率。该项目的长期目标是了解 正常进展的发病率和死亡率下降，并能够更好地预测它是否是暂时的 这种现象是否只限于这个年龄段，或者是否有可能蔓延到其他年龄段，特别是 老年人。我们的方法是观测人口学和经济学的标准方法。大部分工作是 关注记录官方数据和全国调查中的模式，并使用跨空间的模式， 时间和团队来测试一系列假设，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.