What's fueling the rise in deaths among middle-age whites

"On a range of social and economic indicators, middle-aged whites have been falling behind in the 21st century," a research foundation has found.

A recently identified rise in mortality among middle-age, white Americans has more to do with "a lack of progress" in treating common illnesses than with the issues of substance abuse and suicide, which had been initially blamed for the trend, a new report argues.

The research from The Commonwealth Fund, a private foundation that advocates for improvements in health care, found there has been a stalling, and in some cases a reversal, of progress in reducing deaths among middle-age whites from common killers such as heart disease, diabetes and respiratory illness.

The study also found that the "worst trends" in mortality rates among white middle-age people are being seen in a group of seven mostly Southern states, including West Virginia, where white people between the ages of 45 and 54 are dying at the highest rates seen since 1980.

The report found that "the excess deaths among middle-age whites could be due in large part to the erosion of their socioeconomic standing. On a range of social and economic indicators, middle-aged whites have been falling behind in the 21st century."

The report comes more than two months after two Princeton economists drew widespread attention with a study featured in The New York Times that found that the death rate among middle-age whites was rising in the United States — in contrast to all other racial and ethnic groupings in America, and unlike middle-age whites in other wealthy nations.

That earlier study found that deaths from suicide, as well as from drugs and alcohol, were responsible for the trend since 1999. A follow-up story in the Times says that younger white adults also had seen an increase in mortality rates, which was attributed primarily to increased abuse of prescription opioid painkillers.

But the new report from the Commonwealth Fund, a private foundation that advocates for improvements in health care, said that further analysis shows that "the gap between the expected and actual white mortality rates is wider than commonly recognized."

"Moreover, the gap is not adequately explained for the middle-aged by the common narrative of rising levels of substance abuse and suicide," the report said.

In that report, the authors examined actual death rates and compared them with expected death rates, along with looking at causes of death for working-age adults from 1968 to 2015.

Since 1968, death rates across most age groups and racial and ethnic groups has fallen by almost 2 percent, the report noted. But in opposition to that trend, the death rates for middle-age whites rose from 1999 to 2014.

While increased suicide and substance abuse contributed to the higher mortality rate seen in that age group, it accounted for only about 40 percent of the gap between expected and actual death rates, according to the report.

"The larger part of the gap, 60 percent, was attributable to death rates failing to improve as expected for nearly all of the leading causes of death (e.g. heart disease, diabetes, and respiratory diseases) for middle-aged whites," the Commonwealth Fund said in a statement. In contrast, suicide and substance abuse explained almost all of a gap between expected and actual deaths seen among younger whites.

The report noted that in the case of heart disease, the second-leading cause of death for middle-age whites, a rapid decline in mortality see between 1968 and 1998 "essentially leveled out for this population between 1999 and 2014." At the same time, "for blacks and Hispanics, heart disease rates continued their rapid decline," the report said.

The report singled out seven states — West Virginia, Mississippi, Oklahoma, Tennessee, Kentucky, Alabama and Arkansas — where the problem of increased mortality among middle-age whites was "especially severe."

In those states, "the gap between actual and expected mortality in 2014 exceeded 200 deaths per 100,000 people," the report found. That actual mortality rate was 60 to 76 percent higher than the expected rate in those states.

"In contrast, mortality rates for middle-age whites improved slightly in several states, mostly in the Northeast, though not to the degree that would be expected from a historical annual improvement rate of 1.8 percent," the report found.

It noted that "no single disease or condition was responsible for the divergence between the states with the worst mortality trends and the best mortality trends."

Dr. David Blumenthal, president of the Commonwealth Fund and co-author of the new study, said: "We are accustomed to making progress against diseases. We learn how to prevent them and how to treat them and, as we do that, fewer people die from them."

"For middle-aged whites, that progress has stalled and even reversed for some conditions," Blumenthal said. "We need to (figure) out why this is happening."