@article{ref1,
title="Explaining recent mortality trends among younger and middle-aged White Americans",
journal="International journal of epidemiology",
year="2018",
author="Masters, Ryan K. and Tilstra, Andrea M. and Simon, Daniel H.",
volume="47",
number="1",
pages="81-88",
abstract="BACKGROUND: Recent research has suggested that increases in mortality among middle-aged US Whites are being driven by suicides and poisonings from alcohol and drug use. Increases in these 'despair' deaths have been argued to reflect a cohort-based epidemic of pain and distress among middle-aged US Whites. <br><br>METHODS: We examine trends in all-cause and cause-specific mortality rates among younger and middle-aged US White men and women between 1980 and 2014, using official US mortality data. We estimate trends in cause-specific mortality from suicides, alcohol-related deaths, drug-related deaths, 'metabolic diseases' (i.e. deaths from heart diseases, diabetes, obesity and/or hypertension), and residual deaths from extrinsic causes (i.e. causes external to the body). We examine variation in mortality trends by gender, age and cause of death, and decompose trends into period- and cohort-based variation. <br><br>RESULTS: Trends in middle-aged US White mortality vary considerably by cause and gender. The relative contribution to overall mortality rates from drug-related deaths has increased dramatically since the early 1990s, but the contributions from suicide and alcohol-related deaths have remained stable. Rising mortality from drug-related deaths exhibit strong period-based patterns. Declines in deaths from metabolic diseases have slowed for middle-aged White men and have stalled for middle-aged White women, and exhibit strong cohort-based patterns. <br><br>CONCLUSIONS: We find little empirical support for the pain- and distress-based explanations for rising mortality in the US White population. Instead, recent mortality increases among younger and middle-aged US White men and women have likely been shaped by the US opiate epidemic and an expanding obesogenic environment.<p /> <p>Language: en</p>",
language="en",
issn="0300-5771",
doi="10.1093/ije/dyx127",
url="http://dx.doi.org/10.1093/ije/dyx127"
}