High and Rising Mortality Rates Among Working-Age Adults (2021) / Chapter Skim
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1 Introduction
1 Introduction
Pages 17-32
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From page 17... ...
and continued to decrease in the two subsequent years (Arias and Xu, 2018, 2019; Arias, Xu, and Kochanek, 2019) .1 This 3-year period of declining life expectancy represented the longest sustained decline in the United States in a century (since the influenza pandemic of 1918–1919)
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From page 18... ...
Initial studies examining the specific underlying cause or causes of death responsible for increases in mortality focused predominantly on older working-age adults, those ages 45–54. These studies highlighted increases in fatal drug overdoses as a primary factor in rising mortality and found that these increases were driven largely by the less educated, particularly Whites with a high school education or less, for whom mortality had risen sharply since 1999 (Case and Deaton, 2015, 2017)
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From page 19... ...
. Despite research implicating a broad range of causes of death in rising mortality rates, media reports focused on the opioid epidemic and its impact on specific demographic groups and communities (e.g., Egan, 2018; Robertson and Trent, 2018)
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Per capita national health care expenditures increased more than 220 percent between 2000 and 2017.2 While the direct effect of mortality on health care spending likely stems from the high cost of end-of-life care, the increasing burden of health care spending is associated mainly with chronic conditions that develop earlier in life among working-age younger adults and lead to earlier mortality (Einav et al., 2018; French et al., 2017)
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From page 21... ...
. Even before the height of the opioid epidemic, cost estimates based on these data suggested that nonmedical use of prescription opioids was responsible for $8.2 billion in criminal justice costs (Hansen et al., 2011)
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. Finally, the economic effects of rising mortality among working-age adults are both direct and indirect.
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From page 23... ...
, but also upstream on the macrostructural causes (e.g., public policies, macroeconomic trends, social and economic inequality) that may affect the health of Americans in multiple ways and through multiple pathways that flow through local community contexts and intersect with the lives of individuals.
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From page 24... ...
; and business decisions, from how much to pay workers to the marketing of inexpensive calorie-dense foods or highly addictive prescription opioids. These macrostructural factors, in turn, reflect social and cultural values, such as the proper role and size of government, attitudes about social inequality, beliefs in individualism, structural racism, and other forces that shape public policies and spending priorities.
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From page 25... ...
and the Committee on National Statistics (CNSTAT) of the National Academies of Sciences, Engineering, and Medicine will undertake a study that will: identify the key drivers of increasing mid-life mortality and concomitant widening social differen tials; identify modifiable risk factors that might alleviate poor health in mid-life and widening health inequalities; identify key knowledge gaps and make recommendations for future research and data collection; and explore potential policy implications.
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From page 26... ...
. Researchers were unable to determine in real time the extent to which excess deaths overall as well as the observed increases in non-COVID-19 deaths occurred among infected patients whose death certificates omitted mention of the virus or uninfected patients who experienced death caused indirectly by disruptions resulting from the pandemic (e.g., inability to access acute emergency services)
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From page 27... ...
Because of race-based occupational and residential segregation, Hispanic and Black versus White adults were more likely to be employed in such "essential" occupations as health care, farm work, and food service (Bureau of Labor Statistics, 2019) ; to live in multigenerational households (Cohen and Casper, 2002)
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From page 28... ...
STUDY METHODS AND LIMITATIONS OF THE EVIDENCE BASE This report describes and explains the trends in high and rising mortality among working-age adults in the United States and documents the demographic, socioeconomic, and geographic disparities in those trends. To carry out these analyses, the committee developed a multilevel conceptual framework to guide identification of the main drivers of the trends, from upstream macrostructural factors, to local environments in which people live and work, to downstream proximate individual-level factors.
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From page 29... ...
Through a comprehensive review of the research evidence, the committee was able to identify knowledge gaps and offer recommendations for future research and data collection efforts. As the committee began its initial task of reviewing previous research documenting the demographic, socioeconomic, and geographic disparities in mortality trends in the United States, it found extensive variation across studies that would have limited its ability to draw clear conclusions about the relative contributions of specific causes of death to changes in all-cause mortality within subpopulations.
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From page 30... ...
Chapter 2 compares life expectancy and mortality rates in the United States with those in 16 high-income peer countries, beginning in the 1950s, to establish when the United States' relative mortality disadvantage first emerged and the important role played by working-age mortality in contributing to this disadvantage. Chapter 3 examines trends in all-cause mortality within the United States between 1990 and 2017 by sex, age, race and ethnicity, socioeconomic status, and geography to provide greater insight into where and among which populations these increases occurred.
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From page 31... ...
Finally, Chapter 10 evaluates what is known about the broader economic factors that may have contributed to the recent mortality trends. Part III of the report consists of Chapter 11, which recaps the policy and research implications presented in Part II and the rationale for each and offers new policy and research implications for themes that cut across all of the preceding chapters.
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