Citation

Tilstra AM, Simon DH, Masters RK. Am. J. Epidemiol. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Oxford University Press)

DOI

10.1093/aje/kwab088

PMID

unavailable

Abstract

Life expectancy for U.S. white men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in "deaths of despair" (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged white Americans. There has been less attention on black mortality trends from these same causes, and whether the trends are similar or different by cohort and period. We complement existing research and contend that recent mortality trends in both the U.S. black and white populations most likely reflect period-based exposures to 1) the U.S. opioid epidemic and 2) the Great Recession. We analyze cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic black and non-Hispanic white Americans, aged 20-64 in the years 1990-2017. We employ sex-, race-, and cause-of-death- stratified Poisson rate models and Age-Period-Cohort models to compare mortality trends.

RESULTS indicate that rising "deaths of despair" for both black and white Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both white and black Americans changed during the Great Recession, despite some race differences across cohorts.

Language: en

Keywords

United States; opioid; age-period-cohort models; deaths of despair; midlife mortality; mortality trends; race/ethnic trends