Death Rates Rising Among Middle-Aged and Younger Americans; Report Recommends Urgent National Response

This piece was originally published by the National Academics of Sciences, Engineering and Medicine.

WASHINGTON — Young and middle-aged adults (25-64 years old) in the U.S. have been dying at higher rates since 2010, according to a new report from the National Academies of Sciences, Engineering, and Medicine. High and Rising Mortality Rates Among Working-Age Adults says that rising death rates are striking working-age Americans, whose risk of dying from certain conditions — such as drug overdoses or hypertensive heart disease — has been climbing since the 1990s.

The 474-page report, based on data from 1990-2017, documents a public health crisis sweeping the American workforce, which has profound implications for families, employers, and the U.S. economy. This trend was prevalent before the pandemic arrived, but working-age Americans have been deeply affected by the pandemic, the report notes. Americans are more likely to die before age 65 than peers in other rich nations.

The rising death rate is due primarily to drug overdoses, alcohol, suicides, and cardiometabolic conditions — a category that includes diabetes and heart diseases caused by high blood pressure and other conditions. The report recommends urgent policy actions in light of this crisis, including addressing the overdose epidemic, the underlying causes of substance use disorders more broadly, access to mental health services, and stronger efforts to tackle obesity.

“We’re losing more and more Americans in the prime of their lives, in their most productive years, and in their parenting years,” said Kathleen Mullan Harris, James E. Haar Distinguished Professor of Sociology, University of North Carolina, Faculty Fellow at the Carolina Population Center, and chair of the committee that wrote the report. “Our committee was stunned by this mounting crisis, which will only get worse. The most troubling themes in our report — higher mortality than our peer countries; major racial and ethnic, socio-economic, and geographic disparities; lack of access to health insurance and care — have all been exacerbated by the pandemic.”

Mortality Disparities

Prior studies reported rising death rates among middle-aged white adults, in particular women, those with a high school degree or less, and those living in rural areas. But the report says the increase in premature death is more widespread, striking young adults, all racial and ethnic groups, and both rural and metropolitan areas. Death rates are higher and are increasing faster among working-age adults with less education and income. The report says that death rates among Black working-age adults have been disproportionately high for many years due to inequalities in socio-economic status, health care, housing, education, and other factors, reflecting the legacy of structural racism. Although progress occurred at the turn of the century in reducing the mortality gap between Black and white Americans, death rates in working-age Black people are now increasing, effectively erasing that progress.

Drugs, Alcohol, and Suicide

Drugs and alcohol are major contributors to the rise in working-age mortality. From 1990 to 2017, fatal drug overdoses in working-age Americans increased in every state, but increases were especially large in Appalachia, New England, and the industrial Midwest. The committee described the overdose epidemic as a “perfect storm,” created by a market flooded with highly addictive and deadly prescription and illicit drugs, and mounting demand for substances to bring relief from physical, mental, and psychological pain. The report also explores the rise in suicides, which was most dramatic for white men. The increase in deaths, which began in the 1990s, occurred against the backdrop of major changes in American life, including disruptions in the U.S. economy that devastated families and communities, especially in areas like the Rust Belt and Appalachia where working-age death rates increased the most.

Cardiometabolic Diseases

The report also focuses on rising deaths from cardiometabolic diseases, much of it caused by the health consequences (e.g., diabetes, hypertension, heart disease) of the obesity epidemic. Some of the most notable increases have been in the South and outside of large metropolitan areas. Young adults ages 25-44 have been especially affected because most were born after 1980 when the obesity epidemic began. Younger adults have been more exposed to “obesogenic” environments — unhealthy diets and lack of safe, open space for exercise — for their entire lives. Compared to older adults, they became overweight at a younger age and are more likely to remain overweight or obese today.

To address working-age mortality and advance research and data collection, the report recommends, among other actions:

• Policymakers should address substance use disorders and take lessons from the opioid epidemic to implement policies to prevent future crises, such as strengthening regulatory control and monitoring of prescription drugs and improving access to substance use and mental health services.
• Obesity prevention programs should start early in life and target children and teens most at risk for obesity, including racial and ethnic minorities, people living in poverty, and women.
• States that have not done so already should expand Medicaid coverage under the Affordable Care Act.
• Government and private organizations should fund research on more effective ways to prevent substance use disorders, reduce obesity, improve heart health, enhance behavioral health services for mental illness, and help those struggling to stop smoking or to obtain effective treatments for chronic diseases.
• Government and private organizations should encourage creative research strategies that bring together different disciplines to unpack the complex influences on death rates, such as the role of social, economic, and cultural factors at the national, state, community, family, and individual levels.
• To reduce and ultimately eliminate racial/ethnic and other socio-economic inequalities that continue to drive racial/ethnic disparities in U.S. working-age mortality, policymakers and decision-makers at all levels of society will need to dismantle structural racism and discriminatory policies of exclusion in areas such as education, employment and pay, housing, lending, civic participation, criminal justice, and health care.

The study — undertaken by the Committee on Rising Midlife Mortality Rates and Socio-economic Disparities — was sponsored by the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.