Morbidity and Mortality in the 21st Century

Around the turn of the century, after decades of improvement, all-cause mortality rates among white non-Hispanic men and women in middle age stopped falling in the US, and began to rise. While midlife mortality continued to fall in other rich countries, and in other racial and ethnic groups in the US, white non-Hispanic mortality rates for prime-aged adults increased. Mortality declines from the two biggest killers in middle age—cancer and heart disease—were offset by marked increases in drug overdoses, suicides, and alcohol-related liver mortality in this period. By 2014, rising mortality in midlife, led by these "deaths of despair," was large enough to offset mortality gains for children and the elderly, leading to a decline in life expectancy at birth among white non-Hispanics between 2013 and 2014, and a decline in overall life expectancy at birth in the US between 2014 and 2015. Mortality increases for whites in midlife were paralleled by morbidity increases, including deteriorations in self-reported physical and mental health, and rising reports of chronic pain. My current research, supported by a grant from the National Institute on Aging, seeks to understand this turn of events.

South Africa: Poverty, Inequality, and Health