Rising Death Rates Bring New Meaning to Mid-Life Crisis for Americans—Especially White Women

Statistical skirmishing over a high-profile study of sharply rising mortality rates for middle-aged white Americans threatens to overshadow what isn’t in dispute: Many Americans, but especially poorly educated white women, are living in distress and it’s killing a lot of them.

The study, by Anne Case and Angus Deaton, attributed increased mortality among non-Hispanic white, middle-aged (45 to 54) men and women in the U.S. largely to rising death rates from drug and alcohol poisoning, suicide, and chronic liver disease and cirrhosis. They also found rising death rates mirrored self-reported declines in health, mental health, and the ability to conduct activities of daily living, coupled with increases in chronic pain and inability to work. This U.S. mid-life crisis stands in sharp contrast to continued reductions in mid-life mortality rates in other industrialized countries, including France, Germany, and Canada.

This reversal of fortune should send a strong signal to U.S. policymakers that failure to provide access to adequate health care and educational and economic opportunities is literally killing not just white, middle-aged people but Americans of all ages, sexes, races, and ethnicities. For example, though the gap is closing, middle-aged, non-Hispanic blacks still have much higher mortality rates at 582 deaths per 100,000 population, compared to 415 for their white counterparts.

In examining the study’s methodology, Andrew Gellman, writing in Slate, pointed out that Case and Deaton failed to standardize ages to compensate for the growing number of people bunching at the high end of the 45-to 54-year range. After this adjustment, Gellman found a slightly different death-rate story. Increased mortality impacted non-Hispanic white women in both the 35-to-44 and 45-to-54 age groups, while non-Hispanic white men’s death rate, along with blacks and Hispanics of both sexes, actually dropped. Gellman’s finding highlighting the deteriorating situation of white women is less surprising and more consistent with other recent research.

For example, in Health Affairs, my colleagues and I reported on the dramatic rise in chronic conditions among non-elderly Americans between 1999 and 2005, especially between early adulthood and midlife.  We also found that chronic conditions increased more for non-Hispanic whites, especially women, compared to Hispanics or blacks. And a much larger share of women had three or more chronic conditions compared to men—15.8 percent vs. 10.7 percent.  

Consistent with our findings, Nan Astone and colleagues’ analysis of death rates between 1999 and 2011 among U.S. women aged 15 to 54 found a greater rise in death rates among non-Hispanic white women. They attributed half of the increase to accidental poisoning—most likely from prescription painkillers—and the rest from heart disease, lung disease, and other medical conditions.

The first step to reversing this troubling trend among non-Hispanic white women is raising awareness of the problem and teasing apart  and understanding interrelated factors that contribute to high-risk behaviors, subsequent illness, and, eventually, death. And, we need to keep in mind two critical facts: First, as noted, black women’s death rates are still higher than those of non-Hispanic and Hispanic white women. Second, though the rise in alcohol and drug poisonings deserves attention, cancer and heart disease are still the leading causes of death across almost all ethnic and racial groups in the middle and later years. 

Obesity, lack of exercise, smoking, and general stress are killers and a sign of how social trends may disproportionately affect non-Hispanic white women. Less economic opportunity during the Great Recession and greater responsibilities piling up on the so-called sandwich generation—which came of age amid stability and expectations of opportunity—may lead to being overwhelmed and overwrought.

Case and Deaton found greater mortality rate increases among less-educated, non-Hispanic whites than among those with more education that could lead to better job opportunities. Uneducated women stuck in low-skill, low-wage service jobs can barely scrape by on incomes that may be lower than a man’s for similar work and experience. And, caring for aging parents and supporting young adults struggling to achieve financial independence creates additional burdens and responsibilities for many middle-aged Americans.

Other factors are at play too. Unlike black and Hispanic women, white women are less apt to have large extended mutigenerational families nearby to share the load and lend emotional support when the going gets tough. Sustained chronic stress exacerbates pain, a growing problem noted by Case and Deaton, which can open the door to opiate misuse and lead to overeating, inflammation throughout the body, diseases such as diabetes, and more rapid aging.  

For all middle-aged women and their families, work by such government agencies as the Centers for Disease Control and Prevention and philanthropies like the Robert Wood Johnson Foundation on the social determinants of health could be a game-changer.  Health, we now know, is far more than having the right health care. A good education, job opportunity, economic stability, social support, a well-balanced diet, and decent housing in a safe community, evidence suggests, make for a healthier population.

Kathryn Paez is a principal researcher at AIR.