Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns

Abstract

Background A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear. Methods Using official mortality data, we study US annual mortality rates for ages 25–54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities. Results We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns. Conclusions We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.

The boomer penalty: excess mortality among baby boomers in Canada and the United States

“…Fourth, we analyzed the temporal dynamics of these cohort effects by cause. Because Canadian and U.S. populations are highly heterogeneous in terms of race and ethnicity, and mortality differs considerably between these groups (Masters 2012;Woolf et al 2018;Zang et al 2019), we also conducted the above analyses separately for three racial/ethnic groups in the U.S. population: namely, Non-Hispanic blacks (NHB), Hispanics, and Non-Hispanic whites (NHW). For the sake of clarity, we present for each step of the analysis a detailed description of the methods used, immediately followed by a summary of the results obtained from the application of these methods.…”

“…This inter-cohort "contagion" of substance abuse is particularly notable for the case of the millennial cohorts. While the boomer cohorts had the largest relative risks of alcohol-and drug-related mortality during the 1990s and 2000s, the millennial cohorts have started experiencing relative increases in mortality from these causes, to the point that the millennials' risks of alcohol-and drug-related mortality have exceeded those of boomers in recent years (Huang et al 2017;Miech et al 2013;Sauer et al 2018;Zang et al 2019). For both HIV/AIDS and drug mortality, punctual and strong period crises affecting most age groups (i.e., period effects) have been detected.…”

“…It is possible that the stigma and the lower price of crack made the poor black neighborhoods in the inner city more vulnerable to the crack epidemic at the turn of the 1990s (Agar 2003;Johnston 1991;Palamar et al 2015;Palamar and Ompad 2014). Likewise, the medical-legal origin of the opioid crisis, as well as racial discrimination in prescription practices (Barnett et al 2017;Hwang et al 2015;Jones et al 2018;King et al 2014;Manchikanti et al 2017;Quinones 2015;Zang et al 2019), appear to have put the NHW blue-collar population at greater risk during the early stages of the opioid crisis at the turn of the 21 st century. However, there is evidence that these drug epidemics have ravaged all social groups, even though they disproportionately affected specific social status or racial/ethnic groups in certain periods (Agar 2003;Ho 2017;Jalal et al 2018;Woolf et al 2018).…”

“…According to this theory, the unprecedented gradual improvements in early life conditions experienced in recent history -such as better nutrition, reduction of infectious diseases, enhanced medical measures, and higher levels of education -have led to massive declines in mortality across birth cohorts (Floud et al 2011;Fogel and Costa 1997). Other studies focusing on specific causes of death also identified mortality disadvantages for U.S. baby boomers with respect to overdoses (Chauvel et al 2016) and other external causes (Remund et al 2018;Zang et al 2019). Moreover, it has been shown that U.S. boomers report being less satisfied with their health than adjacent birth cohorts, and that they tend to have a high prevalence of obesity, diabetes, hypertension, hypercholesterolemia, substance and alcohol abuse, as well as functional limitations (Duncan et al 2010; King et al 2013;Leveille et al 2005;Martin et al 2009).…”

APC curvature plots: Displaying nonlinear age-period-cohort patterns on Lexis plots

“…Previous exploratory and descriptive analyses have suggested that baby boomers in the United States have a disproportionate susceptibility to drug-related mortality throughout their life course (Acosta et al 2019a;Miech, Koester, and Dorsey-Holliman 2011;Zang et al 2019). Thus, for this specific case, we are interested in comparing the attributes (location, magnitude, and spread) of the cohort mortality curvature of drug-related mortality for several racial/ethnic groups of US males in a single Lexis plot.…”