Trends in Non‐Hispanic White Mortality in the United States by Metropolitan‐Nonmetropolitan Status and Region, 1990–2016

Elo, Irma T.; Hendi, Arun S.; Ho, Jessica Y.; Vierboom, Yana C.; Preston, Samuel H.

doi:10.1111/padr.12249

Cited by 58 publications

(89 citation statements)

References 66 publications

(132 reference statements)

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“…Whereas divisional disparities are declining among males, they are widening among females, with nonmetro females experiencing increasingly concentrated disadvantage in Appalachia and the South. At the national level, others have observed this troubling trend (Elo et al 2019;Woolf and Schoomaker 2019) that appears to be driven by the widening educational gap in mortality Zajacova 2013a, b, 2014;Sasson 2016). Yet, it has received little media or political attention.…”

Section: Discussionmentioning

confidence: 99%

“…Given that heart disease should not be affecting this age group, this is a troubling trend. As noted by Elo et al (2019), adverse conditions from obesity and substance abuse have life course implications. We are likely to see continued increases in obesity-and substance abuse-related mortality in this cohort as they age.…”

Section: Discussionmentioning

confidence: 99%

“…Murray et al ( 2006 ) divided the U.S. into eight Americas based on race, region, and population density, finding comparatively high life expectancy (LE) in the Great Plains and low LE in the Deep South. Vierboom et al ( 2019 ) and Elo et al ( 2019 ) combined metropolitan status and geographic region to create 40 spatial units to examine LE trends from 1990 to 2016, finding that areas with higher LE at the beginning of the period enjoyed larger LE gains. They also found divergent trends between large central metro areas on the coasts and nonmetro areas in Appalachia and the south.…”

Section: What We Know About Within-rural Differences In Mortalitymentioning

confidence: 99%

“…Numerous studies have documented a rural mortality penalty that started in the 1990s and has grown since the mid-2000s (Cosby et al 2008 , 2019 ; Elo et al 2019 ; James 2014 ; James and Cossman 2017 ; Singh and Siahpush 2014 ; Vierboom et al 2019 ). Although the rural–urban mortality gap has widened across all major racial/ethnic groups over the past 20 years, it has widened the most among working-age non-Hispanic (NH) whites (NCHS 2020 ).…”

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confidence: 99%

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Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Monnat

2020

Popul Res Policy Rev

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After decades of lower or comparable mortality rates in rural than in urban areas of the U.S., numerous studies have documented a rural mortality penalty that started in the 1990s and has grown since the mid-2000s. The widening of the gap appears to be especially pronounced among non-Hispanic (NH) whites. However, the rural U.S. is not monolithic, and some rural places have experienced much larger mortality rate increases than others over the past 30 years. Drawing on restricted mortality files from the National Vital Statistics System (NVSS), I examine metro versus nonmetro and intra-nonmetro (divisional and economic dependency) all-cause and cause-specific mortality trends among working-age (25-64) NH white males and females, 1990-2018. Results show that the nonmetro mortality penalty is wide and growing and is pervasive across multiple disease and injury categories. Trends for females are particularly concerning. Smaller nonmetro declines in mortality from cancers and cardiovascular disease (throughout the 1990s and 2000s) and larger increases in metabolic and respiratory diseases, suicide, alcohol-related, and mental/behavioral disorders (throughout the 2010s) collectively drove the growth in the nonmetro disadvantage. There are also large divisional disparities (which are growing for females), with particularly poor trends in New England, South Atlantic, ES Central, WS Central, and Appalachia and more favorable trends in the Mid-Atlantic, Mountain, and Pacific. Mining-dependent counties have diverged from the other economic dependency types since the mid-2000s due to multiple causes of death, whereas farming counties have comparatively lower mortality rates. High and rising mortality rates across a variety of causes and rural places, some of which have been occurring since the 1990s and others that emerged more recently, suggest that there is not one underlying explanation. Instead, systemic failures across a variety of institutions and policies have contributed to rural America's troubling mortality trends generally and within-rural disparities more specifically.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: What We Know About Within-rural Differences In Mortalitymentioning

confidence: 99%

mentioning

confidence: 99%

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Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Monnat

2020

Popul Res Policy Rev

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“…Based on extant literature on the economic and geographic determinants of mortality and life expectancy (e.g. Chetty et al, 2016 ; Elo et al, 2019 ; Woolf and Schoomaker 2020 ), the models adjust for state-level compositional and contextual characteristics including the labor force participation rate, the percentage of workers represented by labor unions, the percentage of the population with a college degree, the percentage of the population ever married, the percentage of the population who are Hispanic, the percentage of the population who are Black, the age structure of the population, the percentage of the population living in metropolitan area counties, and scores of self-reported health.…”

Section: Methodsmentioning

confidence: 99%

The economic underpinnings of the drug epidemic

Seltzer

2020

SSM - Population Health

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U.S. labor markets have experienced transformative change over the past half century. Spurred on by global economic change, robotization, and the decline of labor unions, state labor markets have shifted away from an occupational regime dominated by the production of goods to one characterized by the provision of services. Prior studies have proposed that the deterioration of employment opportunities may be associated with the rise of substance use disorders and drug overdose deaths, yet no clear link between changes in labor market dynamics in the U.S. manufacturing sector and drug overdose deaths has been established. Using restricted-use vital registration records between 1999 and 2017 that comprise over 700,000 drug deaths, I test two questions: First, what is the association between manufacturing decline and drug and opioid overdose mortality rates? Second, how much of the increase in these drug-related outcomes can be predicted by manufacturing decline? The findings provide strong evidence that the restructuring of the U.S. labor market has played an important upstream role in the current drug crisis. Up to 92,000 overdose deaths for men and up to 44,000 overdose deaths for women are predicted by the decline of state-level manufacturing over this nearly two-decade period. These results persist in models that adjust for other social, economic, and policy trends changing at the same time. Critically, the findings signal the value of policy interventions that aim to reduce persistent economic precarity experienced by individuals and communities, especially the economic strain placed upon the middle class.

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Life Expectancy and Mortality Rates in the United States, 1959-2017

Woolf

Schoomaker

2019

JAMA

668

504

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ife expectancy at birth, a common measure of a population's health, 1 has decreased in the United States for 3 consecutive years. 2 This has attracted recent public attention, 3 but the core problem is not new-it has been building since the 1980s. 4,5 Although life expectancy in developed countries has increased for much of the past century, US life expectancy began to lose pace with other countries in the 1980s 6,7 and, by 1998, had declined to a level below the average life expectancy among Organisation for Economic Cooperation and Development countries. 8 While life expectancy in these countries has continued to increase, 9,10 US life expectancy stopped increasing in 2010 and has been decreasing since 2014. 2,11 Despite excessive spending on health care, vastly exceeding that of other countries, 12 the United States has a long-standing health disadvantage relative to other high-income countries that extends beyond life expectancy to include higher rates of disease and cause-specific mortality rates. 6,7,10,13 This Special Communication has 2 aims: to examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and from a new analysis of state-level trends. Methods Data Analysis MeasuresThis report examines longitudinal trends in life expectancy at birth and mortality rates (deaths per 100 000) in the US population, IMPORTANCE US life expectancy has not kept pace with that of other wealthy countries and is now decreasing. OBJECTIVE To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.EVIDENCE Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.FINDINGS Between 1959 and, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in

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Trends in Non‐Hispanic White Mortality in the United States by Metropolitan‐Nonmetropolitan Status and Region, 1990–2016

Cited by 58 publications

References 66 publications

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

Trends in U.S. Working-Age non-Hispanic White Mortality: Rural–Urban and Within-Rural Differences

The economic underpinnings of the drug epidemic

Life Expectancy and Mortality Rates in the United States, 1959-2017

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