{"id":896,"date":"2015-11-18T16:27:22","date_gmt":"2015-11-18T16:27:22","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=896"},"modified":"2017-08-21T11:16:09","modified_gmt":"2017-08-21T11:16:09","slug":"primary-care-corner-with-geoffrey-modest-md-increasing-mortality-of-us-white-population","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/11\/18\/primary-care-corner-with-geoffrey-modest-md-increasing-mortality-of-us-white-population\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Increasing Mortality of US White Population"},"content":{"rendered":"<p><strong>By Dr. Geoffrey Modest<\/strong><\/p>\n<p>\u200bThe NY Times had a striking article from 2 Princeton\u00a0economists (including\u00a0Angus Deaton, who just won the Nobel\u00a0Prize in Economics)\u00a0finding that white Americans aged 45-54 with no more than a high school education\u00a0had an increase in death rates, largely attributed to\u200b suicides\u00a0and substance abuse from alcohol\u00a0and prescription opiates.\u00a0In terms of racial comparisons, white Americans have a mortality rate of 415\/100K,\u00a0African-Americans are at\u00a0581\/100K (though the gap is closing), and Hispanics have a much lower rate of 262\/100K. For the\u00a0NY\u00a0Times article, see\u00a0<a href=\"http:\/\/www.nytimes.com\/2015\/11\/03\/health\/death-rates-rising-for-middle-aged-white-americans-study-finds.html?emc=edit_th_20151103&amp;nl=todaysheadlines&amp;nlid=67866768&amp;_r=0\">http:\/\/www.nytimes.com\/2015\/11\/03\/health\/death-rates-rising-for-middle-aged-white-americans-study-finds.html?emc=edit_th_20151103&amp;nl=todaysheadlines&amp;nlid=67866768&amp;_r=0<\/a> . The full article is also freely\u00a0available (see\u00a0doi: 10.1073\/pnas.1518393112\u200b).<\/p>\n<p>Will summarize the article in more detail:<\/p>\n<ul>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> If the white mortality rate in those 45-54\u00a0had continued to decline at the rate it was from 1979-1998, 488,500\u00a0deaths would have been avoided in the period 1999-2013. This loss of life is comparable to lives lost during the AIDS epidemic though mid-2015.<\/span><\/li>\n<li>Between 1970 and 2013, there was a 44%\u00a0overall decrease in mortality for those 45-54 yo, attributed to behavioral change, prevention and treatment. Similar changes were seen in other wealthy countries. In the US, this was a decrease of 2%\/year. But after 1998, in contrast to other rich countries&#8217; mortality rates which continued to decline at 2%\/yr, the mortality rates for US non-Hispanic whites rose by 0.5%\/yr. See the first\u00a0graph below: all groups\u00a0(including US Hispanic) are trending down, with the solitary\u00a0exception of US whites\u200b (in graph, USW=US whites, USH=US Hispanics).<\/li>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> The increases in mortality\u00a0were largely in US whites with high school degree or less (37% increased mortality over 1999-2013, with an increase of 134\/100K)\u00a0and less so for those with\u00a0some college but no BA (31%) and those with BA or more (32%).<\/span><\/li>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> In those 45-54 group, mortality was dramatically increased for drug and alcohol poisonings, but also for suicides and chronic liver diseases, with not much change for diabetes and decreased mortality from lung\u00a0cancer\u00a0(see 2nd\u00a0graph below). In 2013, drug overdoses were highest in white non-Hispanic, and death from cirrhosis and chronic liver disease fell for blacks and rose for whites.<\/span><\/li>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> The increased mortality in white non-Hispanics increased for each 5 year grouping from age 30 to 64, but the increases were most dramatic in the 45-54 groupings (see last\u00a0graph on\u00a0below). Not shown was those 65-74, who continued to have decreased mortality at 2%\/yr.<\/span><\/li>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> Morbidity increased in parallel to mortality: overall, comparing data from 1997-99 to 2011-13,\u00a0there were significant changes\u00a0in self-assessed health status, pain, psychological distress, difficulties with activities of daily living, and alcohol use. For example, one in three white non-Hispanics aged 45-54 reported chronic joint pain in 2011-13. The Kessler six questionnaire, which assessed serious mental illness, increased from 3.9% to 4.8% of respondants. There were significant decreases (2-3% range) in walking 1\/4-mile, climbing 10 steps, standing or sitting for\u00a02h, shopping, and socializing with friends; and the activities overall were limited by physical and mental health issues. Of note, though obesity played a role, increases in midlife morbidity increased both in those with BMI &gt;30 and those &lt;30.<\/span><\/li>\n<li><span style=\"font-style: inherit;font-weight: inherit\"> &#8220;Concurrent\u00a0declines in self-reported health, mental health, and ability to work, increased reports of pain, and deteriorating measures of liver function all\u00a0point to increasing midlife distress.&#8221;\u200b<\/span><\/li>\n<\/ul>\n<p>So, pretty impressive\/depressing. The CDC estimates that for each prescription pain killer death in 2008, there were 10 admissions for abuse, 32 ER visits for misuse\/abuse, 130 people who were abusers or dependent, and 825 nonmedical opiate\u00a0prescription users (so, mortality is really just the tip of the iceberg in terms of the full societal effects). One aspect in the current discourse not really addressed is the effects of economic insecurity and lack of adequate social supports in the US (it is notable that the economic downturn was worldwide over the past 7-8 years, but the increases in mortality were\u00a0confined to the US). And the greatest change was in non-Hispanic whites with little education (unclear why US Hispanics\u00a0did relatively better, but there may have been less of a dramatic change in their economic and social well-being during the downturn, as well as differences in social\/community supports. International surveys indicate that overall Latin Americans have higher subjective well-being, despite lower incomes). Just raises yet again the 1879\u00a0Virchow quote: &#8220;Don&#8217;t crowd diseases (epidemics) point everywhere to deficiencies of society?&#8221;<\/p>\n<p><span style=\"font-style: inherit;font-weight: inherit\"><\/p>\n<p><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Primary Care Corner with Geoffrey Modest MD: Increasing Mortality of US White Population  [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/11\/18\/primary-care-corner-with-geoffrey-modest-md-increasing-mortality-of-us-white-population\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-896","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/896","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=896"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/896\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=896"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=896"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=896"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}