Increasing Midlife Mortality and Morbidity in White Americans in the 21st Century

21 世纪美国白人中年死亡率和发病率不断上升

基本信息

批准号：
9323236
负责人：
ANGUS S. DEATON
金额：
$ 22.7万
依托单位：
NATIONAL BUREAU OF ECONOMIC RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-08-01 至 2021-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9323236
关键词：
Acquired Immunodeficiency Syndrome Activities of Daily Living African American Age Agreement American Area Cessation of life Cirrhosis Clinical Cohort Effect Country Data Deltastab Demography Deterioration Dimensions Distress Documentation Drug Controls Drug Prescriptions Economics Education Elderly Employment Epidemic Ethnic Origin Geographic Distribution Geography Goals Growth Health Heavy Drinking Hispanics Income Inequality International Lead Life Expectancy Link Location Measures Mental Health Methods Morbidity - disease rate Mortality Decline Not Hispanic or Latino Opiates Opioid Outcome Overdose Pain Parents Patient Self-Report Pattern Pharmaceutical Preparations Pharmacy facility Play Poverty Race Recording of previous events Research Risk Risk Factors Role Route Social Security Stress Suicide Surveys Testing Time Unemployment Wages Woman Work addiction age group aged alcohol poisoning caucasian American chronic liver disease chronic pain cohort expectation experience health economics high school improved inner city liver function men middle age mortality overdose death physical conditioning policy implication prescription opioid racial and ethnic racial difference statistics

项目摘要

OTHER PROJECT INFORMATION – Project Summary/Abstract The goal of this project is to understand the underappreciated and understudied deterioration in health among middle-aged American men and women, especially among white non-Hispanics. All-cause mortality rates for white non-Hispanics aged 45–54, after three decades of decline, have been rising since 1998. The increase has been driven by drug and alcohol poisonings (accidental and intent undetermined), by suicides, and by cirrhosis and chronic liver disease. If white non-Hispanic mortality rates had continued to decline at 1.8 percent a year after 1998—the average rate of decline for whites in the previous two decades—about 500,000 deaths would have been avoided through 2013, a number comparable to cumulative AIDS deaths in the US. There has been no corresponding change in the rate of mortality decline for non-Hispanic blacks or for Hispanics. In the same age group, morbidity among white non-Hispanics has increased for a range of measures, including self- reported physical and mental health, chronic pain, ability to conduct activities of daily living, including work, self-reports of heavy drinking, and clinically measured liver function. In contrast to the midlife group, mortality and morbidity have continued to improve for those aged 65 and above. The project will drill down into these overall statistics, disaggregating by location, by age, by educational group, and by race and ethnicity, as well as by making comparisons with other wealthy countries. It will also attempt to understand the reasons behind the decline in midlife health. There are six specific aims: (1) to document the geographical distribution of the additional midlife deaths across the US and to link mortality and morbidity patterns across space to spatial patterns of income, poverty, inequality, employment, unemployment, and education, (2) to compare mortality and morbidity patterns across rich countries, (3) to investigate the racial and ethnic dimensions of midlife mortality and morbidity change in the US, to try to understand why non-whites and Hispanics have been largely exempt, (4) to understand the concurrent steepening in mortality and morbidity education gradients, (5) to investigate the links between morbidity and mortality, and particularly the role of pain, which has been important in the prescription of opioids, and which is itself a risk factor for suicide, and (6) to investigate the hypothesis that long-term unfavorable economic changes for those currently in midlife, particularly those with low educational attainment, have played a role in precipitating increases in morbidity and mortality. The long-term aim of the project is to understand an important and unusual reversal in the normal progress of morbidity and mortality decline, and to be better able to predict whether it is a temporary phenomenon confined to this age group, or whether it is likely to spread into other age groups, particularly the elderly. Our methods are the standard ones of observational demography and economics. Much of the work is concerned with documenting patterns in official data and nationwide surveys, and using patterns across space, time, and groups to test a range of hypotheses, particularly the links between ill health and economic stress.

其他项目信息 - 项目摘要/摘要该项目的目的是了解健康中的不重视和研究的恶化中年男女，特别是在白人非西班牙裔中。白人非西班牙裔年龄在45-54岁之间，在树木数十年后，自1998年以来一直在上升。是毒品和酒精中毒（未确定的加速性和IND意图），被自杀和cirhosis 慢性肝病。 1998年之后 - 白人的平均下降率在过去的二十年中 - 约有500,000人死亡将一直避免到2013年，这一数字与美国累积艾滋病死亡相当。非西班牙裔黑人或西班牙裔人的死亡率下降率的变化无关。年龄段，病态，白人非西班牙裔人已经增加了一系列措施，包括自我报告了身心健康，慢性疼痛，进行日常生活活动的能力，包括工作，与中年人组相比，大量饮酒的自我报告和临床测量的肝脏功能。对65岁及以上的人的死亡率和病态继续改善。进入这些总体统计数据，按地点，按年龄，教育组和种族和种族分类，以及与其他富裕国家进行比较。在中年健康的下降背后。在美国额外的中年死亡，并将跨空间的病态模式联系起来收入，贫困，不平等，就业，失业和教育的空间模式，（2）比较遍布富裕国家的死亡率和病态模式，以调查种族和种族层面美国的中年死亡率和病态变化豁免更大，（4）了解死亡率和病态教育的同时降低梯度，（5）研究病态与死亡率之间的联系，尤其是疼痛的作用，在阿片类药物的处方中很重要，这是自杀的危险因素，（6）调查以下假设：当前中年人的长期不利经济变化，特别是那些受教育程度低的人，在降水量增加中发挥了作用和死亡率。病态和死亡率下降的正常进展，并能够更好地预测它是否是暂时的现象enonononon con仅限于这个年龄段老年人。与记录官方数据和全国调查中的模式有关，以及在太空之间使用模式，时间和群体来检验一系列假设，尤其是Illth和经济压力之间的联系。