The past century has witnessed remarkable advances in life expectancy in the United States and throughout the world. In 2010, however, progress in life expectancy in the United States began to stall, despite continuing to increase in other high-income countries. Alarmingly, U.S. life expectancy fell between 2014 and 2015 and continued to decline through 2017, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918-1919). The recent decline in U.S. life expectancy appears to have been the product of two trends: (1) an increase in mortality among middle-aged and younger adults, defined as those aged 25-64 years (i.e., “working age”), which began in the 1990s for several specific causes of death (e.g., drug- and alcohol-related causes and suicide); and (2) a slowing of declines in working-age mortality due to other causes of death (mainly cardiovascular diseases) after 2010.

High and Rising Mortality Rates among Working Age Adults highlights the crisis of rising premature mortality that threatens the future of the nation's families, communities, and national wellbeing. This report identifies the key drivers of increasing death rates and disparities in working-age mortality over the period 1990 to 2017; elucidates modifiable risk factors that could alleviate poor health in the working-age population, as well as widening health inequalities; identifies key knowledge gaps and make recommendations for future research and data collection to fill those gaps; and explores potential policy implications. After a comprehensive analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data, this report then looks upstream to the macrostructural factors (e.g., public policies, macroeconomic trends, social and economic inequality, technology) and social determinants (e.g., socioeconomic status, environment, social networks) that may affect the health of working-age Americans in multiple ways and through multiple pathways.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON RISING MIDLIFE MORTALITY RATES AND SOCIOECONOMIC DISPARITIES
• COMMITTEE ON NATIONAL STATISTICS
• Preface and Acknowledgments
• Summary
  • STUDY PURPOSE, APPROACH, AND SCOPE
  • TRENDS IN WORKING-AGE MORTALITY
  • RACIAL/ETHNIC, SOCIOECONOMIC, AND GEOGRAPHIC DISPARITIES
  • IMPLICATIONS FOR RESEARCH AND POLICY
• PART I
  • 1. Introduction
    • INDIVIDUAL AND SOCIETAL IMPLICATIONS OF RISING MORTALITY AMONG WORKING-AGE ADULTS
    • SEARCHING FOR EXPLANATIONS
    • CHARGE TO THE STUDY COMMITTEE
    • IMPACT OF THE COVID-19 PANDEMIC ON WORKING-AGE MORTALITY
    • STUDY METHODS AND LIMITATIONS OF THE EVIDENCE BASE
    • ORGANIZATION OF THE REPORT
  • 2. U.S. Mortality in an International Context
    • LIFE EXPECTANCY AT BIRTH IN THE UNITED STATES VERSUS PEER COUNTRIES
    • THE U.S. MORTALITY DISADVANTAGE BY AGE
    • INTERNATIONAL TRENDS IN WORKING-AGE MORTALITY
    • U.S. MORTALITY BY CAUSE OF DEATH IN INTERNATIONAL PERSPECTIVE
    • SUMMARY
    • ANNEX 2-1. International Trends Methodology
  • 3. U.S. Trends in All-Cause Mortality Among Working-Age Adults
    • TRENDS IN ALL-CAUSE MORTALITY BY SEX AND AGE
    • TRENDS IN ALL-CAUSE MORTALITY BY SEX, AGE, AND RACE AND ETHNICITY
    • TRENDS IN MORTALITY BY SOCIOECONOMIC STATUS
    • GEOGRAPHIC DIFFERENCES IN MORTALITY TRENDS
    • SUMMARY
    • ANNEX 3-1. Mortality Trends Among U.S. Asians/Pacific Islanders and American Indians/Alaska Natives
    • MORTALITY TRENDS AMONG U.S. ASIANS AND PACIFIC ISLANDERS
    • MORTALITY TRENDS AMONG AMERICAN INDIANS/ALASKA NATIVES
    • CHANGES IN HIGH/LOW MORTALITY COUNTIES BY METROPOLITAN STATUS
  • 4. U.S. Trends in Cause-Specific Mortality Among Working-Age Adults
    • TRENDS IN U.S. WORKING-AGE MORTALITY BY CAUSE OF DEATH
    • DISPARITIES IN CAUSE-SPECIFIC MORTALITY BY SOCIOECONOMIC STATUS
    • CAUSE-SPECIFIC MORTALITY TRENDS BY METROPOLITAN STATUS
    • TEMPORAL PATTERNS IN CAUSE-SPECIFIC MORTALITY TRENDS
    • SUMMARY
    • ANNEX 4-1. Trends in Cause-Specific Mortality Among American Indians and Alaska Natives
    • CAUSE-SPECIFIC MORTALITY TRENDS BY METROPOLITAN AREA STATUS
  • 5. U.S. Mortality Data: Data Quality, Methodology, and Recommendations
    • THE U.S. NATIONAL VITAL STATISTICS SYSTEM (NVSS) AND THE CONSTRUCTION OF MORTALITY RATES
    • ESTIMATION OF MORTALITY RATES IN THIS REPORT
    • RECOMMENDATIONS
• PART II
  • 6. A Framework for Developing Explanations of Working-Age Mortality Trends
    • A CONCEPTUAL FRAMEWORK FOR U.S. WORKING-AGE MORTALITY
    • CONSIDERATIONS IN DEVELOPING EXPLANATIONS FOR TRENDS IN WORKING-AGE MORTALITY
    • SUMMARY
    • ANNEX 6-1. Period- and Cohort-Based Examination of Trends in U.S. Working-Age Mortality
    • DRUG-RELATED DEATH RATES AMONG U.S. BLACK AND WHITE MEN
    • DEATH RATES FROM CARDIOMETABOLIC DISEASES AMONG U.S. WHITE MEN AND WOMEN
    • DEATH RATES FROM ALCOHOL USE AMONG U.S. BLACK AND WHITE MEN AND WOMEN
  • 7. Opioids, Other Drugs, and Alcohol
    • TRENDS IN MORTALITY DUE TO DRUG POISONING AND ALCOHOL
    • EXPLANATIONS FOR THE RISE IN WORKING-AGE MORTALITY FROM DRUG POISONING AND ALCOHOL-INDUCED CAUSES
    • SUMMARY
    • IMPLICATIONS FOR RESEARCH AND POLICY
  • 8. Suicide
    • TRENDS IN SUICIDE
    • SUMMARY
    • IMPLICATIONS FOR RESEARCH AND POLICY
  • 9. Cardiometabolic Diseases
    • TRENDS IN CARDIOMETABOLIC MORTALITY
    • EXPLANATIONS FOR THE TRENDS IN CARDIOMETABOLIC MORTALITY
    • SUMMARY
    • IMPLICATIONS FOR RESEARCH AND POLICY
  • 10. The Relationship Between Economic Factors and Mortality
    • CONCEPTUAL CHALLENGES
    • ASSOCIATION BETWEEN ECONOMIC DEPRIVATION AND WORSE, AND RISING, MORTALITY
    • LACK OF A STRONG ASSOCIATION BETWEEN ECONOMIC FLUCTUATIONS AND INCREASED MORTALITY
    • ASSOCIATION BETWEEN INCOME INEQUALITY AND MORTALITY
    • SUMMARY
    • IMPLICATIONS FOR RESEARCH AND POLICY
• PART III
  • 11. Implications for Policy and Research
    • A FRAMEWORK FOR THE CATEGORIZATION OF POLICY AND RESEARCH IMPLICATIONS
    • MEDICAL SCIENCE AND HEALTH CARE ACCESS AND DELIVERY
    • PUBLIC HEALTH
    • SOCIAL AND ECONOMIC POLICIES
    • LESSONS FROM THE COVID-19 PANDEMIC
    • CONCLUSION
• REFERENCES
• Appendix A. Mortality Data Analyses: Review Process and Detailed Mortality Rate Tables
• Appendix B. Meeting Agendas
• Appendix C. Biographical Sketches

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. (2021). High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. https://doi.org/10.17226/25976.

Digital Object Identifier: https://doi.org/10.17226/25976

Library of Congress Control Number: 2021938874

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