The year 2017 marked the third year in a row that life expectancy in the United States had fallen, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918–1919). Already ranked relatively low in life expectancy (26th) in 2015 among the 35 countries that make up the Organisation for Economic Co-operation and Development, the United States would lose even more ground in its global position in national health and well-being. Research had already uncovered some troubling mortality trends and disparities before 2015 and was focused on the search for explanations. Early findings pointed to rising mortality rates among middle-age White adults, although the trends soon revealed that younger adults were also at risk, as were other racial/ethnic groups, such that premature mortality in the working ages of 25–64 was becoming more common in the United States than in prior years and in comparison with its international peers.

In this context, in 2018 the National Institute on Aging and the Robert Wood Johnson Foundation requested that the National Academies of Sciences, Engineering, and Medicine undertake a study on high and rising rates of midlife mortality and concomitant widening social differentials. In response to that request, the National Academies appointed the Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities (under the standing Committee on Population) to carry out the task. Twelve scholars representing a broad array of disciplines—including demography, economics, epidemiology, medicine, public health, sociology, and biostatistics—were included on the committee, which met six times in person over a 2-year period.

This report presents a considerable body of information. The committee decided to conduct its own analysis of the trends in working-age mortality by age, sex, race and ethnicity, and geography using the most up-to-date data to establish its members’ collective understanding of the main drivers of the rising trend and disparities in working-age mortality in the United States. Findings from the committee’s analysis are presented in Part I of this report. The committee then conducted a comprehensive review of the research on rising working-age mortality to evaluate evidence on what had changed in American society to bring about the change in mortality rates and how the patterns of change differed for population subgroups. Findings on the explanations for the rise in working-age mortality are presented in Part II of the report. The committee’s work was arduous because the amount of data was massive; the problem was complex; and the unique trends by age, sex, race and ethnicity, and geography multiplied that complexity. In this report, the committee attempts to communicate these complexities while at the same time identifying the main drivers of high and rising working-age mortality based on current research and their implications for the future. The committee was also very deliberate and conscientious in its recommendations for further data collection, research, and policy.

This study would not have been possible without the contributions of many people. Special thanks go to the members of the study committee, who dedicated extensive time, thought, and energy to this task. Committee members conducted extensive analysis in generating Part I of the report, often enlisting their students and research assistants to help. Julene Cooney (Syracuse University), Nick Graetz (University of Pennsylvania), Jermaine Heath (Harvard Medical School), Fitore Hyseni (Syracuse University), Jeron Impreso (Harvard Medical School), Sammer Marzouk (Harvard University), Harrison Mintz (Harvard Medical School), Rohan Shah (Harvard Medical School), and Yue Sun (Syracuse University) assisted the committee in analyzing mortality trends and assessing selected research literatures. Thanks are also due to Anna Mueller (Indiana University Bloomington), who provided valuable guidance to the committee on suicide deaths.

The committee received useful information and insights from presentations by outside experts at open sessions of committee meetings. We thank Erika Blacksher (University of Washington), Anne Case (Princeton University), Andrew J. Cherlin (Johns Hopkins University), Kathleen Frydl, Carol Graham (Brookings Institution), Christopher Ruhm (University of Virginia), and Jennifer Silva (Indiana University Bloomington).

Several staff members of the National Academies made significant contributions to the report. Ellie Grimes and Mary Ghitelman made sure that the committee meetings ran smoothly, assisted in preparing the manuscript, and otherwise provided key administrative and logistical support; Kirsten Sampson Snyder managed the report review process; Yvonne Wise managed the report production process; and Brian Harris-Kojetin, director of the Committee on National Statistics, provided valuable guidance and oversight. We also thank Rona Briere for skillful editing.

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report: Andrew J. Cherlin, Department of Sociology, Johns Hopkins University; Sandro Galea, School of Public Health, Boston University; Mark D. Hayward, Population Research Center, University of Texas at Austin; Ichiro Kawachi, Department of Social and Behavioral Sciences, Harvard School of Public Health; Peter Muennig, Mailman School of Public Health, Columbia University; Samuel H. Preston, Population Studies Center, University of Pennsylvania; Albert L. Siu, Mount Sinai Medical Center; and Frank A. Sloan, Economics Department and Center for Health Policy, Law and Management, Duke University.

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Bradford Gray, Urban Institute, and Eileen Crimmins, University of Southern California. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Kathleen Mullan Harris, Chair

Malay K. Majmundar, Study Director

Tara Becker, Program Officer

Committee on Rising Midlife Mortality

Rates and Socioeconomic Disparities