‘DEATHS OF DESPAIR’

ECU study finds rising death rate for middle-aged whites in North Carolina

Middle-aged whites in North Carolina are dying at an unprecedented rate, according to a new study by researchers at East Carolina University.

The study – authored by ECU professor emeritus Dr. Chris Mansfield and colleagues in the Department of Public Health, and published in the current issue of the North Carolina Medical Journal – found that suicide and liver disease were major contributors to the increase in deaths from 2000 to 2013 for whites ages 45 to 54.

Dr. Chris Mansfield (right) points out how death rates are declining for nonwhites but going up for whites.
(Photos by Rich Klindworth)

“A large portion of the increase in mortality is attributed to ‘deaths of despair’— suicide, liver disease, drug overdose and behaviors that lead to these deaths,” said Mansfield.

The study reported a 52-percent increase in the suicide rate and a 38.8-percent increase in midlife white deaths due to liver disease from 2000 to 2013, which translates into 623 more middle-aged whites who died by suicide in this time period than would have died if the 2000 rate had held constant. According to the study, these numbers are projected to rise through 2020.

The death rates rose most dramatically for midlife whites in the state’s 40 most economically distressed counties, termed Tier 1 counties by the N.C. Department of Commerce. In these counties, midlife white deaths increased for all causes studied, which included heart disease, lung cancer, diabetes, suicide and liver disease. These causes of death were linked to a rise in health risk factors like drinking, obesity and lack of health insurance. The study did not take into account the impact of opioid drug use because the authors questioned the validity of the coding on death certificates.

“The poor get sick, the sick get poorer,” said Mansfield. “There’s an economics circumstance, that’s for sure … the relationship between poverty or income and health. And we see it play out on the effect on health most in the poorest counties.”

Such findings by Mansfield and colleagues mirror national trends, as the death rates for middle-aged whites have risen across the country. However, the trend is not an international one. There was an increase in life expectancy for midlife whites in Canada and European countries for the same study period, from 2000 to 2013.

“What’s different about European countries? Well, safety net programs,” Mansfield said. “I guess we’re going to have to question the value of our safety net programs, and one of those would be Medicaid. Can we expand Medicaid? Can we preserve access to health care? It doesn’t look like there’s any intention to do that.”

And as midlife white death rates rise nationally, how are nonwhites faring in comparison? This study showed that in North Carolina the rising trend in midlife white deaths contrasts with that of nonwhites, even in the poorest counties.

“What was most surprising in this study was not only that the mortality of whites had increased by about 6 percent over 13 years, but that it had decreased for nonwhites by 30 percent,” said Mansfield. “And when we draw the graphs and extend out the trends, we could see the possibility of some racial disparities being eliminated in North Carolina.”

Mansfield and his colleagues Katherine Jones (center) and Satomi Imai (right) take a closer look at the data they’ve collected over a 14 year period to monitor midlife death rates in North Carolina.

This finding that life expectancy was on the rise for middle-aged nonwhites seems counterintuitive in light of the reality that risk factors such as poor economic circumstance and lack of insurance were reportedly worse for nonwhites than whites. However, Mansfield said these risk factors don’t seem to have the same effect on health behaviors for nonwhites. For example, there was an increase in binge drinking among whites but not among nonwhites.

“This study highlights a state and national trend that should be the focus of ongoing study and policy debate,” said Adam Zolotor, president and CEO of the North Carolina Institute of Medicine, a co-publisher of the NCMJ. “However, this paper also shows that nonwhite mortality rates still exceed white mortality rates by 25 percent in middle age, an ongoing product of poverty and structural racism. Also, by focusing on middle age, the authors do not capture the persistent and tragic inequity still seen in infant mortality rates and among young nonwhite men.”

Mansfield and colleagues conclude their study by asking researchers if it’s still appropriate to benchmark improvement for one group against another. For future studies, Mansfield would like to see researchers develop and observe measures of well-being like optimism in population groups, life satisfaction, stress and resilience. 

“Does good health depend on hope?” the study authors wrote. “Does hope vary across race, culture, time and economic circumstance?”

To read the full study, “Increased Mortality and Health Risk Behaviors of Midlife White North Carolinians: A Marked Contrast to Nonwhites,” visit ncmedicaljournal.com.