"Deaths of despair" on the rise for middle-aged white people in North Carolina

Mortality rates for mid-life white people in North Carolina have increased over a period of 13 years. 

 '"Deaths of despair" on the rise for middle-aged white people in North Carolina

January 11, 2018

Middle-aged whites dying at higher rates

Things have gotten worse for middle-aged white North Carolinians. From 2000 to 2013, their mortality rate increased by almost six percent. This dire picture reflects a national trend that made headlines in 2015 when two Princeton economists published research showing that middle-aged whites in the United States were dying at higher rates than in European countries and Canada. 

“It’s not good news for mid-life whites and those who care about mid-life whites,” said Chris Mansfield, Ph.D. 

Mansfield and a group of researchers at East Carolina University found that by 2013, there were close to 2,000 more deaths among whites aged 45-54 years than there would have been if the mortality rate had stayed the same as it was in 2000. The team used mortality data and survey questions on risk factors to discern how these deaths might be occurring. Their results were published in the North Carolina Medical Journal

Deaths of despair

The study results show that suicide and liver disease played a major role in the increased mortality rate. 

“We call these deaths of despair,” said Mansfield. “Because many of these deaths are associated with risk factors like binge drinking, smoking and other behaviors linked to stress and hopelessness." The team didn’t consider opioid overdose as a factor because they didn’t expect the data to be accurately collected before 2013, when public awareness of the opioid epidemic caused greater scrutiny on death certificates. 

Their research, however, showed some hopeful results for middle-aged nonwhites; their mortality rates, although still higher than whites, have decreased by 30 percent over the same time period. By 2020, the gap between whites and nonwhites will disappear. That’s partially because the rate for whites is getting worse over time, but study authors wrote that more research is needed to understand why middle-aged nonwhites are doing better.  

“We still have unjust racial disparities,” said Mansfield “Although it looks like we’re making some progress.” 

Economic inequality plays a role

Perhaps unsurprisingly, the worst and largest increases in mortality rates occurred in the state’s poorest counties. According to the U.S. Bureau of Labor Statistics, the average yearly wages for these counties are at least 25 percent below the state’s overall average of $45,000. And although the state’s overall productivity has increased since the Great Recession, wages have decreased overall by four percent. 

Mansfield said that it’s possible middle-aged whites in poor counties might be comparing their economic situation to that of their parents and grandparents. 

Jim Mitchell Ph.D., a sociologist from ECU unconnected to the study, said the study poses more interesting questions. 

“I think we need to learn more about what’s inside the heads of whites in these poorer areas,” he said. “Did they expect to be doing better?” 

Unanswered Questions and Policy Implications

To Mansfield, the most puzzling result from the study is the difference between nonwhites, who reported being sicker and having less insurance coverage, and whites. The study also noted that whites reported a greater loss in insurance than nonwhites during the study period. Mansfield said the policy implications are clear: "What's the difference between our country and European countries and Canada? Universal healthcare."

Mansfield also pointed out the precarious state of community health centers across the state, which accept patients regardless of insurance status. "Community health centers are in jeapordy," he said. "If we lose them, it's another chip away at the safety net."


- Rossie Izlar

Rossie Izlar is the associate producer of Sci Tech Now North Carolina, a weekly show highlighting the latest science stories from North Carolina and across the nation.