DO DEATHS OF DESPAIR MOVE TOGETHER? COUNTY-LEVEL MORTALITY CHANGES BY SEX AND URBANIZATION, 1990-2017.
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SUBMITTER: Simon DH
PROVIDER: S-EPMC8316609 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
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DO DEATHS OF DESPAIR MOVE TOGETHER? COUNTY-LEVEL MORTALITY CHANGES BY SEX AND URBANIZATION, 1990-2017.
Simon Daniel H DH Masters Ryan K RK
American journal of epidemiology 20210601 6
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Project description:Life expectancy for US White men and women declined between 2013 and 2017. Initial explanations for the decline focused on increases in "deaths of despair" (i.e., deaths from suicide, drug use, and alcohol use), which have been interpreted as a cohort-based phenomenon afflicting middle-aged White Americans. There has been less attention on Black mortality trends from these same causes, and whether the trends are similar or different by cohort and period. We complement existing research and contend that recent mortality trends in both the US Black and White populations most likely reflect period-based exposures to 1) the US opioid epidemic and 2) the Great Recession. We analyzed cause-specific mortality trends in the United States for deaths from suicide, drug use, and alcohol use among non-Hispanic Black and non-Hispanic White Americans, aged 20-64 years, over 1990-2017. We employed sex-, race-, and cause-of-death-stratified Poisson rate models and age-period-cohort models to compare mortality trends. Results indicate that rising "deaths of despair" for both Black and White Americans are overwhelmingly driven by period-based increases in drug-related deaths since the late 1990s. Further, deaths related to alcohol use and suicide among both White and Black Americans changed during the Great Recession, despite some racial differences across cohorts.
| S-EPMC8579049 | biostudies-literature
Project description:ImportanceIncreasing mortality from suicide, drug overdose, and alcohol-related liver disease (collectively referred to as deaths of despair) is a critical public health crisis. Income inequality and social mobility have been separately associated with all-cause mortality; however, no studies have examined their interaction with these preventable deaths.ObjectiveTo assess the interaction between income inequality and social mobility with deaths of despair among working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations.Design, setting, and participantsThis cross-sectional study analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database on county-level deaths of despair from 2000 to 2019 across racial and ethnic groups. Statistical analysis was performed from January 8 to May 20, 2023.ExposuresThe primary exposure of interest was county-level income inequality, measured by the Gini coefficient. Another exposure was race- and ethnicity-specific absolute social mobility. Tertiles for the Gini coefficient and social mobility were created to evaluate the dose-response association.Main outcomes and measuresThe main outcomes were adjusted risk ratios (RRs) of deaths from suicide, drug overdose, and alcoholic liver disease. The interaction between income inequality and social mobility was formally tested on both the additive and multiplicative scales.ResultsThe sample included 788 counties for Hispanic populations, 1050 counties for non-Hispanic Black populations, and 2942 counties for non-Hispanic White populations. Over the study period, 152 350, 149 589, and 1 250 156 deaths of despair were recorded for working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. Compared with the reference group (counties with low income inequality and high social mobility), counties with greater income inequality (high inequality: RR, 1.26 [95% CI, 1.24-1.29] for Hispanic populations; RR, 1.18 [95% CI, 1.15-1.20] for non-Hispanic Black populations; and RR, 1.22 [95% CI, 1.21-1.23] for non-Hispanic White populations) or less social mobility (low mobility: RR, 1.79 [95% CI, 1.76-1.82] for Hispanic populations; RR, 1.64 [95% CI, 1.61-1.67] for non-Hispanic Black populations; and RR, 1.38 [95% CI, 1.38-1.39] for non-Hispanic White populations) had higher RRs for deaths of despair. In counties with high income inequality and low social mobility, positive interactions were observed on the additive scale for Hispanic populations (relative excess risk due to interaction [RERI], 0.27 [95% CI, 0.17-0.37]), non-Hispanic Black populations (RERI, 0.36 [95% CI, 0.30-0.42]), and non-Hispanic White populations (RERI, 0.10 [95% CI, 0.09-0.12]). In contrast, positive interactions on the multiplicative scale were found only for non-Hispanic Black populations (ratio of RRs, 1.24 [95% CI, 1.18-1.31]) and non-Hispanic White populations (ratio of RRs, 1.03 [95% CI, 1.02-1.05]), but not for Hispanic populations (ratio of RRs, 0.98 [95% CI, 0.93-1.04]). In the sensitivity analyses using continuous Gini coefficient and social mobility, a positive interaction was observed between higher income inequality and lower social mobility with deaths of despair on both the additive and multiplicative scales for all 3 racial and ethnic groups.Conclusions and relevanceThis cross-sectional study found that the joint exposure of unequal income distribution and lack of social mobility was associated with additional risks for deaths of despair, suggesting that addressing the underlying social and economic conditions is crucial in responding to the epidemic of deaths of despair.
| S-EPMC10339154 | biostudies-literature
Project description:IntroductionThe purpose of this study is to examine nationwide disparities in drug, alcohol, and suicide mortality; evaluate the association between county-level characteristics and these mortality rates; and illustrate spatial patterns of mortality risk to identify areas with elevated risk.MethodsThe authors applied a Bayesian spatial regression technique to investigate the association between U.S. county-level characteristics and drug, alcohol, and suicide mortality rates for 2004-2016, accounting for spatial correlation that occurs among counties.ResultsMortality risks from drug, alcohol, and suicide were positively associated with the degree of rurality, the proportion of vacant housing units, the population with a disability, the unemployed population, the population with low access to grocery stores, and the population with no health insurance. Conversely, risks were negatively associated with Hispanic population, non-Hispanic Black population, and population with a bachelor's degree or higher.ConclusionsSpatial disparities in drug, alcohol, and suicide mortality exist at the county level across the U.S. social determinants of health; educational attainment, degree of rurality, ethnicity, disability, unemployment, and health insurance status are important factors associated with these mortality rates. A comprehensive strategy that includes downstream interventions providing equitable access to healthcare services and upstream efforts in addressing socioeconomic conditions is warranted to effectively reduce these mortality burdens.
| S-EPMC10997338 | biostudies-literature
Project description:Recent deaths of despair literature hypothesizes that financial losses are a key mechanism through which education is associated with higher risk for drug use, alcohol abuse, and suicidal ideation. However, few studies have empirically assessed the significance of this harmful pathway or compared it to other hypothesized explanations. Drawing on data from over 8000 respondents in the National Longitudinal Study of Adolescent to Adult Health, this paper finds that lower education-levels are associated with heightened risk of drug use, painkiller use, frequent binge drinking, and suicidal ideation; in turn, decompositions reveal that financial losses mediate about 20 percent of the association between education with drug use and suicidal ideation. The results support a core assumption of the deaths of despair hypothesis-that financial losses among those with low education-levels drive the increase in harmful despair-associated behaviors, which often precede disease and mortality. Future research should extend this work by linking individual-level socioeconomic and health patterns with broader economic changes to better understand how individuals' educational attainment interacts with macro-level structural factors to shape their vulnerability to despair-associated disease and death.
| S-EPMC7944094 | biostudies-literature
Project description:Recent demographic findings show increased rates of death due to suicide, drug addictions, and alcoholism among midlife white adults of lower socioeconomic status (SES). These have been described as "deaths of despair" though little research has directly assessed psychological vulnerabilities. This study used longitudinal data from the Midlife in the U.S. (MIDUS) study to investigate whether low levels of eudaimonic and hedonic well-being predict increased risk of deaths of despair compared to other leading causes of death (cancer, heart disease). The investigation focused on 695 reported deaths with cause of death information obtained from 2004 to 2022 via NDI Plus. Key questions were whether risk for deaths due to despair (suicide, drug addiction, alcoholism) compared to deaths due to cancer or heart disease were differentially predicted by deficiencies in well-being, after adjusting for sociodemographic variables. Low levels of purpose in life, positive relations with others, personal growth and positive affect predicted significantly greater likelihood of deaths of despair compared to deaths due to heart disease, with such patterns prominent among better-educated adults. The findings bring attention to ongoing intervention efforts to improve psychological well-being.
| S-EPMC10418686 | biostudies-literature
Project description: Not available
| S-EPMC6980955 | biostudies-literature
Project description:Do minimum wages and the earned income tax credit (EITC) mitigate rising "deaths of despair?" We leverage state variation in these policies over time to estimate event study and difference-in-differences models of deaths due to drug overdose, suicide, and alcohol-related causes. Our causal models find no significant effects on drug or alcohol-related mortality, but do find significant reductions in non-drug suicides. A 10 percent minimum wage increase reduces non-drug suicides among low-educated adults by 2.7 percent, and the comparable EITC figure is 3.0 percent. Placebo tests and event-study models support our causal research design. Increasing both policies by 10 percent would likely prevent a combined total of more than 700 suicides each year.
| S-EPMC8403492 | biostudies-literature
Project description:Recent research has implicated economic insecurity in increasing midlife death rates and "deaths of despair," including suicide, chronic liver disease, and drug and alcohol poisoning. In this ecological longitudinal study, we evaluated the association between changes in economic insecurity and increases in deaths of despair and midlife all-cause mortality in US counties during 2000-2015. We extended a previously developed measure of economic insecurity using indicators from the Census and Federal Reserve Bank in US counties for the years 2000 and 2010. Linear regression models were used to estimate the association of change in economic insecurity with change in death rates through 2015. Counties experiencing elevated economic insecurity in either 2000 or 2010 had higher rates of deaths of despair and all-cause midlife mortality at baseline but similar rates of increase in deaths of despair from 2001 to 2015 compared with counties with stable low economic insecurity. Counties in the highest tertile of economic insecurity in 2000 and 2010 had 41% (95% confidence interval: 1.36, 1.47) higher midlife mortality rates at baseline and a rate of increase of 2% more per 5-year period (95% confidence interval: 1.00, 1.03) than counties with stable low economic insecurity. Economic insecurity may represent a population-level driver of US death trends.
| S-EPMC7212405 | biostudies-literature
Project description: Not available
| S-EPMC6450301 | biostudies-literature
Project description:Over the past few years, there has been a progressive increase in premature deaths attributable to suicide, drug overdose, and alcohol-related liver disease that impact life expectancy. Regarding the relationship with contextual effects, the evidence is developing, especially in countries with a peripheral economy, as is the case of Brazil. We carried out an analysis aimed at estimating the relationship between socioeconomic insecurity and deaths due to despair in Brazilian cities. We used 5,570 counties' data to create clusters concerning socioeconomic development and then analyzed age-adjusted mortality rates (ASMR) from each of them and compared them using the ANOVA test. Cluster analysis generated two groups of Brazilian municipalities. DoD rates are consistently higher in the group that experiences more deprivation. However, considering differences between 2010 and 2019, the increase in rates was higher in the group with less deprivation experience (48.82 % vs. 39.53 %) We verified an existing gap between the clusters before the beginning of economic stagnation in 2010 The gap between those two groups decreased from 20.58 % (p < 0.001) in 2010 to 14.03 % in 2019 (p = 0.034). The conjuncture of economic crises creates mortality differentials in certain population groups. Also, significant inequalities explain how causes of death from despair affect different subpopulations. Our first approach assessed this assumption, and we could check those differentials at an ecological level. Public policies should focus on reducing the difference in mortality from despair between higher and lower socioeconomic strata.
| S-EPMC10874878 | biostudies-literature