Can Labor Market Policies Reduce Deaths of Despair?
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ABSTRACT:
SUBMITTER: Dow WH
PROVIDER: S-EPMC8403492 | biostudies-literature |
REPOSITORIES: biostudies-literature
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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.
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Project description:BackgroundA startling population health phenomenon has been unfolding since the turn of the 21st century. Whites in the United States, who customarily have the most favorable mortality profile of all racial groups, have experienced rising mortality rates, without a commensurate rise in other racial groups. The two leading hypotheses to date are that either contemporaneous economic conditions or longer-term (post-1970s) economic transformations have led to declining economic and social prospects of low-educated whites, culminating in "deaths of despair." We re-examine these hypotheses and investigate a third hypothesis: mortality increases are attributable to (false) perceptions of whites that they are losing social status.MethodsUsing administrative and survey data, we examined trends and correlations between race-, age- and, education-specific mortality and a range of economic and social indicators. We also conducted a county-level fixed effects model to determine whether changes in the Republican share of voters during presidential elections, as a marker of growing perceptions of social status threat, was associated with changes in working-age white mortality from 2000 to 2016, adjusting for demographic and economic covariates.FindingsRising white mortality is not restricted to the lowest education bracket and is occurring deeper into the educational distribution. Neither short-term nor long-term economic factors can themselves account for rising white mortality, because parallel trends (and more adverse levels) of these factors were being experienced by blacks, whose mortality rates are not rising. Instead, perceptions - misperceptions - of whites that their social status is being threatened by their declining economic circumstances seems best able to reconcile the observed population health patterns.ConclusionRising white mortality in the United States is not explained by traditional social and economic population health indicators, but instead by a perceived decline in relative group status on the part of whites - despite no actual loss in relative group position.
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Project description:ObjectivesWe investigate associations between adverse employment histories over an extended time period and health functioning in later life, and explore whether national labor market policies moderate the association.MethodsWe use harmonized life-history data from the Gateway to Global Aging Data on two European studies (SHARE and ELSA) linked to health beyond age 50 (men = 11,621; women = 10,999). Adverse employment histories consist of precarious, discontinued, and disadvantaged careers between age 25 and 50, and we use depressive symptoms, grip strength, and verbal memory as outcomes.ResultsAdverse employment histories between age 25 and 50 are associated with poor health functioning later in life, particularly repeated periods of unemployment, involuntary job losses, weak labor market ties, and disadvantaged occupational positions. Associations remain consistent after adjusting for age, partnership history, education and employment situation, and after excluding those with poor health prior to or during working life. We find no variations of the associations by national labor market policies.DiscussionOur study calls for increased intervention efforts to improve working conditions at early career stages. Despite the importance in shaping employment histories, the role of national policies in modifying the impact of employment on health is less clear.
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