For middle-aged, white Washingtonians, a troubling death-rate trend

It’s a statistic that’s both saddening and surprising: For the past 15 years, the death rate for middle-aged white Americans has been rising — including here in Washington.

I looked into this data for the state after reading a New York Times article reporting on the work of two Princeton economists, Anne Case and Angus Deaton. Analyzing data from the Centers for Disease Control and Prevention (CDC), they found that — after decades of progress in reducing mortality — the death rate among non-Hispanic white Americans aged 45-54 began increasing after 1999. (The study has been criticized for not adjusting for age, which could account for some — but not all — of the increase; the authors stand by their work).

No other racial and ethnic groups in the U.S. have experienced a similar jump in death rates. Neither have older Americans. And mortality continues to decline for middle-aged whites in other industrialized nations. The increased rate of death is confined to middle-aged white Americans.

So what’s happening?

It’s not the big killers like heart disease and cancer that are to blame — those are in fact declining with advances in prevention and treatment. A sharp rise in suicide and deaths directly related to alcohol and drug abuse is the culprit, offsetting the gains made in treating various diseases. Some of this rise may be due to the increase in prescriptions of opioids for pain, the study’s authors note.

Analyzing the CDC data for Washington, I found that this trend is occurring here, too. But the Seattle area — as in so many ways — stands apart from the rest of the state.

The data shows that outside of King and Snohomish counties, the death rate for middle-aged whites is 20 percent higher in 2014 than it was in 1999. It now stands at 409 deaths for every 100,000 people. But in King and Snohomish counties, that rate has actually declined slightly, and is now about 299 deaths for every 100,000.

One thing that’s consistent throughout the state: For this age group, whites now have a higher mortality rate than nonwhites, which is a reversal from 1999.

Among all the major causes of death, substance abuse and suicide saw the steepest rise for this demographic group in Washington. About 300 more white Washingtonians age 45-54 died from these causes in 2014 than in 1999.

This gap between the Seattle area and the rest of the state makes sense. In their report, Case and Deaton note that the increase in deaths among white middle-age Americans is much more pronounced among the disadvantaged — in particular, those with a high-school diploma or less.

According to 2014 census data, in King County, 81 percent of white, non-Hispanic adults have continued their education beyond high school. In the rest of the state, it’s just 66 percent.

I spoke about this geographic divide between the Seattle area and the rest of the state with Jennifer Sabel, an epidemiologist with the Washington Department of Health. “Some of the research has looked at access to mental-health care, which is a lot higher in urban areas than rural areas — and King County has the lowest rate of suicide in the state,” she explained.

“When we looked at overdoses among the Medicaid population, there was some suggestion that lower-income people are more likely to be prescribed opioids for pain.” People with higher incomes have more options for treating pain, such as physical therapy and acupuncture, she added.

It isn’t fully understood why mortality from substance abuse and suicide is climbing for middle-aged whites but not minorities. I spoke about this with Hedy Lee, associate professor of sociology at the University of Washington, who studies issues of health disparities and race.

“There is a body of research suggesting that there are racial differences in how individuals cope with stress,” she says. For example, alcohol use tends to be higher for whites than for blacks, Latinos or Asians. Suicide rates are also higher for whites.

And there is a greater chance of prescription-drug abuse among whites because they have more access — research shows that whites are far more likely to be prescribed opioids than other racial or ethnic groups. “For whites, engaging in these types of risk behaviors is possibly a way to deal with stress, even though it obviously increases the risk of mortality.”

Lee says that better access to mental-health resources is crucial, particularly in poorer, rural communities. “There’s an increasing amount of stress being placed on disadvantaged groups. At one point, a high-school degree could buy you more in terms of the kind of job you could get, but that’s changing rapidly. These are things that blacks have been dealing with forever because of other forms of structural discrimination, but are now really hitting disadvantaged whites that they’ve maybe been protected from before.”