Revisiting ‘deaths of despair’ among non-college-educated US whites

A 2015 paper by two Princeton University economists (one of whom, Angus Deaton, won a Nobel Prize in that year for other economic work) first highlighted what has come to be called “deaths of despair”—morbidity due to drug abuse, alcohol and suicide, with some related measures of heart disease and cancer, among non-college-educated white Americans (both men and women, but more so for men). Now, a broader analysis, published (in draft form) in the Brookings Institution Papers on Economic Activity, addresses some of the questions raised by the earlier study, but overall confirms the breadth and depth of the findings. The authors (Deaton and his wife, Anne Case) present evidence for the hypothesis that a worsening economic situation (wage growth stagnation, lack of employment) combined with a gradual breakdown in social structures (divorce rates, out-of-wedlock births) has led to rising mortality, most prominently for middle-aged, white American males lacking college degrees.

Mortality in the white, 50-54 age group has been rising since at least the turn of the century. credit: Brookings

The trend is all the more dramatic because mortality has declined for African Americans and Hispanic Americans over the same period of time. (see figure) While the entire US population is subject to roughly the same social and economic forces, the changes in mortality appear to be race- and sex-specific.

What does this have to do with the pharma industry? The Princeton economists take a swing at the manufacturers of opioid drugs: “The main beneficiaries of the opioids are not those who are addicted or who are dying from overdoses, but rather the pharmaceutical companies who have promoted their sales.” However, at this point it’s not black-and-white as to how much drug abuse is due to prescription opioids, and how much to street drugs formulated with synthetic opioids, or heroin. Overall, the paper is an insightful object lesson in population health analysis—a topic that is rising in strategic thinking about healthcare delivery, and will eventually influence therapies, including pharmaceuticals.