Sunday, January 17, 2016

Drug Overdoses Propel Rise in Mortality Rates of Young Whites: Note for a lecture, "E Pluribus Unum? What Keeps the United States United"

By GINA KOLATA and SARAH COHEN JAN. 16, 2016, New York Times

Drug overdoses are driving up the death rate of young white adults in the
United States to levels not seen since the end of the AIDS epidemic more than
two decades ago — a turn of fortune that stands in sharp contrast to falling
death rates for young blacks, a New York Times analysis of death certificates
has found.

The rising death rates for those young white adults, ages 25 to 34, make
them the first generation since the Vietnam War years of the mid-­1960s to
experience higher death rates in early adulthood than the generation that
preceded it.

The Times analyzed nearly 60 million death certificates collected by the
Centers for Disease Control and Prevention from 1990 to 2014. It found death
rates for non-­Hispanic whites either rising or flattening for all the adult age
groups under 65 — a trend that was particularly pronounced in women — even
as medical advances sharply reduce deaths from traditional killers like heart
disease. Death rates for blacks and most Hispanic groups continued to fall.
The analysis shows that the rise in white mortality extends well beyond
the 45-­ to 54­-year-­old age group documented by a pair of Princeton
economists in a research paper that startled policy makers and politicians two
months ago.

While the death rate among young whites rose for every age group over
the five years before 2014, it rose faster by any measure for the less educated,
by 23 percent for those without a high school education, compared with only 4
percent for those with a college degree or more.

The drug overdose numbers were stark. In 2014, the overdose death rate
for whites ages 25 to 34 was five times its level in 1999, and the rate for 35-­ to
44­-year­-old whites tripled during that period. The numbers cover both illegal
and prescription drugs.

“That is startling,” said Dr. Wilson Compton, the deputy director of the
National Institute on Drug Abuse. “Those are tremendous increases.”
Rising rates of overdose deaths and suicide appear to have erased the
benefits from advances in medical treatment for most age groups of whites.
Death rates for drug overdoses and suicides “are running counter to those of
chronic diseases,” like heart disease, said Ian Rockett, an epidemiologist at
West Virginia University.

In fact, graphs of the drug overdose deaths look like those of deaths from
a new infectious disease, said Jonathan Skinner, a Dartmouth economist. “It is
like an infection model, diffusing out and catching more and more people,” he

Yet overdose deaths for young adult blacks have edged up only slightly.
Over all, the death rate for blacks has been steadily falling, largely driven by a
decline in deaths from AIDS. The result is that a once yawning gap between
death rates for blacks and whites has shrunk by two­-thirds.

“This is the smallest proportional and absolute gap in mortality between
blacks and whites at these ages for more than a century,” Dr. Skinner said. If
the past decade’s trends continue, even without any further progress in AIDS
mortality, rates for blacks and whites will be equal in nine years, he said.
There is a reason that blacks appear to have been spared the worst of the
narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have
found that doctors are much more reluctant to prescribe painkillers to
minority patients, worrying that they might sell them or become addicted.

“The answer is that racial stereotypes are protecting these patients from
the addiction epidemic,” said Dr. Kolodny, a senior scientist at the Heller
School for Social Policy and Management at Brandeis University and chief
medical officer for Phoenix House Foundation, a national drug and alcohol
treatment company.

Not many young people die of any cause. In 2014, there were about
29,000 deaths out of a population of about 25 million whites in the 25-­to­-34
age group. That number had steadily increased since 2004, rising by about
5,500 — about 24 percent — while the population of the group as a whole rose
only 5 percent. In 2004, there were 2,888 deaths from overdoses in that
group; in 2014, the number totaled 7,558.

Mortality rates, said Mark D. Hayward, a professor of sociology at the
University of Texas at Austin, are one of the most sensitive measures of quality
of life.

By that measure, said Anne Case, a Princeton economist, “there’s a real
rumbling that bad things are coming down the pike.” Dr. Case made the
original observation with her husband, the Nobel laureate Angus Deaton, in a
published paper that showed death rates for middle­-aged whites rising in
contrast to those in every other rich country.

For young non­-Hispanic whites, the death rate from accidental poisoning
— which is mostly drug overdoses — rose to 30 per 100,000 from six over the
years 1999 to 2014, and the suicide rate rose to 19.5 per 100,000 from 15, the
Times analysis found.

For non­-Hispanic whites ages 35 to 44, the accidental poisoning rate rose
to 29.9 from 9.6 in that period. And for non-­Hispanic whites ages 45 to 54 —
the group studied by Dr. Case and Dr. Deaton — the poisoning rate rose to
29.9 per 100,000 from 6.7 and the suicide rate rose to 26 per 100,000 from
16, the Times analysis found.

But deaths from the traditional killers for which treatment has greatly
improved over the past decade — heart disease, H.I.V. and cancer — went

Drug abuse, of both illegal drugs like heroin and prescription painkillers,
has become a part of the American political discourse as never before in this
country, with some presidential candidates, including Jeb Bush and Carly
Fiorina, telling stories of addiction in their own families.
Sad stories abound.

Maline Hairup died of a heroin overdose on Aug. 24, 2014. She was 38
and a Mormon, engaged to be married in the Salt Lake City Temple, near her
home. Her religion taught her to spurn addictive substances — no alcohol, no
caffeine. But that night, after years of taking prescription narcotics for chronic
pain complicated by mental illness, she tried heroin, her sister Mindy Vincent
said. Ms. Vincent believes it was the only time her sister used that drug.
There are men like Steve Rummler, who lived in Minnesota and died of a
heroin overdose at age 43, taking the drug after becoming addicted to
OxyContin, which was initially prescribed for a back injury. “He didn’t
understand the risks,” said his mother, Judy Rummler.

Researchers are struggling to come up with an answer to the question of
why whites in particular are doing so poorly. No one has a clear answer, but
researchers repeatedly speculate that the nation is seeing a cohort of whites
who are isolated and left out of the economy and society and who have gotten
ready access to cheap heroin and to prescription narcotic drugs.

“There are large numbers of people who never get established in the
economy, who live outside family relationships and are on the edge of
poverty,” Dr. Hayward said. Many end up taking prescription narcotics, he

“Poverty and stress, for example, are risk factors for misuse of
prescription narcotics,” Dr. Hayward said.

Eileen Crimmins, a professor of gerontology at the University of Southern
California, said the causes of death in these younger people were largely social
— “violence and drinking and taking drugs.” Her research shows that social
problems are concentrated in the lower education group.

“For too many, and especially for too many women,” she said, “they are
not in stable relationships, they don’t have jobs, they have children they can’t
feed and clothe, and they have no support network.”

“It’s not medical care, it’s life,” she said. “There are people whose lives are
so hard they break.”

A version of this article appears in print on January 17, 2016, on page A1 of the New York edition with the headline: Drug Overdoses Propel Rise in Mortality Rates of Whites.

No comments: