Deaths of Despair(ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities

Introduction: Recent media coverage and research have emphasized increasing mortality rates for middle-aged white Americans. A concern is that this has shifted focus away from the health burden of other population subgroups. This cross-sectional study compares the magnitude of racial/ethnic mortality disparities across age groups and investigates how changing mortality trends have affected these disparities.

Methods: Mortality data from 2007 to 2016 by race/ethnicity and age were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database in 2018‒2019. Absolute and relative racial/ethnic mortality disparities by age groups were determined by calculating between-group variance and mortality rate-adjusted between-group variance, respectively. Trends in disparities were analyzed using joinpoint regression modeling. Annual percentage change in rate-adjusted between-group variance was calculated for each trend segment as well as the relative contribution of each racial/ethnic group to the change.

Results: The largest relative and absolute disparities were found in the youngest and oldest age groups, respectively. Trend analysis detected an inflection point between 2009 and 2012 for most age groups where a period of decreasing disparities changed to one of increasing disparities. Three quarters of the decreasing disparities in Period 1 were resultant of lowering mortality among the black subgroup. During Period 2, the increase in child disparities were due to increased mortality among blacks, whereas increased adult disparities were due to increased mortality among whites shifting the overall mean away from subgroups with lower rates.

Conclusions: Racial/ethnic mortality disparities persist and are widening for some age groups. It is imperative to maintain focus on the age groups where those with historically poorer health are contributing most to the increase.