Death Rates Rising Among Middle-Aged and Younger Americans

Young and middle-aged adults ages 25- to 64-years old in the U.S. have been dying at higher rates since 2010, according to a new report from the National Academies of Sciences, Engineering, and Medicine.

The report, High and Rising Mortality Rates Among Working-Age Adults, says rising death rates have been striking working-age Americans, whose risk of dying from certain conditions — such as drug overdoses or hypertensive heart disease — has been climbing since the 1990s.

Data from the report is based from 1990-2017, pre-COVID-19 days. It documents a public health crisis sweeping the American workforce, which has profound implications for families, employers, and the U.S. economy. This trend was prevalent before the pandemic arrived, but working-age Americans have been deeply affected by the pandemic, the report notes. Americans are more likely to die before age 65 than peers in other rich nations.

The rising death rate is mainly due to drug overdoses, alcohol, suicides, and cardiometabolic conditions that include diabetes and heart diseases caused by high blood pressure and other conditions.

“We’re losing more and more Americans in the prime of their lives, in their most productive years, and in their parenting years,” said Kathleen Mullan Harris, James E. Haar Distinguished Professor of Sociology, University of North Carolina, and chair of the committee that wrote the report. “Our committee was stunned by this mounting crisis, which will only get worse. The most troubling themes in our report — higher mortality than our peer countries; major racial and ethnic, socio-economic, and geographic disparities; lack of access to health insurance and care — have all been exacerbated by the pandemic.”

Drugs, Alcohol, and Suicide

Drugs and alcohol are major contributors to the rise in working-age mortality, the report said. In that 27-year-long period, fatal drug overdoses in working-age Americans increased in every state, but increased most in Appalachia, New England, and the industrial Midwest.

The overdose epidemic was described to be created by a market flooded with highly addictive, deadly prescription and illicit drugs, and mounting demand for substances to bring relief from physical, mental, and psychological pain.

The rise in suicides was most dramatic for white men, according to the report. The increase in deaths, which began in the 1990s, occurred during disruptions in the U.S. economy that devastated families and communities, especially in Rust Belt and Appalachia where working-age death rates increased the most.

Mortality Disparities

In the report, it was found the increase in young death among Americans is more widespread, reaching young adults of all racial and ethnic groups, as well as in both rural and and metropolitan areas.

Death rates are higher and are increasing faster among working-age adults with less education and income, according to the report. Death rates among Black working-age adults have been very high for many years due to inequalities in socio-economic status, healthcare, housing, education, and more. Although progress has occurred in reducing the mortality gap between Black and white Americans, death rates in working-age Black people are now increasing the report said.

Cardiometabolic Diseases

The report also focuses on rising deaths from cardiometabolic diseases which are caused by conditions resulting from the obesity epidemic: diabetes, hypertension, and heart disease. Some of the most notable increases have been in the South and outside of large metropolitan areas.

Young adults ages 25 to 44 have been especially affected because most were born after 1980 when the obesity epidemic began. Younger adults have been more exposed to “obesogenic” environments — unhealthy diets and lack of safe, open space for exercise — for their entire lives. Compared to older adults, they became overweight at a younger age and are more likely to remain overweight or obese today.

To address working-age mortality, it's recommended the healthcare industry address:

• Policymakers should address substance use disorders to implement policies, prevent future crises, strengthen regulatory control, monitor prescription drugs and improve access to substance use and mental health services.
• Obesity prevention programs should start early in life and target children and teens most at risk for obesity, including racial and ethnic minorities, people living in poverty, and women.
• States that have not done so already should expand Medicaid coverage under the Affordable Care Act.
• Government and private organizations should fund research on more effective ways to prevent substance use disorders, reduce obesity, improve heart health, enhance behavioral health services for mental illness, and help those struggling to stop smoking or to obtain effective treatments for chronic diseases.
• Government and private organizations should encourage creative research strategies that bring together different disciplines to unpack the complex influences on death rates, such as the role of social, economic, and cultural factors at the national, state, community, family, and individual levels.
• To reduce and ultimately eliminate racial/ethnic and other socio-economic inequalities that continue to drive racial/ethnic disparities in U.S. working-age mortality, policymakers and decision-makers at all levels of society will need to dismantle structural racism and discriminatory policies of exclusion in areas such as education, employment and pay, housing, lending, civic participation, criminal justice, and health care.