Is economic insecurity to blame for the increase in deaths among middle-aged whites?

The death rate among middle-aged non-Hispanic whites in the United States increased between 1999 and 2013, according to a new study by Anne Case and Angus Deaton. In other rich nations it fell during this period, and it had been falling here in the US in prior years.

From Case and Deaton, “Rising Morbity and Mortality,” 2015

What caused this shift? One hypothesis, advanced by Case and Deaton and by some others, points to rising economic insecurity and stagnant wages and incomes. I’m skeptical.

  • Trends in wages, household incomes, and economic security in the US were about the same from 1979 to 1995 as they were in the 2000s (see here, here, and here). Yet Case and Deaton find that the death rate for middle-aged whites increased only in the latter period, not in the former.
  • Around 80% of middle-aged whites are homeowners. From 1999 to 2006, the first half of the Case-Deaton period, home values appreciated rapidly. So even though many were experiencing job insecurity and wage and income stagnation, quite a few also enjoyed a significant increase in wealth. Yet the rise in the death rate among middle-aged whites was, if anything, faster during this period than in the period of falling home prices after 2006.
  • The Great Recession of 2008-09 increased economic insecurity among middle-aged whites. Employment rates dropped and household incomes shrank. Yet there was no acceleration in the increase in middle-aged white deaths.
  • Whites, African Americans, and Hispanics have experienced similar trends in wages, household incomes, and income instability since the late 1990s. But while the death rate among the middle-aged has risen for whites, it has fallen sharply for blacks and Hispanics.
  • Men and women have experienced similar trends in wages since the late 1990s. But as Andrew Gelman has found, the middle-aged white death rate has increased  more for women than for men.
  • Trends in household income and in income instability since the late 1990s vary a good bit across the US states. Yet Case and Deaton report a rise in self-assessed poor health (correlated with mortality) among middle-aged whites in all 50 states.

If economic insecurity isn’t the chief driver, what is? I’m not sure, but the increase in availability of prescription opiod pain relievers such as oxycodone and methadone, noted by Case and Deaton and others, might be a more plausible culprit.