
A group of middle-aged whites in the U.S. is dying at a startling rate - dsmithatx
https://www.washingtonpost.com/national/health-science/a-group-of-middle-aged-american-whites-is-dying-at-a-startling-rate/2015/11/02/47a63098-8172-11e5-8ba6-cec48b74b2a7_story.html
======
timmaah
NYTimes take on it from yesterday:
[https://news.ycombinator.com/item?id=10495758](https://news.ycombinator.com/item?id=10495758)

------
cubano
I can _totally_ understand why individuals with substance abuse problems give
up in their early 50's and commit suicide, as I personally have felt this tug
at times.

It is very difficult, both emotionally and financially, to look back at a life
of wrecked relationships and blown opportunities and not feel an intense
disgust with yourself and a deep fear about the future.

Also, there is simply no place for you in society anymore. In your 50's, you
are almost completely judged by your status in life; your house, your cars,
your relationships...someone fighting addiction for 30 years will have little
to none of this.

Even super close old friends eventually give up on you and stop returning
calls.

I often say these days the only real regrets I have in life is hurting those
who loved me due to my substance abuse lifestyle.

~~~
rayiner
> Also, there is simply no place for you in society anymore. In your 50's, you
> are almost completely judged by your status in life; your house, your cars,
> your relationships...someone fighting addiction for 30 years will have
> little to none of this.

Much of the country is not that way. My father in law is that age, and I think
very few people in his community would judge him by that standard. He's a
prominent member of a popular foodie Facebook group in his town, to the point
where people stop him in the street and take selfies with him. In his
community, that's a much bigger deal than owning a Porsche.

Almost all of my wife's side of the family (from coastal Oregon) is like that.
Most of her cousins are doing great things with food, art, or in the church,
and people praise them for that. When they ask what we do (we're both
corporate attorneys), they nod politely. I am sure they would be horrified--
rather than impressed--to hear how much we spend on rent.

~~~
sanderjd
Those are just _different_ status indicators. The parent's point that people
are expected to accumulate status stands.

~~~
rayiner
A former drug abuser starting over at 50 has a fighting chance at finding a
"place in society" when that society cares more about how you contribute your
time than about your accumulated wealth.

~~~
sanderjd
This is a good point, and I'm finding on re-reading my comment that I was too
flippant. I do think the point stands that it is easier for younger people to
find their place without existing expertise or relationships, but certainly
it's easier to build status in some communities than others.

------
sithadmin
Though I'm still on the fence about the validity of the comparison, an
argument that I've seen online regarding these stats is that it echoes similar
trends in addiction and suicide that manifested in post-USSR Russia, which
were arguably driven by an increase in general despair and decline in quality
of life. Here's an interesting qualitative description of the phenomenon:
[http://www.nybooks.com/blogs/nyrblog/2014/sep/02/dying-
russi...](http://www.nybooks.com/blogs/nyrblog/2014/sep/02/dying-russians/)

Now, back to the contemporary statistics: the correlation between increased
mortality and socioeconomic groups 'hardest-hit' by recent economic concerns
(globalization, the recession, and income inequality) seems quite clear, but
I'm wondering if the correlation with mortality associated with drug poisoning
would hold true if the same information were collected about a country with a
less dysfunctional approach to narcotics and addiction management. I have a
hunch that it wouldn't.

~~~
mbrutsch
> an increase in general despair and decline in quality of life.

Yet in our own country, suicide is treated as a "mental illness", and rarely
does anyone acknowledge the circumstances which make suicide the rational
option.

~~~
humanrebar
Please don't call suicide a rational option.

One can argue that oppression and malaise are driving people to despair. It's
another argument entirely to say that wasting a life makes sense.

~~~
JoeAltmaier
Assisted suicide is regarded as a human right by some. There are good rational
arguments for that. Lets not be too PC to have the conversation.

~~~
skwirl
I didn't get the impression that mbrutsch was referring to assisted suicide.
Check out the quoted line. He/she was referring to suicide as the rational
option for "an increase in general despair and decline in quality of life."

~~~
JoeAltmaier
Ok, but same response. Folks' lives are their own to keep or 'throw away'.

~~~
skwirl
A society that treats suicide as a rational way to treat mental illness is not
a society I want to have anything to do with.

~~~
icegreentea
I think the original point was that suicide is not always a sign of mental
illness.

~~~
Karunamon
Guess it depends on how you define mental illness- humans have a very strong
biological drive to survive.. there's an argument to be made that a thought
pattern that contradicts that very basic need is aberrant.

~~~
gknoy
Sir Terry Pratchett decided that he'd rather die while able to make the
decision, rather than letting his mind be destroyed by Alzheimer's. (Granted,
his passing was natural, but he campaigned eloquently for the right to make
such a choice.)

I also knew someone who suffered great pain on a daily basis, and I have a
hard time considering his suicide irrational. I knew a guy (a friend of a
friend) who, through foolishness in his youth, ruptured three of his spinal
discs, and had damaged two other ones. He was in constant excruciating pain.
In the trailing decade of his life, he could not get sufficient pain relief to
hold a job, could not get/afford treatment because of that, and basically was
in a pain-filled hell, as he put it. At some point, after he'd been in near-
constant excruciating pain for twenty years, he decided he no longer wanted to
live.

I don't think either of these men were mentally ill, or making irrational
choices.

------
cryoshon
Yeah, I can imagine how it would be extremely stressful and life-shortening to
be perpetually worried about money.

Wealth inequality has been rising for a very long time, with all but the
highest income brackets stagnating. This isn't sustainable, it's literally
causing the serfs to be so stressed that they die or kill themselves because
of how few resources they get. We need at least some of these people alive and
functioning if our society is to continue.

~~~
ridgeguy
I think rising wealth inequality is underestimated as a cause of suicide in
the US. So many statistics indicate that financial stress is rising on the
99%, with no little change in sight.

I suspect large numbers of American lives are being shortened, even if not by
outright suicide, through diseases caused by constant stress, mostly economic.

~~~
vixen99
What has inequality got to do with it? The 24/7 issue is whether people have a
decent life day to day. Why is the existence of insanely rich Mrs X a cause of
suicide? Of course there is an issue, especially in the US, whereby wealth
translates into power. No more office boy to president! There seems to be
reluctance to tackle this but that's up to Americans. Assuming you believe
inequality is a bad thing in itself, you can only counter it by taking money
from the rich. One does wonder however whether taking money from a hard-
working entrepreneur and giving even more of it to an organization that has
run up astronomical debts already (most Western governments) - to dole out to
others is such a smart move. Opportunities here for fresh thinking. And since
when has anybody really benefited in the long run from being given money. Give
me a multiple of my income and I'll down tools and do something interesting
but not necessarily economically productive.

~~~
ridgeguy
Only with regard to your first three sentences:

It isn't wealth inequality or the existence of "insanely rich" per se, it's
the ever-growing sector of Americans who are excluded from wealth _and who no
longer see any realistic hope of changing that through their own efforts_.
It's the latter view that is a growing suicide motivator, IMHO.

------
roymurdock
_The mortality rate for white men and women ages 45-54 with less than a
college education increased markedly between 1999 and 2013, most likely
because of problems with legal and illegal drugs, alcohol and suicide, the
researchers concluded. Before then, death rates for that group dropped
steadily, and at a faster pace._

A graph in the article [0] shows a large spike in deaths by poisoning, a
modest increase in suicides and chronic liver disease, no change in diabetes,
and a decrease in lung cancer. So the authors quasi-conclude that the increase
in this demographic is due to underlying psychic pain (tough times post-
recession?) that causes people to overdose/die from alcohol poisoning.

There is a weird stat at the bottom of the article - according to the
"National Heroin Task Force" (who knew there was such a thing) 110 people
overdose on legal/illegal drugs every day. The CDC says that only 6 people die
from alcohol poisoning every day. So if we take those stats at face value,
which we probably shouldn't because the National Heroin Task Force has an
incentive to overblow the problem, then we would conclude that heroin is a
much larger problem than alcoholism across this demographic.

One other discrepancy was the author throwing in this strange citation that
(supposedly) bemoans the future of Medicare:

 _" This is the first indicator that the plane has crashed," said Jonathan
Skinner, a professor of economics at Dartmouth College, who reviewed the study
and co-authored a commentary that appears with it. "I don’t know what’s going
on, but the plane has definitely crashed."_

It's not often that you see this level of insightful journalism and deep
analysis, so I took a moment to savor that nugget of knowledge. Then I
wondered - isn't it a "good" thing for the Medicare system if the working
class is dying off after contributing to the pot but before taking anything
out?

[0]
[https://img.washingtonpost.com/rf/image_1484w/2010-2019/Wash...](https://img.washingtonpost.com/rf/image_1484w/2010-2019/WashingtonPost/2015/11/02/Health-
Environment-Science/Images/Whitedeath2.jpg?uuid=rEBj4IF6EeWnymq27CD4OQ)

~~~
6stringmerc
Though it's not a concern within my inner circle, I've studied the War on
Drugs and to claim the "National Heroin Task Force" should be baseline accused
of "overblowing" the problem shows, well, straight up ignorance. Currently,
yes, it's a much more fatal problem than alcoholism. The toxicity of opiate
addiction - and the unregulated black market for which to get heroin - is a
deadly mixture of factors.

 _So as painkiller overdoses leveled off at about 16,000 in recent years,
heroin deaths skyrocketed from just over 3,000 in 2010 to more than 8,200 in
2013, according to CDC data. Though all heroin users didn 't necessarily start
with painkillers, it's the transition from painkillers to heroin, Humphreys
and other experts say, that led to the recent dramatic spike in heroin abuse._

Below is a link to a Vox article that presents evidence regarding the above
quote, and the reason there's a heroin epidemic in the US is because of the
overly aggressive (lobbied, and punished for dishonesty in marketing)
pharmaceutical industry pushing opiate drugs. Now, with the crackdown on
pills, there are wide, wide swaths of the US population who've gone from pills
to the horse:

[http://www.vox.com/2015/10/1/9433099/opioid-painkiller-
heroi...](http://www.vox.com/2015/10/1/9433099/opioid-painkiller-heroin-
epidemic)

~~~
roymurdock
_Excessive alcohol use led to approximately 88,000 deaths and 2.5 million
years of potential life lost (YPLL) each year in the United States from 2006 –
2010, shortening the lives of those who died by an average of 30 years.
Further, excessive drinking was responsible for 1 in 10 deaths among working-
age adults aged 20-64 years. The economic costs of excessive alcohol
consumption in 2010 were estimated at $249 billion, or $2.05 a drink._

So alcohol causes 10x the amount of deaths per year, and when you factor in
economic damages caused by people operating machinery, driving, hurting
themselves when drunk it seems like heroin abuse is neither a "much more fatal
problem" nor a much more widespread problem than alcoholism. Faster growing,
yes.

[http://www.cdc.gov/alcohol/fact-sheets/alcohol-
use.htm](http://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm)

~~~
6stringmerc
Care to balance out the statistics of the alcohol deaths with the number of
people in the United States who use alcohol? I did a quick search and came up
with this via the NIH:

 _In 2013, 86.8 percent of people ages 18 or older reported that they drank
alcohol at some point in their lifetime; 70.7 percent reported that they drank
in the past year; 56.4 percent reported that they drank in the past month...
In 2013, 24.6 percent of people ages 18 or older reported that they engaged in
binge drinking in the past month_

...and, via the 2010 US Census, there are 193,000,000 people between the ages
of 18 and 64.

So, if we consider the math, many, many more people consume alcohol than
heroin, and as such, 88,000 is a much smaller "fatal problem" than you frame
it. So, not as widespread as alcoholism, but much more fatal for those
affected. I stand by my assertion that there's no need to "over-state" the
heroin problem in the US.

------
pnathan
Blue collar white Americans haven't exactly been celebrated in the past 30
years. One might suspect that there is a connection.

~~~
rdtsc
They have become this mythical creature in political rhetoric along with
"small business owners". A lot of stuff is done and claimed in their name.
Little of it becomes true, but the rhetoric of appealing to "hard working men
and women" never fails.

~~~
pnathan
I am related several different ways to blue collar people: they see the sham.

~~~
MisterBastahrd
None of my relatives do. They eat that stuff up, because the alternative is to
admit that they're a mediocre bunch that hasn't risen one iota above the
wealth or social status of their predecessors, despite their derision for poor
people of color for not climbing that same social ladder.

------
panglott
"While the death rate for African Americans is still greater than the rate for
whites, the turnaround among whites is shocking because of the advantages they
enjoy, said David Weir..."

Is this just reversion to the mean? That is, is the death rate for working-
class white people simply converging to to the death rate for African
Americans?

If so, that's the most horrible way to end white privilege :(

~~~
ajross
No, a "reversion to the mean" is a statistical error caused by small sample
sizes. For obvious reasons, you're not likely to see it when looking at death
statistics for a population in the tens of millions. There's a clear
hypothesis here for a real effect.

~~~
astine
Unless you are using a different meaning of 'reversion to the mean' than I am
familiar with, it's not a statistical error and has nothing to do with the
size of the sample. 'Regression to the mean' happens when you have an
imperfect correlation between two data fields.

------
daxfohl
I wonder if the next generation will sneer when watching circa 2015 clips of
people boozing at virtually every social outing, like we do when we see old
clips of people smoking everywhere.

~~~
mikeash
I'm doubtful. Smoking is a fairly recent phenomenon for the most part, while
drinking long predates written history.

~~~
rustynails
Smoking has been around for about 5000 years,
[https://en.m.wikipedia.org/wiki/History_of_smoking](https://en.m.wikipedia.org/wiki/History_of_smoking)

It may be the impact to others that gave smoking it's stigma compared to
alcohol. Smoke drifts through the air and leaves a pungent smell in clothing.
For non-smokers, this can be far more impacting than alcohol when both
substances are consumed in moderation.

~~~
mikeash
Right, but it wasn't the modern form of smoking a lot every day as a habit, as
far as I can tell, but more of an occasional thing. That's what I tried to
cover, vaguely, with "for the most part." Smoking a little bit isn't too bad,
it's when you're inhaling multiple cigarettes every day that you really have
trouble.

------
lujim
So from 1979 - 1999 mortality rates fell an average of 2% but have risen half
a percent per year since then. If I had to guess it could be that the
pressures of stagnant incomes, skyrocketing higher health care costs, and more
volatile economic conditions could be a bit of a pressure cooker for stress,
poor diets, and increased alcohol/drug use.

~~~
_sword
Adding to that, the authors of the article and the paper are constructing an
argument that over-prescription of opiod painkillers is a significant
component of the problem.

~~~
JoeAltmaier
How about: they got more affluent, ate too much red meat and died of strokes?

~~~
lujim
Yeah could be that, but think stress.

We started the millennium with a stock market crash, 9/11, the Concord
crashed, the Space Shuttle broke up on reentry, two wars kicked off and just
when things started calming down... the Great Recession. If you weren't laid
off then you probably knew a few people that were. It seemed like everything
we had built over the past two decades was failing us all at once.

The 90's seemed like a time when you just watched Seinfeld on Thursday nights
and watched your stocks go up in value. The 2000's and on have been a bit more
stressful.

------
at-fates-hands
Interesting there is no mention of obesity and the correlated diseases which
are associated with being overweight.

The US has an obesity epidemic right now and it has huge risks for some of
these health issues:

1\. high blood pressure

2\. diabetes

3\. heart disease

4\. cancer

5\. ulcers

Yet absolutely no mention of this in any of the stats or the issues which may
be contributing to early deaths of this segment of the population.

~~~
ben010783
They do mention it. They suggest that those types of ailments are increasing,
but not at a pace that would explain these deaths.

"...the study clearly shows they are not the result of diseases such as lung
cancer or diabetes, which are declining and increasing slowly, respectively."

------
CPLX
I was surprised to read through all this and not see a more direct mention of
the likely triad of causes for this phenomenon: debt, divorce, and dependents.

Especially divorce.

~~~
stillsut
But isn't divorce down (or at least flat) since 1980?

However % of out-of-wedlock births have continued to rise.

Anecdotally and statistically, it seems like 'Family Court' findings are the
major cause for a precarious-to-struggling decade long stretch of life.

------
shawnee_
The findings discussed in this study make an interesting side note to this
(older HN) discussion:
[https://news.ycombinator.com/item?id=5424241](https://news.ycombinator.com/item?id=5424241)

The generation of "middle-aged whites" (which the article describes as being
aged 45-54 between 1999 and 2013) probably doesn't get enough credit. So...
lack of college education is a common denominator in many of their deaths. But
people keep forgetting the information economy came _after_ we had our hefty
physical infrastructure.

Alcohol and drug abuse are how people self-medicate when they can't afford
expensive / professional medical care. We're only barely starting to scratch
the surface of this problem with AHA; but for many of the "uneducated" people
in this generation who were/are employed in construction / physical labor...
it probably seems like too little too late.

------
learning_still
"This is the first indicator that the plane has crashed,” said Jonathan
Skinner, a professor of economics at Dartmouth College, who reviewed the study
and co-authored a commentary that appears with it. “I don’t know what’s going
on, but the plane has definitely crashed."

This basically sums up my fears. Whatever is going on, economics is at the
root of it.

------
JustSomeNobody
How much of this is due to the economy? The people in this group, surely, are
finding it harder to get well paying jobs. It is much harder to find a middle
income job working with your hands now than it was 20, 30 years ago.

What did this group's wages do during this same time period? Something had to
push them to this. I am guessing this is it.

~~~
adventured
People with no college experience, are basically the only group not
participating in the rebounded economy. In fact the only demographics that are
actually losing jobs to immigrants in net, are lower class whites and blacks.
Their job opportunities have been seriously harmed by the immigration influx.
It makes perfect sense you would see a decline in their well being accordingly
(especially considering the US has a weaker welfare state in sheer benefits
volume, including for mental health, versus much of western Europe).

------
PsychopompPoet
elephant in the room - our culture is broken

~~~
bcabs
pmuch.

[https://www.youtube.com/watch?v=ao8L-0nSYzg](https://www.youtube.com/watch?v=ao8L-0nSYzg)

~~~
runarb
I really wish that the whole Rat Park experiment this video relies on had been
true, and a cure for addiction was that easy, but as I understand it the
scientist behind the Rat Park experiment falsified the data to spark a public
debate.

The idea was great, but further studies failed to reproduce the original
results and all major science journals rejected the paper.

We are not making it easier to handle this big issue of addiction by relying
on fals or unreproducible data.

~~~
eric_h
Do you have a source that thoroughly supports the debunking of the Rat Park
experiment? This is the first I'd heard that it was unreproducible and the
result of falsified data.

------
jimrandomh
The study itself:
[http://www.pnas.org/content/early/2015/10/29/1518393112.full...](http://www.pnas.org/content/early/2015/10/29/1518393112.full.pdf)

Kudos to the authors and journal for providing a full PDF immediately. Boo to
the Washington Post for not linking.

------
hownottowrite
Yay! GenX makes the news at at last! [Spoiler: I'm 45 and white. This isn't
sarcasm. It's just how we are.]

------
ChuckMcM
My concern is that this only gets worse going forward. We have so many people
raised to "hit the milestone, get the prize" sort of life strategies that when
you run out of milestones to hit it will greatly depress them.

------
kriro
Vaguely reminds me of the chapter on suicides in Tipping Point (iirc). I
wonder if this can be explained in a similar fashion instead of by macro
trends?

------
jgalt212
In short, poor white folks struggle mightily just like poor black folks (or
folks of any color) do.

~~~
MadManE
It's a little terrifying that this needs to be said. We are now operating
under the assumption that if you are white, then your life can't be bad in any
way and you have money to burn.

I guess the propaganda has worked.

------
laboo
Fox News Channel, founded 1996.

------
intrasight
Why just non-college considered in study? Seems to be an example of selection
bias.

