
Changes in midlife death rates across racial and ethnic groups in the US - pseudolus
https://www.bmj.com/content/362/bmj.k3096
======
WhompingWindows
"Drug overdoses were the leading cause of increased mortality in midlife in
each population, but mortality also increased for alcohol related conditions,
suicides, and organ diseases involving multiple body systems."

Perhaps we can start treating addiction like a disease and not a moral
failing?

~~~
sigfubar
Addiction progresses like a disease, but begins as a moral failing. If I were
to begin using heroin today, it would be by conscious choice, not because
there's something wrong with my body.

~~~
vxxzy
Could it be, at the onset? The decision to take drugs? Where one is suffering
from depression or some form of chemical imbalance? Or, could one be prone to
risk taking behavior? Is the precursor to risk taking behavior, biochemical?

~~~
WhompingWindows
I don't know if it's a true "decision" to take drugs for many people. If they
have crippling pain due to an injury, they may be prescribed pain medication
and then find they can't get off. See my other comment for a scenario.

~~~
prepend
It’s complex because there are different reasons for addiction.

Prescription rates are very high to support your example [0]

Recreational use is a bit harder, for me at least, to gauge. I found the 2017
global drug survey [1] showing about 2% opium/heroine use among respondents.

[0] [https://www.cdc.gov/drugoverdose/maps/rxrate-
maps.html](https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html)

[1] [https://www.globaldrugsurvey.com/wp-
content/themes/globaldru...](https://www.globaldrugsurvey.com/wp-
content/themes/globaldrugsurvey/results/GDS2017_key-findings-report_final.pdf)
(I wasn’t very familiar with this source, but I saw 10+ citations including
some respectable journals like BMJ, [https://www.globaldrugsurvey.com/about-
us/methods-and-limita...](https://www.globaldrugsurvey.com/about-us/methods-
and-limitations/)

------
Alex3917
It’s gotten to the point where doctors are no longer strongly pushing meeting
all the RDIs for eating healthy and exercising if you’d otherwise be working,
since (absent other risk factors) how much earning power you have at 35 is a
better predictor of your total life expectancy than whatever amount of
permanent damage you’d do to your body before then.

~~~
st26
That sounds very anecdotal.

~~~
Alex3917
Almost definitely. I'm seeing this move toward pragmatism across medicine
though. E.g. even my infant daughter is getting recommendations from her
pediatrician that don't adhere strictly to the AAP or WHO guidelines.

~~~
jtuente
Umm, isn't that why they're called guidelines instead of rules or laws?
They're a generalized solution for the populace at large which may be adjusted
for individuals as their needs differ. Comparatively, BMI is a guideline and
body fat/cholesterol/activity levels/nutrition intake are the more important
drivers to health that determine what changes need to be made for improvement.

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nautilus12
We are too stressed in the US. Our companies don't treat employees like
people, treat them like automotas. No paternity leave, very very little
maternity leave. 2 weeks vacation. We are working too hard and burning our
selves out.

~~~
dominotw
> we are working too hard and burning our selves out.

Are we? Every single medium-big sized company I've worked was overstaffed to
the gills, you could fire about 40-60% of ppl and no one would notice.

If you work for any online ecommerce company you would notice that their main
shopping time is during work hours.

~~~
cryoshon
i agree regarding the widespread overstaffing and the ubiquitous e-loafing,
but the issue is more complicated than that.

it's possible to not do very much work at work but still suffer from the bad
lifestyle factors:

sitting all day, being constantly stressed regarding stability, being
constantly reminded of your social status (or lack thereof), not having enough
time after work to do errands or take care of children, not having enough
unbroken chunks of vacation time without having to answer an email or do any
work, not getting paid enough to comfortably cover all the bills, being
reminded of how hard it will be to make ends meet if you get seriously ill,
etc.

even if these excess employees were actually doing necessary work all of the
time, these problems wouldn't go away. they might even get worse.

------
bilbo0s
Sounds like Americans have had a marked decrease in mental and physical health
over the time period analyzed. (1999-2016).

I think maybe easier access to healthcare, mental and physical, could help?

Also a lot of this might be signs of an overworked populace? (How many jobs
are people working to make ends meet? Do the ends meet after all the jobs are
worked? etc). So we should probably look at that as well.

But I think one of the biggest things we should take a long hard look at is
our lifestyle. (I know that work hours are a part of that, but I broke that
out on its own because it's at least a _bit_ easier). What are we doing during
our days? (A lot more screen time these days than there were pre 1999. How
many hours do people spend checking reddit/facebook/TinderInstaChat? What
impact does that have on physical and mental health?)

What are we eating and drinking? (This might have something to do with it?)

Are there any environmental factors that have arisen as a result in subtle
lifestyle changes during the indicated time period?

Etc etc etc.

I guess, in short, I think a comprehensive trend such as the one outlined in
the study likely requires a comprehensive look at possible causes.

~~~
ronnier
I wish it called out the difference between males and females. Is the trend
mostly with males?

~~~
bilbo0s
Actually, it specifically said that the overdose trend is more pronounced in
_females_.

But what's _not_ said seems to also be relevant to the issue you raise. For
instance, for suicides, I'd wager the trend is more pronounced for males.
(Though they didn't call that out. So that may or may not be the case).

But whether those in poor mental health are committing suicide, or seeking
escape in opioids and other drugs, the final result was clearly the same.
Doesn't really matter if you're male or female.

~~~
toomuchtodo
Women are more likely to attempt suicides, men are more successful in their
attempts.

[https://afsp.org/about-suicide/suicide-statistics/](https://afsp.org/about-
suicide/suicide-statistics/)

~~~
PurpleBoxDragon
If we adjusted for the period in which they were suicidal, and calculated how
many days per suicide attempt existed, would women still have a higher number?
That would seem a better measure given that the simple stats of total attempts
in general means that a man who commits suicide counts for less than a woman
who attempts many times but never commits.

~~~
watwut
People dont try suicide for days. They try once and are either rescued or not.
Next suicide attempt does not happen next day, it happens months/years later.
It also have less to do with commitment and more to do with choosen method.
Men tend to use guns or something of the sort while women are more likely to
attempt to overdose - so there is enough time to find you.

I remember reading that most people in usa try suicide once and rarely second
time.

------
hyperpape
I read through the methods, and didn't see any attempt to correct for changes
in the age composition of the population ranges. From my minimal familiarity
with it, it doesn't sound like it invalidates the results, but it does tend to
complicate them.

[http://andrewgelman.com/2015/11/06/correcting-rising-
morbidi...](http://andrewgelman.com/2015/11/06/correcting-rising-morbidity-
and-mortality-in-midlife-among-white-non-hispanic-americans-in-the-21st-
century-to-account-for-bias-in/)

[http://andrewgelman.com/2015/11/06/age-adjustment-
mortality-...](http://andrewgelman.com/2015/11/06/age-adjustment-mortality-
update/)

~~~
WhompingWindows
Did you read the methods, though? This is the first sentence:

Methods We examined age adjusted mortality rates based on the 2000 US standard
population for 1999-2016 using the Underlying Cause of Death Detailed
Mortality database in the Center for Disease Control and Prevention’s Wide-
ranging Online Data for Epidemiologic Research (CDC WONDER) platform.27 The
agency’s methods for age adjustment are described elsewhere.

~~~
hyperpape
Yes, I read this sentence.

This is a problem with common ways of doing age adjustments.

The issue is somewhat subtle: if you partition people into age bands (45-56),
at different times in history, the average person who is in that age group may
be older or younger, because different years had higher or lower birth rates.
This was a particularly strong effect when the baby boomers were in the 45-56
age range.

My initial comment was that this paper didn't make clear whether they
addressed the issue. Having now followed through to the CDC link they have, it
looks like it also uses somewhat coarse age bands.

