Rising Midlife Mortality Rates and Socioeconomic Disparities

Consensus

Download PDF

Paperback - $117.00
Ebook - $94.49

The past century has witnessed remarkable advances in life expectancy in the United States and throughout the world. In 2010, however, progress in life expectancy in the United States began to stall, despite continuing to increase in other high-income countries. Alarmingly, U.S. life expectancy fell between 2014 and 2015 and continued to decline through 2017, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918-1919). The recent decline in U.S. life expectancy appears to have been the product of two trends: (1) an increase in mortality among middle-aged and younger adults, defined as those aged 25-64 years (i.e., "working age"), which began in the 1990s for several specific causes of death (e.g., drug- and alcohol-related causes and suicide); and (2) a slowing of declines in working-age mortality due to other causes of death (mainly cardiovascular diseases) after 2010.

High and Rising Mortality Rates among Working Age Adults highlights the crisis of rising premature mortality that threatens the future of the nation's families, communities, and national wellbeing. This report identifies the key drivers of increasing death rates and disparities in working-age mortality over the period 1990 to 2017; elucidates modifiable risk factors that could alleviate poor health in the working-age population, as well as widening health inequalities; identifies key knowledge gaps and make recommendations for future research and data collection to fill those gaps; and explores potential policy implications. After a comprehensive analysis of the trends in working-age mortality by age, sex, race/ethnicity, and geography using the most up-to-date data, this report then looks upstream to the macrostructural factors (e.g., public policies, macroeconomic trends, social and economic inequality, technology) and social determinants (e.g., socioeconomic status, environment, social networks) that may affect the health of working-age Americans in multiple ways and through multiple pathways.

Additional materials

Briefing Slides

Publication information

596 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-68473-0
ISBN Ebook: 0-309-68474-9
DOI: https://doi.org/10.17226/25976

Suggested citation

National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press.

Import this citation to:

Kathleen M. Harris

KATHLEEN MULLAN HARRIS (NAS) is the James E. Haar distinguished professor of sociology, adjunct professor of public policy, and faculty fellow at the Carolina Population Center at the University of North Carolina at Chapel Hill. Her research focuses on social inequality and health with particular interests in health disparities, biodemography, sociogenomics, and life course processes. Professor Harris is director and principal investigator of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a longitudinal study of more than 20,000 teens who are being followed into adulthood. Under her leadership, the study has pioneered innovative study designs and integrative multidisciplinary research to understand social, environmental, behavioral, biological and genetic linkages in developmental and health trajectories from adolescence into adulthood. Her work has appeared in a wide range of disciplinary journals including demography, genetics, family, epidemiology, biology, public policy, survey methodology, medicine, and social and health behavior. She was awarded the Clifford Clogg Award for Early Career Achievement by the Population Association of America in 2004 and the Golden Goose Award from the US Congress in 2016 for major breakthroughs in medicine, social behavior, and technological research through the Add Health Study. She serves on the National Advisory Committee on Racial, Ethnic, and Other Populations of the Census Bureau. Professor Harris is past president of the Population Association of America and an elected member of the National Academy of Sciences. She is the chair of the Committee on Population at the National Academies of Sciences, Engineering and Medicine. She has a Ph.D. in demography from the University of Pennsylvania.

Michael E. Chernew

MICHAEL E. CHERNEW (NAM) is Leonard D. Schaeffer professor of health care policy and director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy at Harvard Medical School. His research interests focus on innovations in payment reform and benefit design. Professor Chernew is a member of the Congressional Budget Office’s Panel of Health Advisors and a member of the Committee on National Statistics at the National Academies of Sciences, Engineering, and Medicine. He also serves as vice chair of the Massachusetts Health Connector Board of Directors, research associate of the National Bureau of Economic Research, co-editor of the American Journal of Managed Care, and editor of the Journal of Health Economics. In 2010, he was elected to the National Academy of Medicine. Professor Chernew has a Ph.D. in economics from Stanford University.

David M. Cutler

DAVID M. CUTLER (NAM) is Otto Eckstein professor of applied economics in the faculty of arts and sciences at the Harvard Kennedy School. He has examined how population health is changing over time, the importance of medical and non-medical factors in improved health; and its value of increased medical spending. Professor Cutler has written extensively arguing that medical care is more productive than current statistics indicate, and that the medical care cost problem is overstated. He is also interested in the economics of health insurance, and the impact of managed care on the medical system. In 2001, he was elected a member of the National Academy of Medicine. He serves as research associate at the National Bureau of Economic Research, and fellow of the Employee Benefit Research Institute. He has authored two books, several chapters in edited books, and many published papers on the topics of health care and other public policy topics. Professor Cutler has a Ph.D. in economics from MIT.

Ana V. Diez Roux

ANA V. DIEZ ROUX (NAM) is dean and distinguished university professor of epidemiology in the Dornsife School of Public Health at Drexel University. She is internationally known for her research on the social determinants of population health and the study of how neighborhoods, particularly urban neighborhoods, affect health. Professor Roux’s work on neighborhood health effects has been highly influential in the policy debate on population health and its determinants. She has led large NIH and foundation funded research and training programs in the United States and in collaboration with international partners. Most recently, she convened the Network for Urban Health in Latin America and the Caribbean which focuses on promoting research, training, and policies to promote urban health throughout the region. Professor Roux was awarded the Wade Hampton Frost Award for her contributions to public health by the American Public Health Association. She is an elected member of the American Epidemiological Society, the Academy of Behavioral Medicine Research, and the National Academy of Medicine. She has an M.D. from the University of Buenos Aires, an M.P.H. from the Johns Hopkins University, and a Ph.D. from the Johns Hopkins University School of Hygiene and Public Health.

Irma T. Elo

IRMA T. ELO is director of the Population Aging Research Center (PARC), and associate chair of the Sociology Department at the University of Pennsylvania. She has served as a member and/or chair of several national and international committees, including: Board of Scientific Counselors of the National Center for Health Statistics (NCHS); Census Bureau’s Scientific Advisory Committee (CSAC); sociology section of population for the American Sociological Association; Population Association of America’s (PAA’s) board of directors; PAA’s Committee on Population Statistics; and, International Advisory Board of the Swedish Initiative for Research on Microdata in the Social and Medical Sciences. Professor Elo’s main research interests focus on socioeconomic and racial/ethnic disparities in health and mortality across the life course and demographic estimation of mortality—she has extended this focus to include health and mortality among racial/ethnic immigrant subgroups. Professor Elo is currently PI of the NIA-funded study, Causes of Geographic Divergence in American Mortality Between 1990 and 2015: Health Behaviors, Health Care Access and Migration. She has a Ph.D. in public affairs and demography from Princeton University.

Darrell J. Gaskin

DARRELL J. GASKIN is William C. and Nancy F. Richardson professor in health policy and director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health. He is a health services researcher and health economist and an internationally recognized expert in health and healthcare disparities. Professor Gaskin has published in the leading health services and public health research journals, including American Journal of Public Health, HSR, Health Affairs, Inquiry, Medical Care, Medical Care Research and Review, and Social Science and Medicine. He serves on the editorial boards of HSR, Medical Care, and Medical Care Research and Review. Professor Gaskin also serves as chairman of the Board of Directors of AcademyHealth and as a member of the Center for Health Policy Development Board, the board of directors for the National Academy of State Health Policy. He has an M.A. degree in economics from MIT, and a Ph.D. in health economics from the Johns Hopkins University.

Robert A. Hummer

ROBERT A. HUMMER is Howard W. Odum distinguished professor of sociology and fellow of the Carolina Population Center at the University of North Carolina at Chapel Hill. Professor Hummer currently serves as vice president of the Population Association of America, deputy editor of Demography, associate editor of Demographic Research, and as a member of the Scientific Advisory Committee of the U.S. Census Bureau. In 2010, he was presented with the Clifford Clogg Award for Early Career Achievement by the Population Association of America. His research focuses on the accurate description and more complete understanding of population health and mortality patterns and trends in the United States. Professor Hummer has been funded by NICHD and/or NSF throughout most of his career. He is widely published, including journal articles, book chapters, and books. Professor Hummer’s work focuses on the understanding of racial/ethnic, immigrant-native, and socioeconomic differences in population health/mortality, as well as with the effective use of very large data sets to study U.S. health/mortality patterns and trends. He is a member of the Committee on Population at the National Academies of Sciences, Engineering and Medicine. He has a Ph.D. in population health from Florida State University.

Ryan Masters

RYAN K. MASTERS is assistant professor of sociology at the University of Colorado Boulder and faculty associate of the Population Program and Health and Society Program at the University of Colorado Boulder's Institute of Behavioral Science. His interests include the examination of long-term trends in U.S. morbidity, chronic diseases, and mortality rates—his research spans three substantive areas related to these topics. Professor Masters is interested in the health consequences of the U.S. obesity epidemic, especially as it relates to premature mortality among the U.S. adult population. He has been involved in advancing and testing new methodological approaches to studying period-based factors (e.g., health-promoting policies and new medical technologies) and cohort-based factors (e.g., early-life disease exposure) related to adult health. Professor Masters has an M.A. and Ph.D. in sociology from the University of Texas at Austin.

Shannon M. Monnat

SHANNON M. MONNAT is Lerner chair for public health promotion, associate professor of sociology, and co-director of the Policy, Place, and Population Health Lab in the Maxwell School of Citizenship and Public Affairs at Syracuse University (SU). Professor Monnat also serves as senior research associate in the Center for Policy Research at SU and fellow at the Carsey School of Public Policy at the University of New Hampshire. Her research interests broadly fall at the intersection of place, public policy, and health. Her most recent research has focused on opioid abuse and other diseases and deaths of despair, particularly trying to understand why rates of substance abuse and mortality are higher in some places than others. Professor Monnat has published over 50 peer-reviewed academic journal articles, book chapters, research briefs, and reports, and has presented her research to numerous public, academic, and policy audiences. She has a Ph.D. in sociology from the State University of New York at Albany.

Bhramar Mukherjee

BHRAMAR MUKHERJEE is John D. Kalbfleisch collegiate professor of biostatistics, professor and chair of biostatistics, professor of epidemiology, and professor of global public health, at the University of Michigan. She also serves as research professor at the Michigan Institute of Data Science, and associate director of cancer control and population sciences at the University of Michigan Rogel Cancer Center. Professor Mukherjee’s research interests include statistical methods for analysis of electronic health records, studies of gene-environment interaction, Bayesian methods, shrinkage estimation, and analysis of multiple pollutants. She has co-authored more than 200 publications in statistics, biostatistics, medicine, and public health, and is serving as PI on NSF and NIH-funded methodology grants. Professor Mukherjee is founding director of the University of Michigan’s summer institute on Big Data. She serves as fellow of the American Statistical Association and the American Association for the Advancement of Science and is the recipient of many awards for her scholarship, service and teaching at the University of Michigan and beyond. Professor Mukherjee has an M.Stat. in applied statistics and data analysis from the Indian Statistical Institute, an M.S. degree in mathematical statistics from Purdue University, and a Ph.D. in statistics from Purdue University.

Robert B. Wallace

ROBERT B. WALLACE (NAM) is Irene Ensminger Stecher professor of epidemiology and internal medicine at the University of Iowa Colleges of Public Health and Medicine. He has conducted many population health studies as well as clinical trials, focusing on the prevention and control of chronic illnesses and other disabling conditions of older persons. He has continuing experience with community interventions related to the prevention of falls and motor vehicle injuries in older persons. Professor Wallace was a member of the U.S. Preventive Services Task Force, and the National Advisory Council on Aging of the National Institute on Aging. He is an elected member of the National Academy of Medicine and has had substantial experience with NAM studies and panels. He is currently involved in several active research projects funded by the National Institutes of Health and is a fellow of the American College of Preventive Medicine. Professor Wallace has an M.D. in medicine from Northwestern University, and an M.Sc. in epidemiology from the State University of New York at Buffalo.

Steven H. Woolf

STEVEN H. WOOLF (NAM) is director emeritus and senior advisor of the Center on Society and Health at Virginia Commonwealth University (VCU), and professor in the department of family medicine and population health at VCU. At VCU, he also holds the C. Kenneth and Dianne Wright distinguished chair in population health and health equity. Dr. Woolf has edited three books and published more than 200 articles in a career that has focused on raising public awareness about the social, economic, and environmental conditions that shape health and produce inequities. Beyond research, he works to address these issues through outreach to policymakers and the public, including testimony before Congress, consulting, editorials in major newspapers and social media, and speaking engagements. Dr. Woolf served on the U.S. Preventive Services Task Force and was elected to the National Academy of Medicine in 2001. He has an M.P.H. in public health from Johns Hopkins University and an M.D. in medicine from Emory University School of Medicine.

Webinar

Webinar on Drugs and Alcohol: High and Rising Mortality Rates Among Working-Age Adults

June 10, 2021

2:00 PM - 3:00 PM (EDT)

Past

Materials

Slides

About

Please join the National Academies of Sciences, Engineering, and Medicine for the first webinar in a three webinar series for the recent report, High and Rising Mortality Rates Among Working-Age Adults.

In March 2021, the Committee on Population (CPOP) at the National Academies of Sciences, Engineering, and Medicine released the report High and Rising Mortality Rates Among Working-Age Adults. In this webinar, CPOP explores the role of drugs and alcohol in contributing to rising mortality rates among working-age adults (i.e., middle-aged and younger adults ages 25-64 years). Join us as we develop a deeper understanding of these complex phenomena and discuss implications for policy and research.

Speakers include:

Kathleen Mullan Harris, University of North Carolina at Chapel Hill
Michael E. Chernew, Harvard Medical School
Darrell J. Gaskin, Johns Hopkins University Bloomberg School of Public Health
Shannon M. Monnat, Syracuse University

Additional Information

Is it a Closed Session event?

Not Closed

Contact

Mary Ghitelman

mghitelman@nas.edu

Disclaimer

It is essential to the National Academies mission of providing evidence-based advice that participants in any of our meetings or events avoid political or partisan statements or commentary and maintain a culture of mutual respect. The statements and presentations during our meetings or events are solely those of the individual participants and do not necessarily represent the views of other participants or the National Academy of Sciences, which is a non-partisan, tax exempt organization that includes under its Charter the National Academy of Engineering and National Academy of Medicine, and that operates the National Research Council.

Log In

Sign in to access your saved publications, downloads, and email preferences.

Former MyNAP users: You'll need to reset your password on your first login to MyAcademies. Click "Forgot password" below to receive a reset link via email. Having trouble? Visit our FAQ page to contact support.

Members of the National Academy of Sciences, National Academy of Engineering, or National Academy of Medicine should log in through their respective Academy portals.

Email (required)
Password (required)

Don't have an account?

Register

Email (required)
New password (required)
Retype password (required) Password must be at least 8 characters
I accept the terms of use
terms of use

Thank You

Thank you for creating a MyAcademies account!

Enjoy free access to thousands of National Academies' publications, a 10% discount off every purchase, and build your personal library.

Forgot Password

Enter the email address for your MyAcademies (formerly MyNAP) account to receive password reset instructions.

Reset Requested

We sent password reset instructions to your email . Follow the link in that email to create a new password. Didn't receive it? Check your spam folder or contact us for assistance.

Reset Password

New password (required)
Retype password (required) Password must be at least 8 characters

Reset Password

Your password has been reset.

Log In

Verify email

Verify Your Email Address

We sent a verification link to your email. Please check your inbox (and spam folder) and follow the link to verify your email address. If you did not receive the email, you can request a new verification link below

Subscribe

First Name
Last Name
Email (required)
I agree to receive emails from the National Academies (required)

We respect your privacy and will never share your information.

Rising Midlife Mortality Rates and Socioeconomic Disparities

Featured publication

Description

Contributors

Committee

Sponsors

Staff

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Transit Cooperative Research Program

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Future Directions for Social and Behavioral Science Methodologies in the Next Decade: A Workshop

Aging in Place with Dementia: A Workshop

Ensuring the Quality, Credibility, and Relevance of U.S. Homeland Security Statistics

Additional materials

Publication information

Suggested citation

Materials

About

Additional Information

Contact

Mary Ghitelman

Disclaimer

My Academies

Rising Midlife Mortality Rates and Socioeconomic Disparities

Dropdown items

Featured publication

High and Rising Mortality Rates Among Working-Age Adults

Description

Contributors

Committee

Sponsors

Staff

Major units and sub-units

Contact

Contact us

Provide feedback

Request materials

More like this

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Health Care Financing to Improve Availability of Affordable Contraception: Identifying Promising Practices

Transit Cooperative Research Program

Review of the draft United by Nature assessment

Modernizing Mathematics Education for Grades 9-14

Future Directions for Social and Behavioral Science Methodologies in the Next Decade: A Workshop

Aging in Place with Dementia: A Workshop

Ensuring the Quality, Credibility, and Relevance of U.S. Homeland Security Statistics