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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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HIGH AND RISING MORTALITY RATES

AMONG WORKING-AGE ADULTS

Kathleen Mullan Harris, Malay K. Majmundar, and Tara Becker, Editors

Committee on Rising Midlife Mortality Rates
and Socioeconomic Disparities

Committee on Population
Committee on National Statistics
Division of Behavioral and Social Sciences and Education

A Consensus Study Report of

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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This activity was supported by contracts between the National Academy of Sciences and the National Institute on Aging of the National Institutes of Health (HHSN263201800029I/HHSN26300036), and the Robert Wood Johnson Foundation (#75873). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-0-309-68473-6
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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. https://doi.org/10.17226/25976.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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COMMITTEE ON RISING MIDLIFE MORTALITY RATES AND SOCIOECONOMIC DISPARITIES

KATHLEEN MULLAN HARRIS (Chair), Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill

MICHAEL E. CHERNEW, Department of Health Care Policy, Harvard Medical School

DAVID M. CUTLER, Department of Economics, Harvard University

ANA V. DIEZ ROUX, Dornsife School of Public Health, Drexel University IRMA T. ELO, Department of Sociology, Population Studies Center, University of Pennsylvania DARRELL J. GASKIN, Bloomberg School of Public Health, Johns Hopkins University

ROBERT A. HUMMER, Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill

RYAN K. MASTERS, Department of Sociology, University of Colorado Population Center, Institute of Behavioral Science, University of Colorado Boulder

SHANNON M. MONNAT, Department of Sociology and Lerner Center for Public Health Promotion, Syracuse University

BHRAMAR MUKHERJEE, School of Public Health, University of Michigan

ROBERT B. WALLACE, College of Public Health, University of Iowa

STEVEN H. WOOLF, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine

Staff

MALAY K. MAJMUNDAR, Study Director

TARA BECKER, Program Officer

ELLIE GRIMES, Senior Program Assistant

MARY GHITELMAN, Senior Program Assistant

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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COMMITTEE ON POPULATION

KATHLEEN MULLAN HARRIS (Chair), Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill

EMILY M. AGREE, Department of Sociology and Department of Population, Family, and Reproductive Health, John Hopkins University

DEBORAH BALK, Marxe School of Public and International Affairs and CUNY Institute for Demographic Research, Baruch College of the City University of New York

NANCY BIRDSALL, Center for Global Development (President Emeritus), Washington, DC

ANN K. BLANC, Social and Behavioral Science Research, Population Council, New York, NY

COURTNEY C. COILE, Department of Economics, Wellesley College

DANA A. GLEI, Research Consultant, Georgetown University

ROBERT A. HUMMER, Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill

HEDWIG (HEDY) LEE, Department of Sociology, Washington University in St. Louis

JENNIFER J. MANLY, Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, Department of Neurology, Columbia University

ANNE R. PEBLEY, Department of Community Health Sciences, Department of Sociology, California Center for Population Research, Bixby Center on Population and Reproductive Health, University of California, Los Angeles

ISABEL V. SAWHILL, The Brookings Institution, Washington, DC

DAVID T. TAKEUCHI, School of Social Work, University of Washington

REBECA WONG, Health Disparities, University of Texas Medical Branch at Galveston

MALAY K. MAJMUNDAR, Director

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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COMMITTEE ON NATIONAL STATISTICS

ROBERT M. GROVES (Chair), Office of the Provost, Georgetown University

LAWRENCE D. BOBO, Department of Sociology, Harvard University

ANNE C. CASE, Woodrow Wilson School of Public and International Affairs (Emerita), Princeton University

MICK P. COUPER, Institute for Social Research, University of Michigan

JANET M. CURRIE, Woodrow Wilson School of Public and International Affairs, Princeton University

DIANA FARRELL, JPMorgan Chase Institute, Washington, DC

ROBERT GOERGE, Chapin Hall at The University of Chicago

ERICA L. GROSHEN, The ILR School, Cornell University

HILARY HOYNES, Goldman School of Public Policy, University of California, Berkeley

DANIEL KIFER, The Pennsylvania State University

SHARON LOHR, School of Mathematical and Statistical Sciences (Emerita), Arizona State University

JEROME P. REITER, Duke University

JUDITH A. SELTZER, University of California, Los Angeles

C. MATTHEW SNIPP, School of the Humanities and Sciences, Stanford University

ELIZABETH A. STUART, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health

JEANNETTE WING, Data Science Institute, Columbia University

BRIAN A. HARRIS-KOJETIN, Director

CONSTANCE F. CITRO, Senior Scholar

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Preface and Acknowledgments

The year 2017 marked the third year in a row that life expectancy in the United States had fallen, the longest sustained decline in life expectancy in a century (since the influenza pandemic of 1918–1919). Already ranked relatively low in life expectancy (26th) in 2015 among the 35 countries that make up the Organisation for Economic Co-operation and Development, the United States would lose even more ground in its global position in national health and well-being. Research had already uncovered some troubling mortality trends and disparities before 2015 and was focused on the search for explanations. Early findings pointed to rising mortality rates among middle-age White adults, although the trends soon revealed that younger adults were also at risk, as were other racial/ethnic groups, such that premature mortality in the working ages of 25–64 was becoming more common in the United States than in prior years and in comparison with its international peers.

In this context, in 2018 the National Institute on Aging and the Robert Wood Johnson Foundation requested that the National Academies of Sciences, Engineering, and Medicine undertake a study on high and rising rates of midlife mortality and concomitant widening social differentials. In response to that request, the National Academies appointed the Committee on Rising Midlife Mortality Rates and Socioeconomic Disparities (under the standing Committee on Population) to carry out the task. Twelve scholars representing a broad array of disciplines—including demography, economics, epidemiology, medicine, public health, sociology,

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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and biostatistics—were included on the committee, which met six times in person over a 2-year period.

This report presents a considerable body of information. The committee decided to conduct its own analysis of the trends in working-age mortality by age, sex, race and ethnicity, and geography using the most up-to-date data to establish its members’ collective understanding of the main drivers of the rising trend and disparities in working-age mortality in the United States. Findings from the committee’s analysis are presented in Part I of this report. The committee then conducted a comprehensive review of the research on rising working-age mortality to evaluate evidence on what had changed in American society to bring about the change in mortality rates and how the patterns of change differed for population subgroups. Findings on the explanations for the rise in working-age mortality are presented in Part II of the report. The committee’s work was arduous because the amount of data was massive; the problem was complex; and the unique trends by age, sex, race and ethnicity, and geography multiplied that complexity. In this report, the committee attempts to communicate these complexities while at the same time identifying the main drivers of high and rising working-age mortality based on current research and their implications for the future. The committee was also very deliberate and conscientious in its recommendations for further data collection, research, and policy.

This study would not have been possible without the contributions of many people. Special thanks go to the members of the study committee, who dedicated extensive time, thought, and energy to this task. Committee members conducted extensive analysis in generating Part I of the report, often enlisting their students and research assistants to help. Julene Cooney (Syracuse University), Nick Graetz (University of Pennsylvania), Jermaine Heath (Harvard Medical School), Fitore Hyseni (Syracuse University), Jeron Impreso (Harvard Medical School), Sammer Marzouk (Harvard University), Harrison Mintz (Harvard Medical School), Rohan Shah (Harvard Medical School), and Yue Sun (Syracuse University) assisted the committee in analyzing mortality trends and assessing selected research literatures. Thanks are also due to Anna Mueller (Indiana University Bloomington), who provided valuable guidance to the committee on suicide deaths.

The committee received useful information and insights from presentations by outside experts at open sessions of committee meetings. We thank Erika Blacksher (University of Washington), Anne Case (Princeton University), Andrew J. Cherlin (Johns Hopkins University), Kathleen Frydl, Carol Graham (Brookings Institution), Christopher Ruhm (University of Virginia), and Jennifer Silva (Indiana University Bloomington).

Several staff members of the National Academies made significant contributions to the report. Ellie Grimes and Mary Ghitelman made sure

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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that the committee meetings ran smoothly, assisted in preparing the manuscript, and otherwise provided key administrative and logistical support; Kirsten Sampson Snyder managed the report review process; Yvonne Wise managed the report production process; and Brian Harris-Kojetin, director of the Committee on National Statistics, provided valuable guidance and oversight. We also thank Rona Briere for skillful editing.

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report: Andrew J. Cherlin, Department of Sociology, Johns Hopkins University; Sandro Galea, School of Public Health, Boston University; Mark D. Hayward, Population Research Center, University of Texas at Austin; Ichiro Kawachi, Department of Social and Behavioral Sciences, Harvard School of Public Health; Peter Muennig, Mailman School of Public Health, Columbia University; Samuel H. Preston, Population Studies Center, University of Pennsylvania; Albert L. Siu, Mount Sinai Medical Center; and Frank A. Sloan, Economics Department and Center for Health Policy, Law and Management, Duke University.

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by Bradford Gray, Urban Institute, and Eileen Crimmins, University of Southern California. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Kathleen Mullan Harris, Chair
Malay K. Majmundar, Study Director
Tara Becker, Program Officer
Committee on Rising Midlife Mortality
Rates and Socioeconomic Disparities

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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ANNEX 2-1 International Trends Methodology

Source of International Trend Comparison Data

Data for the Sixteen Peer Countries

Data for the United States

Analytic Strategy

Life Expectancy at Birth

Arriaga Age Decomposition of Differences in Life Expectancy

Ratio of Age-Specific Mortality in the United States to That in the Peer Countries

The Probability of Death Between Ages 25 and 64

3 U.S. Trends in All-Cause Mortality Among Working-Age Adults

Trends in All-Cause Mortality by Sex and Age

Trends in All-Cause Mortality by Sex, Age, and Race and Ethnicity

Trends in Mortality by Socioeconomic Status

Geographic Differences in Mortality Trends

Trends in All-Cause Mortality by Metropolitan Area Type

Trends in All-Cause Mortality Across U.S. Regions and States

Trends in All-Cause Mortality Across U.S. Counties

Summary of Geographic Trends in Mortality

Summary

ANNEX 3-1 Mortality Trends Among U.S. Asians/Pacific Islanders and American Indians/Alaska Natives

Mortality Trends Among U.S. Asians and Pacific Islanders

Mortality Trends Among American Indians/Alaska Natives

Changes in High/Low Mortality Counties by Metropolitan Status

4 U.S. Trends in Cause-Specific Mortality Among Working-Age Adults

Trends in U.S. Working-Age Mortality by Cause of Death

Non-Hispanic White Adults

Working-Age Non-Hispanic Black Adults

Hispanic Adults

Disparities in Cause-Specific Mortality by Socioeconomic Status

Cause-Specific Mortality Trends by Metropolitan Status

Temporal Patterns in Cause-Specific Mortality Trends

Summary

ANNEX 4-1 Trends in Cause-Specific Mortality Among American Indians and Alaska Natives

Cause-Specific Mortality Trends by Metropolitan Area Status

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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3-2 All-cause mortality rates (deaths per 100,000 population) by sex, age group, and race and ethnicity, 1990–2017

B3-1 All-cause mortality rates for Asian/Pacific Islander males and females ages 25–64, 1990–2017

B3-2 Ratio of all-cause mortality rates among non-Hispanic American Indians/Alaska Natives to those among non-Hispanic Whites, Contract Health Service Delivery Area (CHSDA) counties, 1999–2009

3-3 All-cause mortality rates by race and ethnicity, sex, age group, and metropolitan status, 1990–2017

3-4 All-cause mortality rates (deaths per 100,000 population) by U.S. Census region and state, 1990–1992 and 2015–2017

3-5a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Males ages 25–44

3-5b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Males ages 25–44

3-6a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Males ages 45–64

3-6b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Males ages 45–64

3-7a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Females ages 25–44

3-7b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Females ages 25–44

3-8a County-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 and 2015–2017: Females ages 45–64

3-8b Absolute change in county-level all-cause mortality rates (deaths per 100,000 population), 1990–1992 to 2015–2017, by U.S. county: Females ages 45–64

A3-1 Locations of Contract Health Service Delivery Area (CHSDA) counties across the United States

A3-2 Life expectancy at birth for males and females by race and ethnicity, 2007–2009

A3-3 Percentage of U.S. counties in top and bottom sex- and age-specific county mortality rate quintiles, 1990–1992 and 2015–2017, by metropolitan status

A3-4 Distribution of U.S. population in counties with highest and lowest mortality rates, 1990–1992 and 2015–2017, based on 1990–1992 county mortality rate quintiles, by sex and age

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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4-1 Decomposition of changes in cause-specific mortality rates (deaths per 100,000 population) by time period: Males

4-2 Decomposition of change in cause-specific mortality rates (deaths per 100,000 population), by time period: Females

4-3 Percentage of mental and behavioral disorder–related deaths due to alcohol, drugs, and all other causes, ages 25–64, 1990–2017

A4-1 Leading causes of death in Contract Health Service Delivery Area (CHSDA) counties in 1999–2009

6-1 Conceptual framework: A life-course multilevel model of factors involved in high and rising mortality among working-age adults

A6-1 DGP1 Mx by birth cohort

A6-2 DGP2 Mx by birth cohort

A6-3 DGP3 Mx by birth cohort

A6-4 DGP1 Mx by period

A6-5 DGP2 Mx by period

A6-6 DGP3 Mx by period

A6-7 Drug-related mortality rates by 5-year age group, 25–29 to 60–64, between 1990 and 2017, U.S. Black and White men

A6-8 Drug-related mortality rates for U.S. Black and White men ages 55–59 and 60–64 versus 25–54 average, 1990–2017

A6-9 Mortality rates for cardiometabolic diseases by 5-year age group, 40–44 to 60–64, between 1990 and 2017, U.S. White men and women

A6-10 Alcohol-related mortality rate by 5-year age group, 40–44 to 60–64, between 1990 and 2017, U.S. Black and White women and men

7-1 Mortality rates among U.S. working-age adults (ages 25–64) (deaths per 100,000 population) from drug poisoning by sex, age, and race and ethnicity

7-2 Drug poisoning mortality rates (deaths per 100,000 population) for U.S. working-age males and females (ages 25–64) by metropolitan status, 1990–1993 through 2015–2017

7-3 Drug poisoning mortality rates (deaths per 100,000 population) for U.S. working-age males and females (ages 25–64) by region and state, 1990–1992 and 2015–2017

7-4 Percentage of all fatal drug poisonings among U.S. working-age adults (ages 25–64) that involved opioids, by sex, 1999–2018

Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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7-5 Drug poisonings involving opioids among U.S. working-age adults (ages 25–64) by sex, 1990–2018

7-6 Specific drug involvement in drug poisonings among U.S. working-age adults (ages 25–64) by sex, 1999–2018

7-7 Mortality rates (deaths per 100,000 population) for U.S. working-age adults for alcohol-induced causes by sex, age, and race and ethnicity

7-8 Alcohol-induced mortality rates (deaths per 100,000 population) for U.S. working-age males and females (ages 25–64) by region and state, 1990–1992 and 2015–2017

7-9 Percentage change in per capita ethanol consumption by beverage type, United States, 1977–2016

7-10 Prescription opioid sales and deaths, 1999–2013

8-1 Suicide rates per 100,000 population among U.S. working-age adults (ages 25–64), 1990–2017, by sex, age, and race and ethnicity

8-2 Suicide rates per 100,000 population among U.S. working-age males and females (ages 25–64), 1990–1993 through 2015–2017, by metropolitan status

8-3 Suicide rates per 100,000 population among U.S. working-age males and females (ages 25–64), 1990–1992 and 2015–2017, by region and state

8-4 Number of suicides among U.S. working-age non-Hispanic Whites (ages 25–64), 1990–2017, by type and gender

9-1 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (ages 25–64), 1990–2017, by sex, age, and race and ethnicity

9-2 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (ages 25–64), 1990–1993 through 2015–2017, by metropolitan status

9-3 Mortality rates (deaths per 100,000 population) from endocrine, nutritional, and metabolic diseases among U.S. working-age males and females (ages 25–44), 1990–1992 and 2015–2017, by region and state

9-4 Mortality rates (deaths per 100,0000 population) from hypertensive heart disease among U.S. working-age males and females (ages 25–64), 1990–2017, by sex, age, and race and ethnicity

9-5 Mortality rates (deaths per 100,000 population) from hypertensive heart disease among U.S. working-age males and females (ages 25–64), 1990–1993 through 2015–2017, by metropolitan status

Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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9-6 Mortality rates (deaths per 100,000 population) from hypertensive heart disease among U.S. working-age males and females (ages 25–44), 1990–1992 and 2015–2017, by region and state

9-7 Mortality rates (deaths per 100,000 population) from ischemic heart disease and other circulatory system diseases among U.S. working-age males and females (ages 25–64), 1990–2017, by sex, age, and race and ethnicity

9-8 Mortality rate (deaths per 100,000 population) from ischemic heart disease and other diseases of the circulatory system among U.S. working-age males and females (ages 25–64), 1990–1993 through 2015–2017, by metropolitan status

9-9 Mortality rates (deaths per 100,000 population) from ischemic heart disease and other diseases of the circulatory system among U.S. working-age males and females (ages 25–44), 1990–1992 and 2015–2017, by region and state

9-10 Obesity rates by income measured as percentage of poverty in each respective period, among U.S. adults, 1960–2016 (obesity defined as body mass index [BMI] >30)

9-11 Obesity prevalence by educational attainment for men and women, 2011–2014 (obesity defined as body mass index [BMI] >30)

9-12 Death rates for cardiovascular disease (CVD) in the United States and selected peer countries 1999–2017

9-13 Trends in smoking by education among adults ages 20–74, 1974–2016

TABLES

2-1 Age-Standardized Mortality Rates (deaths per 100,000 population) for All Causes of Death and Specific Causes of Death in the United States and Peer Countries, 2000, 2008, and 2015

A2-1 Availability of Mortality Data for the 16 Peer Countries

4-1 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Non-Hispanic White Adults Ages 25–64

4-2 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Non-Hispanic Black Adults Ages 25–64

4-3 Cause-Specific Mortality (deaths per 100,000 population), 1990–1993 and 2015–2017: Hispanic Adults Ages 25–64

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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4-4 Summary of Findings: Cause-Specific Mortality Among Working-Age Adults, 1990–2017

A4-1 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non-Hispanic White Adults

A4-2 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Non-Hispanic Black Adults

A4-3 Absolute Change in Cause-Specific Mortality and Percentage of Total Increase or Decrease in Mortality by Size of Metropolitan Area, 1990–1993 to 2015–2017: Hispanic Adults

5-1 Assignment to 20 Cause-of-Death Categories

5-2 ICD-9 and ICD-10 Codes for Drug- and Alcohol-Related Deaths due to Mental and Behavioral Disorders

A6-1 Simulated Data Used in Annex Figures 6-1 to 6-6

11-1 Recommendations and Policy Conclusions

A-1 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 25–44

A-2 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 25–44

A-3 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 25–44

A-4 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 25–44

A-5 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 25–44

A-6 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 25–44

A-7 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 45–54

A-8 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 45–54

A-9 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 45–54

A-10 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 45–54

A-11 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 45–54

A-12 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 45–54

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. High and Rising Mortality Rates Among Working-Age Adults. Washington, DC: The National Academies Press. doi: 10.17226/25976.
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A-13 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 55–64

A-14 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 55–64

A-15 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 55–64

A-16 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 55–64

A-17 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 55–64

A-18 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 55–64

A-19 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 25–64 Living in Large Central Metropolitan Areas

A-20 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 25–64 Living in Large Fringe Metropolitan Areas

A-21 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 25–64 Living in Small/Medium Metropolitan Areas

A-22 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Males Ages 25–64 Living in Nonmetropolitan Areas

A-23 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 25–64 Living in Large Central Metropolitan Areas

A-24 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 25–64 Living in Large Fringe Metropolitan Areas

A-25 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 25–64 Living in Small/Medium Metropolitan Areas

A-26 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Males Ages 25–64 Living in Nonmetropolitan Areas

A-27 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 25–64 Living in Large Central Metropolitan Areas

A-28 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 25–64 Living in Large Fringe Metropolitan Areas

A-29 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 25–64 Living in Small/Medium Metropolitan Areas

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A-30 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Males Ages 25–64 Living in Nonmetropolitan Areas

A-31 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Large Central Metropolitan Areas

A-32 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Large Fringe Metropolitan Areas

A-33 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Small/Medium Metropolitan Areas

A-34 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic White Females Ages 25–64 Living in Nonmetropolitan Areas

A-35 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Large Central Metropolitan Areas

A-36 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Large Fringe Metropolitan Areas

A-37 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Small/Medium Metropolitan Areas

A-38 Cause-Specific Mortality Rates (deaths/100,000): Non-Hispanic Black Females Ages 25–64 Living in Nonmetropolitan Areas

A-39 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 25–64 Living in Large Central Metropolitan Areas

A-40 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 25–64 Living in Large Fringe Metropolitan Areas

A-41 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 25–64 Living in Small/Medium Metropolitan Areas

A-42 Cause-Specific Mortality Rates (deaths/100,000): Hispanic Females Ages 25–64 Living in Nonmetropolitan Areas

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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.

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