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3 U.S. Trends in All-Cause Mortality Among Working-Age Adults
Pages 55-94

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From page 55...
... Since 2010, this change in working-age mortality has been large enough to stall and then reverse the decades-long trend of increasing life expectancy at birth within the United States (Arias and Xu, 2019)
From page 56...
... 2 As shown in Figure 3-1, mortality rates are reported here for four age deciles: 25–34, 35–44, 45–54, and 55–64. 3 An exception occurred for females ages 55–64, among whom mortality declined steadily until the late 2000s.
From page 57...
... Among females ages 35–44, mortality rates were nearly unchanged, while among females ages 25–34, the rates were higher in 2015–2017 than in 1990–1993. In contrast, because working-age males saw declines in mortality during the 1990s and 2000s that exceeded the recent increases, their mortality rates remained lower in 2015–2017 than in 1990–1993, despite the increases in mortality they experienced in the 2010s.
From page 58...
... , mortality rates ticked upward among most of these groups, including those ages 25–44 of both sexes and all three races/ethnicities, White males and females ages 45–64, Black males ages 45–54, and Black females ages 55–64. In fact, among White males and females ages 25–44 and White females ages 45–54, mortality rates in 2015–2017 were already higher than they were in 1990–1993.
From page 59...
... Deaths (per 100,000) 2500 1250 2000 1000 1500 750 1000 500 500 250 0 0 NH White NH Black Hispanic NH White NH Black Hispanic FIGURE 3-2  All-cause mortality rates (deaths per 100,000 population)
From page 60...
... At older ages, mortality also declined until 2009–2011 but plateaued thereafter. At all ages, however, API male and female mortality rates remained lower than the rates among other racial/ethnic groups.
From page 61...
... TRENDS IN ALL-CAUSE MORTALITY AMONG WORKING-AGE ADULTS 61 b. Asian and Pacific Islander Males and Females, ages 45-54 and 55-64 Deaths per 100,000 Population 800 700 600 500 400 300 200 100 0 Males 45-54 Males 55-64 Females 45-54 Females 55-64 FIGURE B3-1  All-cause mortality rates for Asian/Pacific Islander males and fe males ages 25–64, 1990–2017.
From page 62...
... High-quality mortality and population data are collected for tribal areas, allowing researchers to construct mortality and life expectancy estimates for AI/ANs living in 637 Contract Health Service Delivery Area (CHSDA) counties that contain tribal lands or are adjacent to such lands (Arias, Xu, and Jim, 2014; Espey et al., 2014)
From page 63...
... used to generate the original analyses documented in this report, some of which differentially affect mortality estimates for low- and high-SES individuals. One important limitation of these data is that the NVSS files include only a single measure of SES -- educational attainment -- and this measure, when drawn from death certificates, suffers from wellestablished issues of accuracy, availability, and quality (Rostron, Boies, and Arias, 2010)
From page 64...
... Relative mortality disparities by educational attainment were generally wider among women, while relative disparities by family income were generally wider among men. However, Kitagawa and Hauser (1973)
From page 65...
... They report very little change in mortality rates for those in the bottom 5 percent of the income distribution but a marked decrease in mortality among those in the top 5 percent. As a result, the disparity in mortality by individual-level income increased starting at the beginning of the 21st century, with estimated life expectancy differences of 10.1 years among women and 14.6 years among men for those in the highest and lowest income percentiles in the country, respectively.
From page 66...
... ; (2) large fringe metropolitan areas (surrounding counties of the large central metros, hereafter referred to as "large fringe metros")
From page 67...
... Younger working-age Whites experienced increasing mortality in all areas outside of large central metros, with the largest increases occurring in nonmetros. Among older White females, only those in nonmetros saw increasing mortality; mortality decreased in more populated areas.
From page 68...
... NH White Females, ages 25-44 350 200 Deaths per 100,000 Persons Deaths per 100,000 Persons 300 175 150 250 125 200 100 150 75 100 50 1990-93 2000-02 2009-11 2015-17 1990-93 2000-02 2009-11 2015-17 b. NH Black Males, ages 25-44 e.
From page 69...
... In fact, younger working-age adults in large central metros generally had higher mortality rates in 1990–1993, but mortality rates in these areas were below those in less-populated areas
From page 70...
... and White males created a large and growing nonmetro mortality "penalty" that was particularly large among working-age Whites. The large relative improvements in mortality among Black adults, combined with increasing mortality in nonmetro areas among younger White adults, led to a significant narrowing of racial disparities in mortality between working-age Blacks and Whites over the period within all metropolitan area types.
From page 71...
... 10  In the Northeast and West, respectively, mortality rates decreased by 28.9 percent and 33.1 percent among males ages 25–44, by 32.5 percent and 25.1 percent among males ages 45–64, by 17.7 percent and 8.4 percent among females ages 25–44, and by 29.0 percent and 22.8 percent among females ages 45–64. These declines exceeded those in the other two regions.
From page 72...
... Although mortality declined by 10.2 percent within the region overall among females ages 45–64, the South accounted for all but one of the eight U.S. states in which mortality increased.12 West Virginia, Kentucky, Tennessee, Oklahoma, Arkansas, Alabama, and Mississippi had especially unfavorable mortality trends among working-age adults.
From page 73...
... . Trends among females ages 25–44 were even less favorable; their mortality rates increased by 20.2 percent overall, with large increases in Ohio (55.0%)
From page 74...
... Males ages 25-44 Oklahoma (b) Females ages 25-44 Tennessee Tennessee South Carolina South Carolina Oklahoma South South South SOUTH SOUTH Delaware Georgia Delaware Maryland North Carolina North Carolina SOUTH Florida Georgia North Carolina Delaware Florida Florida Texas Maryland Georgia Maryland Virginia Texas Virginia Texas Virginia New Mexico New Mexico New Mexico Nevada Alaska Alaska Arizona Montana Montana Montana Wyoming Wyoming Wyoming Arizona Arizona Alaska Nevada Nevada Oregon Utah Idaho West West West Hawaii Idaho Utah WEST Colorado Colorado Idaho Oregon WEST Washington WEST Oregon Colorado Washington Hawaii California Hawaii Washington Utah California California HIGH AND RISING MORTALITY RATES AMONG WORKING-AGE ADULTS
From page 75...
... TRENDS IN ALL-CAUSE MORTALITY AMONG WORKING-AGE ADULTS 75 (d) Females ages 45-64 800 700 Deaths per 100,000 Population 600 500 400 300 200 Pennsylvania Maine Rhode Island NORTHEAST Vermont New Jersey New York New Hampshire Massachusetts Connecticut Missouri Michigan Tennessee South Carolina Nevada Alaska Montana Wyoming WEST Ohio Indiana Kansas MIDWEST Illinois South Dakota Iowa North Dakota Mississippi Nebraska Wisconsin Minnesota West Virginia Oklahoma Arkansas Kentucky Alabama Louisiana Georgia SOUTH Delaware North Carolina Florida Texas Maryland Virginia New Mexico Arizona Oregon Washington Idaho Utah California Colorado Hawaii Northeast Midwest South West 1990-1992 2015-2017 FIGURE 3-4 All-cause mortality rates (deaths per 100,000 population)
From page 76...
... mortality within that state's less-populated areas. The county-level mortality rates also identify areas of increasing mortality that cross state boundaries, such as the growing mortality disadvantage in the Appalachian region that includes areas of Ohio, Kentucky, West Virginia, and Pennsylvania.
From page 77...
... SOURCE: Data from National Vital Statistics System Detailed Mortality Files. mortality rates were concentrated in New England, the Northeast, and the Midwest.
From page 78...
... The counties that experienced improvements in mortality among young females were less consolidated by region but were often located along the coasts and parts of the central United States, particularly in large central metros. Among females ages 45–64, the counties that experienced large increases in mortality stretched across the Appalachian region and through Tennessee, Arkansas, and Oklahoma, just as occurred among younger females (Figures 3-8a and 3-8b)
From page 79...
... females, however, the mortality increases for females ages 45–64 were smaller and less geographically widespread. In contrast, areas with counties showing increasing mortality among older females were more pronounced and more widespread throughout the United States relative to counties with increasing mortality among males in this older age group.
From page 80...
... SOURCE: Data from https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm. A much smaller number of counties experienced substantial decreases in mortality among females ages 45–64.
From page 81...
... , 1990–1992 and 2015–2017: Females ages 25–44. NOTE: Mortality rates are shown for 1990–1992 (left)
From page 82...
... , 1990–1992 to 2015–2017, by U.S. county: Females ages 25–44.
From page 83...
... , 1990–1992 and 2015–2017: Females ages 45–64. NOTE: Mortality rates are shown for 1990–1992 (left)
From page 84...
... , 1990–1992 to 2015–2017, by U.S. county: Females ages 45–64.
From page 85...
... Apart from DC, the largest and most consistent improvements in mortality among working-age adults occurred in states with large populations that are anchored by large central metros, including New York, California, New Jersey, and Illinois. Mortality trends were not uniform within regions or states, and within-state disparities were often as pronounced as those among states.
From page 86...
... Only females ages 55–64 experienced decreasing mortality during this period. These racial/ethnic differences in mortality trends during the period had a significant impact on racial/ethnic disparities in mortality among working-age adults.
From page 87...
... Mortality rates increased across several regions and states, particularly within the younger working-age group and most glaringly in central Appalachia, New England, the central United States, and parts of the Southwest and Mountain West. These increases occurred more broadly throughout the country among working-age females, while increases among males were more geographically concentrated.
From page 88...
... . Despite the growing size of the API population, valid estimates of age-specific mortality rates and life expectancy for this population have been challenging because of misclassification of race on some death certificates.
From page 89...
... This estimate is consistent with scattered published age-specific mortality and life expectancy estimates for the API population, according to which API life expectancy is the highest among all U.S. racial/ ethnic groups, exceeding that of non-Hispanic Whites life expectancy by 6–8 years for both women and men (Acciai, Noah, and Firebaugh, 2015; Singh and Hiatt, 2006)
From page 90...
... In 2007–2009, AI/AN male life expectancy in the CHSDA counties was 7.9 years lower than the national estimate for non-Hispanic White males, 2.2 years lower than for non-Hispanic Black males, and 10.4 years lower than for Hispanic males. The respective figures for females were 6.4 years, 2.6 years, and 9.0 years (Annex Figure 3-2)
From page 91...
... U.S. TRENDS IN ALL-CAUSE MORTALITY AMONG WORKING-AGE ADULTS 91 ANNEX FIGURE 3-1  Locations of Contract Health Service Delivery Area (CHSDA)
From page 92...
... counties in 2007–2009. National non-Hispanic Black, non-Hispanic White, and Hispanic life expectancy in 2008.
From page 93...
... , males ages 45–64 (upper right panel) , females ages 25–44 (lower left panel)
From page 94...
... 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. NOTE: The light blue bars show the percentage of the population living in counties that fall in the bottom (most favorable)


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