Why Are So Many Middle-Aged White Americans Dying Young?

Suicide, substance abuse, and liver disease are the top midlife causes of death.

Posted Nov 04, 2015

 Petar Paunchev/Shutterstock
Source: Petar Paunchev/Shutterstock

In the past decade, mortality rates for middle-aged white Americans have jumped dramatically, compared to other demographic groups. Why are they dying so young?

I don't know the answer to this question. That said, in this blog post I will present you with the statistics and my personal life experience regarding this topic. 

Morbidity and Mortality Are Rising Among Middle-Aged White Americans

Anne Case, Ph.D., and Angus Deaton, Ph.D., of Princeton University, detail these findings in a study, “Rising Morbidity and Mortality in Midlife Among White non-Hispanic Americans in the 21st Century,” was published online on November 2, 2015 in the Proceedings of the National Academy of Sciences. The analysis was funded by the National Institute on Aging (NIA), part of the National Institutes of Health.   

According to data from the Centers for Disease Control and Prevention, the U.S. Census Bureau, individual death records, and other sources used in their analysis, the three causes of death that accounted for the change in mortality among non-Hispanic whites were suicide, drug and alcohol poisoning, chronic liver diseases and cirrhosis.

A July 2014 study, “The Changing Face of Heroin Use in the United States,” reported that the abuse of heroin had migrated from low-income urban areas with large minority populations to more affluent suburban and rural areas with primarily white populations.

The researchers found that more recent users of heroin were older men and women living in less urban areas who were introduced to opioids through prescription drugs. Prior to the 1980s, Whites and nonwhites were equally represented in those who began using heroin but nearly 90% of respondents who began use in the last decade were white.  

The researchers concluded, “Although the ‘high’ produced by heroin was described as a significant factor in its selection, it was often used because it was more readily accessible and much less expensive than prescription opioids.”

Why Are So Many White Americans Drawn to Opioids and Heroin?

Deaths from heroin have quadrupled since 2013 claiming 8,260 lives. Some experts at the CDC are calling this the worst drug overdose epidemic in U.S. history.

According to the CDC drug overdose statistics, among those who died from prescription opioid overdose between 1999 and 2013 most were ages 25 to 54. This age group also had the highest overdose rates compared to other age groups. However, the overdose rate for adults aged 55–64 increased more than seven-fold during this same time period.

Drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day.

In their conclusion, the researchers also note that the reversal in health trends since 1999 indicates that today's middle-aged adults will be entering their senior years and Medicare eligibility in worse health than American adults, who are currently age 65 and older.

What Forces Cause Some Middle-Aged White Americans to Self-Destruct?

I went on an extra-long run this afternoon, pondering the million-dollar question of what prevented me from self-destructing while so many of my white, middle-aged friends have died. As the father of an 8-year-old, I also want to protect my daughter from becoming "just a statistic" in her generation.

Although on paper, it would appear that I won the “birthplace” lottery being born and raised in one of the most affluent zip codes in America, on the upper east side of Manhattan, to parents who were well educated, wealthy, and white. There was always one glitch. I'm gay. At the time, this was a deal-breaker in terms of me being the prodigal son, but being gay would ultimately turn out to be a 21st Century blessing in disguise.

Looking back on the factors that may have protected me from dying of the top leading causes of death in this study—suicide, drug and alcohol poisoning, and chronic liver disease or cirrhosis—I think that the main factor boils down to resilience and turning feelings of worthlessness into a need for achievement.

Growing up gay, I learned that my life would always be a struggle. Unlike my straight white peers, I never assumed that my happiness and fulfillment was a birthright. From a young age, I realized that I was a social outcast. Because of the homophobia of the era, I would have to struggle to prove my self-worth

Top of the World

I first realized that I was gay after going to see Karen and Richard Carpenter in concert around 1974. Firstly, I realized on an intuitive level that other boys my age didn't love the Carpenters fanatically the way that I loved their music. Secondly, I would have dreams about Richard Carpenter, and realized that I had a crush on him based on the feeling I got when I looked at the Sepia toned picture of him on that bridge inside the Greatest Hits album.

From a very young age, I felt like a black sheep and identified more with marginalized groups who were treated like second-class citizens than my peers who were being groomed to become future ‘Masters of the Universe.’

Because of the homophobia that surrounded me, I felt like any entitlement that went along with the privileged class that I was born into didn’t apply to me. Which was a good thing, I now believe. I never drank the Kool-Aid of The American Dream but lived by my Alice Walker inspired mantra, “Expect nothing. Live frugally on surprise.”

At boarding school in Wallingford, Connecticut during the 1980s my dean played a pivotal role in making me more resilient by bullying me about being an unathletic sissy. Instead of feeling like I was being invited to join the “old boys’ club” I knew that the powers that be hated me and wanted me to stay in the closet or disappear altogether. As a gay person, I was not welcome to be part of their club — if I ever came out.

Luckily, at some point in my adolescence I was able to turn the homophobia I felt from the male-white establishment into rocket fuel that made me determined to prove them wrong. I decided that I could be outspokenly gay and be a world-class athlete. In my book acknowledgements I thanked my dean at boarding school saying,

“Thank you for trying to convince me that I would amount to nothing. Whether it was reverse psychology or not, you forced me to make something of my life just to prove you wrong. I needed to succeed at first just to spite you. I didn't ever want you to be able to say, "I told you so." My resentment toward you was the seed that sparked my athletic conversion. At the end of the day, I am grateful to you for being so hard on me, even though it really sucked at the time. Thank you."

I decided in high school that I would never allow anyone to try to convince me that I was less because of the way I was born. 

This is very tricky territory. Obviously, I would never want to subject anyone to the pain and suffering of discrimination or bullying that ultimately helped me succeed. But, as food for thought, I do think there may be a sweet spot between coddling our kids, and antagonizing them to become ‘better’ by telling them that they’re less than if they're not superachievers. 

Conclusion: There Will Be Sunbeams in Your Soul Again

Drawing conclusions based on generalizations about race, age, and mortality makes me uncomfortable. I debated even writing about the latest findings because the correlation and causation of this study is questionable. And my perspective on it is clearly conjecture. Every human being has such a unique life story and forces that drive them to make choices at various stages of life.

From the perspective of giving some advice, I think a good starting point is to live by Alice Walker’s words of “Expect nothing. Live frugally on surprise.” As a society, there may be a tendency to have sour grapes if the American dream doesn’t turn out the way you thought it would.

Ultimately, I think that we all want to feel that our lives matter. And they do, obviously. But in terms of generativity and creating things that will outlast you, this takes hard work and commitment. And regardless of whether you were born with a silver spoon in your mouth or not, each of us has to put a tremendous amount of effort into making our lives seem worthwhile.

Lastly, as someone who has come close to killing myself, I realize now that if I were dead, I couldn’t be writing this now. If you are suicidal please reach out and ask for help. On page 141 of The Athlete's Way I write about my own experience with suicide,

"When you are in the blackest of blackness the light seems like it will never enter your brain again. But it will. The light will flicker again. That is the human spirit, it always, always comes back. I've been there myself. If you are depressed or suicidal do whatever you have to do to stay vital and get yourself back on track. You were born to be alive. Don't isolate. Reach out. Ask for help. There will be sunbeams in your soul again. Ride out the storm—but don't do it alone. People will take care of you. Let them. And make a vow, when you're back on top to give something back." 

If you are feeling suicidal please call 1-800-273-TALK (8255). Or contact the National Suicide Prevention Lifeline in any way that works for you. 

In closing, here is the entire “Expect Nothing. Live Frugally on Surprise” quotation from Alice Walker that has pulled me through good times and bad.

“Expect nothing. Live frugally
On surprise.
become a stranger
To need of pity
Or, if compassion be freely
Given out
Take only enough
Stop short of urge to plead
Then purge away the need.

Wish for nothing larger
Than your own small heart
Or greater than a star;
Tame wild disappointment
With caress unmoved and cold
Make of it a parka
For your soul.

Discover the reason why
So tiny human midget
Exists at all
So scared unwise
But expect nothing. Live frugally
On surprise.”  —Alice Walker

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