Pubdate: Sun, 17 Jan 2016
Source: New York Times (NY)
Copyright: 2016 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Authors: Gina Kolata and Sarah Cohen

DRUG OVERDOSES PROPEL RISE IN MORTALITY RATES OF WHITES

Drug overdoses are driving up the death rate of young white adults in 
the United States to levels not seen since the end of the AIDS 
epidemic more than two decades ago - a turn of fortune that stands in 
sharp contrast to falling death rates for young blacks, a New York 
Times analysis of death certificates has found.

The rising death rates for those young white adults, ages 25 to 34, 
make them the first generation since the Vietnam War years of the 
mid-1960s to experience higher death rates in early adulthood than 
the generation that preceded it.

The Times analyzed nearly 60 million death certificates collected by 
the Centers for Disease Control and Prevention from 1990 to 2014. It 
found death rates for non-Hispanic whites either rising or flattening 
for all the adult age groups under 65 - a trend that was particularly 
pronounced in women - even as medical advances sharply reduce deaths 
from traditional killers like heart disease. Death rates for blacks 
and most Hispanic groups continued to fall.

The analysis shows that the rise in white mortality extends well 
beyond the 45- to 54-year-old age group documented by a pair of 
Princeton economists in a research paper that startled policy makers 
and politicians two months ago.

While the death rate among young whites rose for every age group over 
the five years before 2014, it rose faster by any measure for the 
less educated, by 23 percent for those without a high school 
education, compared with only 4 percent for those with a college 
degree or more.

The drug overdose numbers were stark. In 2014, the overdose death 
rate for whites ages 25 to 34 was five times its level in 1999, and 
the rate for 35- to 44-year-old whites tripled during that period. 
The numbers cover both illegal and prescription drugs.

"That is startling," said Dr. Wilson Compton, the deputy director of 
the National Institute on Drug Abuse. "Those are tremendous increases."

Rising rates of overdose deaths and suicide appear to have erased the 
benefits from advances in medical treatment for most age groups of 
whites. Death rates for drug overdoses and suicides "are running 
counter to those of chronic diseases," like heart disease, said Ian 
Rockett, an epidemiologist at West Virginia University.

In fact, graphs of the drug overdose deaths look like those of deaths 
from a new infectious disease, said Jonathan Skinner, a Dartmouth 
economist. "It is like an infection model, diffusing out and catching 
more and more people," he said.

Yet overdose deaths for young adult blacks have edged up only 
slightly. Over all, the death rate for blacks has been steadily 
falling, largely driven by a decline in deaths from AIDS. The result 
is that a once yawning gap between death rates for blacks and whites 
has shrunk by two-thirds.

"This is the smallest proportional and absolute gap in mortality 
between blacks and whites at these ages for more than a century," Dr. 
Skinner said. If the past decade's trends continue, even without any 
further progress in AIDS mortality, rates for blacks and whites will 
be equal in nine years, he said.

There is a reason that blacks appear to have been spared the worst of 
the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. 
Studies have found that doctors are much more reluctant to prescribe 
painkillers to minority patients, worrying that they might sell them 
or become addicted.

"The answer is that racial stereotypes are protecting these patients 
from the addiction epidemic," said Dr. Kolodny, a senior scientist at 
the Heller School for Social Policy and Management at Brandeis 
University and chief medical officer for Phoenix House Foundation, a 
national drug and alcohol treatment company.

Not many young people die of any cause. In 2014, there were about 
29,000 deaths out of a population of about 25 million whites in the 
25-to-34 age group. That number had steadily increased since 2004, 
rising by about 5,500 - about 24 percent - while the population of 
the group as a whole rose only 5 percent. In 2004, there were 2,888 
deaths from overdoses in that group; in 2014, the number totaled 7,558.

Mortality rates, said Mark D. Hayward, a professor of sociology at 
the University of Texas at Austin, are one of the most sensitive 
measures of quality of life.

By that measure, said Anne Case, a Princeton economist, "there's a 
real rumbling that bad things are coming down the pike." Dr. Case 
made the original observation with her husband, the Nobel laureate 
Angus Deaton, in a published paper that showed death rates for 
middle-aged whites rising in contrast to those in every other rich country.

For young non-Hispanic whites, the death rate from accidental 
poisoning - which is mostly drug overdoses - rose to 30 per 100,000 
from six over the years 1999 to 2014, and the suicide rate rose to 
19.5 per 100,000 from 15, the Times analysis found.

For non-Hispanic whites ages 35 to 44, the accidental poisoning rate 
rose to 29.9 from 9.6 in that period. And for non-Hispanic whites 
ages 45 to 54 - the group studied by Dr. Case and Dr. Deaton - the 
poisoning rate rose to 29.9 per 100,000 from 6.7 and the suicide rate 
rose to 26 per 100,000 from 16, the Times analysis found

But deaths from the traditional killers for which treatment has 
greatly improved over the past decade - heart disease, H.I.V. and 
cancer - went down.

Drug abuse, of both illegal drugs like heroin and prescription 
painkillers, has become a part of the American political discourse as 
never before in this country, with some presidential candidates, 
including Jeb Bush and Carly Fiorina, telling stories of addiction in 
their own families.

Sad stories abound.

Maline Hairup died of a heroin overdose on Aug. 24, 2014. She was 38 
and a Mormon, engaged to be married in the Salt Lake City Temple, 
near her home. Her religion taught her to spurn addictive substances 
- - no alcohol, no caffeine. But that night, after years of taking 
prescription narcotics for chronic pain complicated by mental 
illness, she tried heroin, her sister Mindy Vincent said. Ms. Vincent 
believes it was the only time her sister used that drug.

There are men like Steve Rummler, who lived in Minnesota and died of 
a heroin overdose at age 43, taking the drug after becoming addicted 
to OxyContin, which was initially prescribed for a back injury. "He 
didn't understand the risks," said his mother, Judy Rummler.

Researchers are struggling to come up with an answer to the question 
of why whites in particular are doing so poorly. No one has a clear 
answer, but researchers repeatedly speculate that the nation is 
seeing a cohort of whites who are isolated and left out of the 
economy and society and who have gotten ready access to cheap heroin 
and to prescription narcotic drugs.

"There are large numbers of people who never get established in the 
economy, who live outside family relationships and are on the edge of 
poverty," Dr. Hayward said. Many end up taking prescription 
narcotics, he added.

"Poverty and stress, for example, are risk factors for misuse of 
prescription narcotics," Dr. Hayward said.

Eileen Crimmins, a professor of gerontology at the University of 
Southern California, said the causes of death in these younger people 
were largely social - "violence and drinking and taking drugs." Her 
research shows that social problems are concentrated in the lower 
education group.

"For too many, and especially for too many women," she said, "they 
are not in stable relationships, they don't have jobs, they have 
children they can't feed and clothe, and they have no support network."

"It's not medical care, it's life," she said. "There are people whose 
lives are so hard they break."
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MAP posted-by: Jay Bergstrom