In wealthy countries, rates of premature death tend to go down as we improve health care and promote healthy behaviour. As young people stop smoking and get treatment for diseases like HIV, they’re less likely to die early, as has been the general trend in the US and other wealthy countries for about the past 40 years, from 1970 to 2010.
So it’s a bit disturbing to hear that premature death rates have been on the rise for certain 30-year-old populations in the US over the past 15 years or so.
Premature mortality rates in the US are on the rise for white individuals (women especially), American Indians, and Alaska Natives, according to a study published January 26 in The Lancet. That increase is driven by accidental deaths like drug overdoses, liver disease and cirrhosis largely caused by alcohol abuse, and suicide.
“Death at any age is devastating for those left behind, but premature death is especially so, in particular for children and parents,” said senior study author Amy Berrington of the National Cancer Institute in a press release.
The study, which analysed death certificate data ranging from 1999 to 2014, found that mortality rates for 30-year-old white women rose up to 2.3% per year over that time period; those for 30-year-old white men rose .6% per year; annual rates for 30-year-old Native Americans rose 4.3%; and rates for 30-year-old Alaska Natives rose 1.9% per year.
For white Americans, that represents a reversal, but the authors write that premature death rates for middle-aged American Indians and Alaska Natives have risen for every birth cohort since 1948.
The researchers write that these sorts of increases are “extremely unusual in high-income countries.” They say increases this high are on par with premature mortality spikes at the height of the AIDS epidemic in the US (mid-80s to mid-90s) or in Russia in the post-economic crisis late-1990s.
Some improvements in mortality rates
However, the study also found some important improvements in mortality rates over the same time period.
Premature death rates for Hispanics, Asians, and Pacific Islanders (already all lower than other groups) continued to fall throughout this 1999-2014 range, resulting in 112,000 fewer premature deaths in Hispanics aged 25 to 64 and 34,000 fewer premature deaths among Asians and Pacific Islanders.
Even more impressively, premature death rates for black Americans decreased up to 3.9% per year, resulting in 311,000 fewer deaths among individuals aged 25-64. This narrows the gap between black and white Americans, though death rates among black Americans were still 1.5 times higher than those of white Americans in the 2011-2014 time period, one of the most recent spans that the study included data from.
These improvements were largely due to public health successes in getting people treatment for HIV and in lowering smoking rates. “[T]here is an urgent need for aggressive actions targeting emerging causes of death, namely drug overdoses, suicide, and liver disease,” said lead study author Meredith Shiels, also of the National Cancer Institute.
By tracking these death rates we can see what sorts of interventions are working and find the groups that most need new interventions.
Berrington explains the motivation for this research with a quote from her mentor, the epidemiologist Sir Richard Doll, saying “Death in old age is inevitable, but death before old age is not.”
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