Deaths of despair

Since the late 1990s, there has been a marked increase in the overall mortality of middle-aged white non-Hispanic males and females in the United States (Case and Deaton 2015, 2017, 2020). This increase in mortality was largely attributed to increases in deaths by suicide, drug and alcohol poisonings (both accidental and undetermined intent) and deaths due to chronic liver diseases and cirrhosis—together termed ‘deaths of despair’ by Case and Deaton (Case and Deaton, 2015, 2017, 2020). They linked this trend to a decline in economic security, a lack of universal health care and the widespread availability of opioids (Case and Deaton 2015, 2017, 2020). In 2017, Case and Deaton suggested that a similar increase in mortality from deaths of despair may be emerging in other countries (Case and Deaton 2017).

Selected causes of death, by sex, Australia, 1997 to 2018.

The line graph shows age-standardised rates of death by suicide, alcoholic liver disease and cirrhosis, accidental poisoning, and all of these causes combined from 1997 to 2018. Users can also choose to view age-standardised death rates and numbers of deaths for this period by sex and cause of death. Rates of deaths by these selected causes of death  show no clear trend over the period 1997–2018. Since 2014, the rate has remained around 23–24 deaths per 100,000 population which was similar to rates at the start of the period (1997 to 1999). Between these dates rates were lower (around 20.0 deaths per 100,000 population). 

An analysis of Australian mortality data using methods similar to those used by Case and Deaton shows that Australians are not increasingly dying due to these ‘deaths of despair’ over time. The rates of combined deaths by suicide, alcoholic liver disease and cirrhosis, and accidental poisoning (deaths of despair) over the period 1997–2018 show no clear trend. Over the past 5 years the rate has remained around 23–24 deaths per 100,000 population (from 2014 to 2018), similar to rates at the start of the period 1997–1999; between these dates rates remained lower (around 20.0 deaths).

Males are more likely than females to die by these selected causes of death (suicide, alcoholic liver disease and cirrhosis, and accidental poisoning). At the start of the period, rates of combined deaths by suicide, alcoholic liver disease and cirrhosis, and accidental poisoning in males were at a high of around 36–38 deaths per 100,000 population from 1997 to 1999 and female rates were around 11 deaths—about 3.2 to 3.4 times lower than males. In the past 5 years from 2014, death rates for both males and females have shown little variation with male rates ranging between 33 to 35 deaths per 100,000 population and female rates around 12 to 13 deaths—that is, these causes of death are about 2.8 times more common in males than females.

For males, deaths by suicide account for the majority (53–67%) of these ‘deaths of despair’ over the period 1997–2018. In contrast, deaths by suicide account for less than half (43–48%) of these deaths in females.

References

Case A and Deaton A 2020. Deaths of Despair and the Future of Capitalism. Princeton: Princeton University Press.

Case A, Deaton A 2017. Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity 397.

Case A, Deaton A 2015. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. PNAS. 112(49):15078-15083.