The Rising Death Rates of Middle-Aged Non-Hispanic White Americans: More Food For Thought.

Or dental floss to clean your teeth after chewing on the Case-Deaton study, discussed in my earlier post.  Andrew Gelman makes an interesting point about what might drive some small part of the findings (that even though middle-aged people in lots of other countries and among US Hispanics and non-Hispanic blacks still enjoy declining mortality rates, it seems that non-Hispanic white Americans in that age group do not.).

That point is this:  The age group that Case and Deaton studied, the ages from 45 to 54, has not had a constant average age over time.:

But could this pattern be an artifact of the coarseness of the age category? A commenter here raised this possibility a couple days ago, pointing out that, during the period shown in the above graph (1989 to the present), the 45-54 bin has been getting older as the baby boom has been moving through. So you’d expect an increasing death rate in this window, just from the increase in average age.

If you like, the load in the boat containing all 45-54 year-old Americans has been tilting towards the higher end of that span, because of the baby boom effect.

Gelman does some back-of-the-envelope calculations and suggests that the correct death rates for middle-aged non-Hispanic white Americans might not have increased, after all,  but stayed constant.  This is still different than the evidence from other countries or the evidence on American Hispanics and non-Hispanic blacks, because all those groups seem to have enjoyed declining mortality rates.

The question of interest for me has to do with non-Hispanic blacks.  I get that American Hispanics might not show the same baby boom effect if their countries of origin didn't demonstrate a baby boom.  But many European countries (though not Sweden) in this graph should show similar effects to the tilting of the boat of the middle-aged towards higher ages:

The group I'm most curious about in this context is the group of non-Hispanic black Americans.  Didn't they experience the same baby boom effect as non-Hispanic white Americans?  Studying that question could throw more light on the findings.

Why am I harping so much about these details?

When we find something very unexpected and shocking, such as the sudden increasing mortality rates of poor white women (but not of poor black women, say) or poorer non-Hispanic whites between the ages of 45 and 54 (but not of poorer Hispanics or non-Hispanic blacks), we should double- and triple-check all the calculations.  That's because it's hard to make up explanations which would explain those ethnic and/or racial differences.  For instance, poverty-based explanations shouldn't work differently on whites, blacks and Hispanics.

Or put in another way, before we launch all the necessary extra studies about these phenomena we should be more certain that they are real.

One simpler way to describe

Most of these studies are about changes in a ratio, one where mortality is the numerator and where some population measure is the denominator.   It's natural to interpret changes in the ratio as coming from changes in the numerator (such as increasing death rates for poor white women), and that can be the case (and perhaps is).  But before we conclude that, we should make sure that the denominator hasn't changed.

By that change I don't mean quantitative changes* but more the idea that who it is we are counting in the denominator may have changed.  Gelman's point above is an example of that type of a change.  Another similar example is mentioned in this older post of mine, about the rising mortality rates of poorer white American men and especially women:**

Suppose that the group "white people without a high school diploma"  has shrunk not only in proportion to the overall population but in proportion to all whites.  If that's the case, it could be that past studies of similarly defined groups had more people with higher life expectancies in them, but that the most recent group does not, perhaps because education has become more accessible, filtering away first those with minimal risk factors?

That one is about who it is who remains in the "least educated" groups over time, and this could differ between white, black and Hispanic Americans.

So what can we conclude about the Case-Deaton study?  Certainly that the numbers deserve more investigation.

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Edited later to add first footnote

* That explanation is a simplistic one, for which my apologies.  The changes in what types of people are included in a certain category (by age, gender, race, geographic area) obviously can affect both the numerator and the denominator.  But my tool should work as a pedagogical one, to remind us that when a ratio changes it's not necessarily (or only) the numerator that is changing.

**One newer study, still in a draft form, suggests that  changes in the distribution of education might not explain the rising mortality rates of poorer white women, but might do it for poorer white men.

Snippet Posts, 11/5/15: On the Dangers of Open-Carry Laws And The Early Demise of Poorer Non-Hispanic White Americans

1.  The Colorado shooting rampage touches upon one often-ignored way other people's right to open-carry endangers any potential victim of mass shooters:

Two days before Noah Harpham killed three people in a Colorado Springs shooting rampage, the 33-year-old wrote an incoherent Internet essay post and rambled in a video uploaded to YouTube.

...

Bettis said she recognized the gunman as her neighbor — whom she didn't know by name — and that before the initial slaying she saw him roaming outside with a rifle. She called 911 to report the man, but a dispatcher explained that Colorado has an open carry law that allows public handling of firearms.

Bolds are mine.

This phenomenon isn't limited to just guns, but it's pretty common there.  In this case the police didn't act as rapidly as would have been the case if open-carry had been illegal*.  Whether some of the victims might have been saved under that scenario is unclear.  But worth thinking about.



2.  A new study looks at the death rates among Americans between ages 45 and 54.  It argues that something troubling is taking place among poorer white non-Hispanic Americans in that age group:

The recent divergence in death rates between the United States and other rich countries is striking. Between 1979 and 1999, Case and Deaton show, mortality for white Americans ages 45 to 54 had declined at nearly 2 percent per year. That was about the same as the average rate of decline in mortality for all people the same age in such countries as France, Germany, the United Kingdom, and Sweden. (See figure below.) After 1999, the 2 percent annual decline continued in other industrialized countries and for Hispanics in the United States, but the death rate for middle-aged white non-Hispanic Americans turned around and began rising half a percent a year.

The authors, Anne Case and Angus Deaton, note that white Americans still have a higher life expectancy than black Americans, but the difference between black and white mortality rates (as a ratio where 1 would stand for equal rates) has shrunk from 2.09 in 1999 to 1.40 in 2013.

What's driving these results?  Most of the increase in white non-Hispanic mortality rates in this age group is caused by rising death rates among those with the lowest education levels (and probably therefore the lowest incomes).  And the reasons look to me linked to self-harm:

This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.

I've only skimmed through the study so far, but it's worth pointing out that the various explanations Case and Deaton offer are speculative ones, i.e., not something one could directly deduce from the statistics they report.  This doesn't mean that their proposed explanations wouldn't be the correct ones, of course.** But the data is silent about what's causing these changes. 

Case and Deaton didn't find this pattern among older Americans, who are still all enjoying declining mortality rates (as are blacks and Hispanics in the studied age range).  It would have been interesting to see if the pattern would be visible among Americans younger than the 45-54 age group the study analyzed.

I need to spend more time thinking about that study.  The changes look very recent and pretty drastic, and it's hard not think that they have something to do with the economic despair*** of the least educated middle-aged non-Hispanic whites.  But why wouldn't the same economic despair affect the poor non-Hispanic blacks and Hispanics in that age group in a similar manner?

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Edited later to fix a typo and to add the first footnote.  For the sake of clarity.  I was half-asleep because of fatigue when I wrote the original draft.

*  What I mean when I say that this phenomenon is not limited only to guns is this:  The cues the police uses to judge whether a crime might be taking place are different when the cue behavior itself is illegal than when it is made legal.  In the latter case the old cue is no longer workable.  For a non-gun example, think of masked people entering a bank.  That might cause the bank staff to press the alarm button or call the police.  But if being masked is completely legal they cannot do that or at least get help as fast should a bank robbery indeed be in progress.

** Earlier studies have also found an increase in the mortality rates among poorer white men and especially among poorer white women, so it's clear that something is happening among the poorest non-Hispanic whites which requires attention and analysis not only from economists but also from health care researchers.  But what the specific chains of cause-and-effect might be still remains to be researched.

***Caused by the collapse of the housing markets, the most recent recession, the disappearance of better-paying jobs for those with at most a high-school diploma, the way we are being talked to slowly accept no long-term retirement security and so on. 


 

Short Posts, 2/11/15. On Diplomacy And Human Rights, A God In Your Corner and Gendered Work

1.  "Diplomacy" is like sausage-making.  You don't really want to delve too deep into the process.  An example from today's Eschaton post:

President Karimov is not a man with a big, warm heart.  His human rights record is abominable.

Of course human rights in global politics are mostly used like lipstick on a pig:  as an excuse for something else a country wishes to do that's about money and power.

Hmm.  Why are all my nasty metaphors about pigs?  They are smart animals, probably with good ethics, too.  My apologies for that, dear pigs.

2.  Deus ex machina in action:  

Former House Speaker John Boehner says he used "Catholic guilt" to persuade Paul Ryan to run for speaker.

On CNN's "State of the Union" Sunday Boehner said he invoked God to persuade his fellow Catholic from refusing to run for speaker to agreeing to do so.
Boehner says he told Ryan: "'This isn't about what you want to do. It's about what God wants you to do. And God has told me, he wants you to" run for speaker.

I used the "ex machina" term somewhat differently from its usual definition.  That's because it's so very often used to strangle all criticism, to turn the person interpreting god into some god's henchman (or more rarely his henchwoman, given how little power religions give women to have that cellphone connection to the divine powers).  This troubles me a lot, because it makes debate impossible.

Debate becomes a boxing match where in one corner stands a tiny human, in the other corner all the contradictory and sometimes violent commands some religion has collected, gathered, translated and interpreted over millennia. 

In other words, a god, as brought to you by whatever religion we are talking about, and somewhere inside all that religious information there might just be found a command to squash that tiny human who has dared to raise his or her voice (or dared to use that intelligence which presumably the divine powers donated us).

So no, you can't box with gods.  Unless you are a snake goddess or something similar.  And divine powers really don't care who wins a sporting contest, despite all the athletes who thank god after their victories.  Just a general public information statement.

3.  A recent Finnish dissertation argues that we see work as gendered in ways which affect public policies (link in Finnish, sorry). 

For instance, putting money into male-dominated* industries is viewed as good for the economy (think of fixing roads and bridges or giving subsidies to heavy industry or mining), whereas female-dominated* industries (childcare, teaching, nursing) are seen as expense items, something to cut back when times are harder.  Like the extra parsley sprig on the sandwich. Nice if you can afford it but not necessary.

Of course many of the female-dominated industries are in the public sector or at least largely funded through taxes, and that could explain part of the differences in attitudes.  But it's still true that hiring more teachers or nurses during recessions would raise their taxable income and thus government tax revenues just as well as hiring more road workers or bridge builders would.

So I think there's more to this kind of thinking (which I saw in action during the last US recession; lots of talk about roads and bridges). 

Another reason could be in our tendency to "see" more clearly the concrete products of work rather than the impact of services. 

But it may also be the case that traditional gender roles would make it easier not to notice that caring for children or the sick or the elderly is productive work and deserves payment, because traditionally most of it was done by women outside the formal labor markets.

The author of the dissertation also notes that these tendencies (and the lack of good measures for the outputs of female-dominated industries) could cause pressure for the return of more traditional gender roles if recessions raise labor demand for men but lower it for women. The breadwinner is, after all, most likely to be the spouse who has the highest salary.

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*These terms refer to the numbers of workers in the industry.  If the majority of them are men, for example, then the industry is male-dominated.