This paper by Anne Case and Angus Deaton, one of whom just won a Nobel prize in economics, reports that mortality rates are rising for middle-aged non-Hispanic Whites. It’s gotten tons of attention (see e.g., “Why poor whites are dying of despair” in The Week, and this in NY Times).
It’s an odd paper, though, in its focus on just one narrow age group over time. The coverage mostly describes the result as if conditions are changing for a group of people, but the group of people changes every year as new 45-year-olds enter and 54-year-olds leave. That means the population studied is subject to change in its composition. This is especially important because the Baby Boom wave was moving through this group part of that time. The 1999-2013 time frame included Baby Boomers (born 1945-1964) from age 35 to age 68.
My concern is that changes in the age and sex composition of the population studied could account for a non-trivial amount of the trends they report.
For example, they report that the increased mortality is entirely concentrated among those non-Hispanic White men and women who have high school education or less. But this population changed from 1999 to 2013. Using the Current Population Survey — which is not the authority on population trends, but is weighted to reflect Census Bureau estimates of population trends — I see that this group became more male, and older, over the period studied. That’s because the Baby Boomers moved in, causing aging, the population reflects women’s advances in education, relative to men, circa the 1970s. Here are those trends:
It’s odd for a paper on mortality trends not to account for account for sex and age composition changes in the population over time. Even if the effects aren’t huge, I think that’s just good demography hygiene. Now, I don’t know exactly how much difference these changes in population composition would make on mortality rates, because I don’t have the mortality data by education. That would only make a difference if the mortality rates differed a lot by sex and age.
However, setting aside the education issue, we can tell something just looking at the whole non-Hispanic White population, and it’s enough tor raise concerns. In the overall 45-54 non-Hispanic White population, there wasn’t any change in sex composition. But there was a distinct age shift. For this I used the 2000 Census and 2013 American Community Survey. I could get 1999 estimates to match Case and Deaton, but 2000 seems close enough and the Census numbers are easier to get. (That makes my little analysis conservative because I’m lopping off one year of change.)
Look at the change in the age distribution between 2000 and 2013 among non-Hispanic Whites ages 45-54. In this figure I’ve added the birth year range for those included in 2000 and 2013.
That shocking drop at age 54 in 2000 reflects the beginning of the Baby Boom. In 2000 there were a lot more 53-year-olds than there were 54-year-olds, because the Baby Boom started in 1946. (Remember, unlike today’s marketing-term “generations,” the Baby Boom was a real demographic event.) So there was a general aging, but also a big increase in 54-year-olds, between 2000 and 2013, which will naturally increase the mortality rate for that year.
So, to see whether the age shift had a non-trivial impact on the number of deaths in this population, I used one set of mortality rates: 2010 rates for non-Hispanic Whites by single year of age, published here. And I used the age and sex compositions as described above (even though the sex composition barely changed I did it separately by sex and summed them).
The 2010 age-specific mortality rates applied to the 2000 population produce a death rate of 3.939 per 1,000. When applied to the 2013 population they produce a death rate of 4.057 per 1,000. That’s the increase associated with the change in age and sex composition. How big is that difference? The 2013 death rate implies 118,313 deaths in 2013. The 2000 death rate implies 114,869 deaths in 2013. The difference is 3,443 deaths. Remember, this assumes age-specific death rates didn’t change, which is what you want to assess effects of composition change.
So I can say this: if age and sex composition had stayed the same between 2000 and 2013, there would have been 3,443 fewer deaths among non-Hispanic Whites in the ages 45-54.
Here is what Case and Deacon say:
If the white mortality rate for ages 45−54 had held at their 1998 value, 96,000 deaths would have been avoided from 1999–2013, 7,000 in 2013 alone.
So, it looks to me like age composition change accounts for about half of the rise in mortality they report. They really should have adjusted for age.
Here is my spreadsheet table (you can download the file here):
As always, happy to be credited if I’m right, and told if I’m wrong. But if you just have suggestions for more work I could do, that might not work.
Follow up: Andrew Gelman has three excellent posts about this. Here’s the last.
14 thoughts on “Age composition change accounts for about half of the Case and Deaton mortality finding”
Thanks. Most informative.
You might be interested in looking at a table I made up from Case and Deaton’s graphs estimating the increase in death rates by 5 year cohorts due to the 3 main causes of growth (overdoses, suicides, and liver failures), which shows much worse growth for Baby Boomers versus those born before and after. My guess is that this is due to the aging effect you’ve identified, but also to cultural changes related to the drug culture’s popularity when each cohort was young.
Here’s the table:
I’m a lurker — I often read, but rarely comment. And when I do comment, I have always been critical.
With that throat clearing aside, your post is outstanding: it taught me far more in a few paras than I knew coming in.
Hat duly tipped.
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I’ve now created a table looking at death rates due to overdoses, suicides, and liver problems among whites by 5 year rather than 10 year groups. I can see some of this Baby Boom effect explained in this post, but I think there was also a somewhat independent “Sixties Effect” from sex,drugs, and rock and roll based on what year it was when you were around 18:
However, in Figure 1 of Case and Deaton, the mortality rates of all nations are plotted unadjusted, and hence when comparing the Us whites 45-54 with other nations, th comparison (or lack of it) still looks poor. Data for other nations from mortality.org still looks better than US, after ag adjustment. I think that was the pont of the paper.
However, I woke up this morning and saw the figure in the middle of
and all the more convinced that Case and Deaton numbers are wrong. I can bet my first born that the mortality rates of 49-54 year olds di not increase 25-45%.
I did a little poking around with different data sources to see what county-level death rates for this cohort (45-54 YO non-Hispanic Whites) was associated with in 2013 (not looking at changes in death rates since 1999, so as to obviate the age composition issue.) Not surprisingly, richer counties have lower 45-54 YO NHW death rates:
As they say, money can’t buy happiness, but the log of money can.
Obesity (the CDC’s 2012 numbers) has a lot of explanatory power for middle-aged white death rates in 2013, both by itself:
And even if you control for median household income, the elasticity of death rates with obesity, controlling for median household income, is a little under 0.4; if a county increases its obesity rate from 24 percent to 25 percent, holding income constant, it is associated with an increase in death rates for 45-54 YO Non-Hispanic Whites of 1 percent.
The CDC says that obesity rates for women didn’t increase that much in the last decade: http://imgur.com/FruRY3J even as death rates rose more for women than for men, but perhaps we’re seeing a delayed effect of the huge climb prior to 2000, with increased pain and reduced mobility being partially responsible for the large increases in drug abuse, alcohol poisoning, and suicide that Case & Deaton observe. On the other hand, obesity could be just correlated with other social changes that are the real drivers of the increased deaths, though it would have to be in a way that didn’t disappear when you control for income.
Disability data isn’t publicly available for all counties in every year, since the CPS doesn’t sample every county in every year. That means you lose some sample size, but even so the rate receiving SSI-Disability in a county is the single best predictor of death rates in this cohort (45-54 YO Non-Hispanic Whites in 2013) of anything.
You can tell some of this isn’t just the effects of poorer, more rural counties also having higher disability rates, since the sign on county population reverses itself once you control for disability and income. While more rural counties (those with lower population) definitely have higher death rates:
Even so, the association between population and death rates disappears once you control for obesity, disability, and income, which by themselves explain about 66 percent of the county-level variation.
To me, this all suggests that Case & Deaton’s strong implications that increasing obesity, morbidity, and disability (aside from any economic changes) are important drivers behind the rising mortality rates seems right, perhaps with pain of various sorts (and uncontrolled pain management) being an important mediator. Other social changes might also be important- eg, marriage rates appear to explain a slight amount of the variation, though no more than an additional percentage point when controlling for the above factors, and focusing on employment rates as opposed to income doesn’t seem to make a difference. And there remains the question of why increasing obesity and disability rates have not produced the same surge in mortality rates among other groups as they have in non-Hispanic whites.