Looks like there are some serious methodological errors in the much touted see links below* Turns out the headlines and main takes aways are wrong based on somewhat subtle method problems. Below are quotes from a paper that debunks.
“The mortality patterns and trends revealed by the data, and the range of public health narratives that can be told, are richer and more complex than those presented by Case and Deaton, which were the focus of dozens of newspaper reports.
”As well as quantitatively reducing the reported mortality rate increase, which had captured so much media attention, the correction also qualitatively changed the findings in two ways:
– first, male and female trends were no longer similar enough to be meaningfully grouped together with still-worsening mortality trends for women over that period but a reversal in these adverse trends for men;
– second, if males and females are to be combined, the reported continuously worsening trend in death rates from 1999 onwards would need to be amended to describe a stabilization from around 2005, which may now even be reversing.
the greatest relative increases in mortality seem to be in younger adults, rather than the 45-54 year age group which Case and Deaton focused on.
“Case and Deaton’s paper is an important case study in the complex relationship and relative strengths and weaknesses of traditional academic journal publishing, mainstream old media and specialist new media. In this case, academic blogging provided a degree of methodological scrutiny that was missing from the PNAS ‘contributed submission’ route through which Case and Deaton’s paper entered a high-impact academic journal; their findings were then simplified, publicized and amplified by mainstream media. It seems likely the strong, clear, unequivocal message of the paper— things are getting worse for middle-aged White, non- Hispanic Americans—was both a reason for the media attention and partly an artifact of failing to correct for a statistical risk of bias known since at least the 19th century.
Drug-based deaths have increased for both males and female White Non Hisspanics aged 45-54 years, consistent with the emphasis in Case and Deaton, but for both males and females WNH drug deaths have increased at younger adult ages too.
For male WNHs aged around 30 years, in particular, there is evidence of a marked increase in such deaths, largely following the 2008 recession.
For male Black NH especially there is evidence of a cohort effect, with an increased risk of drug deaths for those aged around 40–50 years in 1999, diminishing after around 2008. It is worth noting that this broad cohort ‘drifted’ into and out of the 45–54 year age range over the period 1999-2012, again highlighting a difficulty with assuming this age group to remain homogeneous over time.
However, the 2008 recession seems to be associated with both increased drug deaths among WNHs of middle age and decreased car deaths amongst WNHs of younger adult age, and so a better understanding of the health impact of the recession clearly requires looking at all age groups…Again the focus on the 45–54 year age range meant that Case and Deaton did not identify this pattern in the data.
Suicide rates have therefore clearly increased in recent years for WNH males, and Case and Deaton’s paper was valuable in highlighting this increase. However, being able to look at mortality rates at all ages shows that this increase, and the increase in drug-based deaths, was not just a middle-aged phenomenon. Looking at all ages shows the 2008 recession as having an exacerbating role in both causes of deaths for WNHs, as well as an inhibitory role for young adult WNHs.
Rising deaths from certain external causes amongst middle-aged WNHs are, however, an important and troubling public health phenomenon in the USA, and Case and Deaton are to be commended in identifying and highlighting such issues.
*“‘Deaths of Despair’ Are Surging Among the White Working Class” Bloomberg
New research identifies a ‘sea of despair’ among white, working-class Americans