Here’s the deal (data from CDC Wonder, age-standardized to a uniform distribution in the age range):
Hoo boy. Looky here, something interesting: From 1999 to 2013, the death rate for middle-aged white women steadily increased. The death rate for middle-aged white men increased through 2005, then decreased.
Since 2005, the death rate has been rising for middle-aged white women and declining for middle-aged white men. Not by a lot—we’re talking a change of 4% over a decade—but this is what we see.
It’s funny. We’re so used to the narrative that things are getting worse for men, it’s so hard to be a guy in the modern era, etc. But in his particular case it’s the middle-aged women who are doing worse (relatively speaking; of course the absolute death rates remain much higher for men than for women, that’s just how things always are).
Background: Why age adjustment is needed
As Anne Case and Angus Deaton noted in a much-talked-about recent paper, the mortality rate among middle-aged white Americans has been roughly constant in recent decades, even while it’s dropped dramatically among other other groups and other countries.
Here’s the graph of the raw data of mortality among 45-54-year-old non-Hispanic whites in the U.S.:
But that curve, which shows a steady increase since 1999, is wrong—or, should I say, misleading. As we discussed recently in this space (see here, here, and here), it can be tricky to interpret raw death rates binned across ages, especially in the U.S. What with the baby boom generation moving through, the average age in the 45-54 group crept up from 49.3 in 1999 to 49.7 in 2013.
An increase of 0.4 years might not sound like much, but mortality rate increases a lot by age—more than doubling between the ages of 45 and 54—so even a small shift in average age can cause a big shift in the observed trends.
Here’s what we get after adjusting for age:
The flat pattern after 2005 is the sum of the increasing trend for women and the down slope for men.
What’s the point?
The published curves were biased because they did not correct for the changing age distribution within the 45-54 bin. When we make the adjustment we find something different: no longer a steady increase. And when we look at men and women separately, we find something more.
This update has not yet percolated through the news media.
For example, here’s Paul Krugman in the New York Times:
There has been a lot of comment, and rightly so, over a new paper by the economists Angus Deaton (who just won a Nobel) and Anne Case, showing that mortality among middle-aged white Americans has been rising since 1999.
Ross Douthat in that same newspaper yesterday:
Starting around the turn of the millennium, the United States experienced the most alarming change in mortality rates since the AIDS epidemic. . . . concentrated among less-educated, late-middle-aged whites.
Julia Belluz writes in vox.com about “the shocking rise in mortality rates among middle-aged white Americans.”
And Angus Deaton quoted in the Times the other day:
If we want to be more precise about the age range involved, we could say that for all single years of age from 47 to 52, mortality rates are increasing.
All these reports should be corrected to make it clear that the increase stopped in 2005. Since 2005, mortality rates have increased among women in this group but not men.
The age-aggregation bias did come up in this online NYT article, but the focus there was on the comparison between 1999 and 2013, so it did not come up that the net increase stopped after 2005, and that men and women’s mortality rates have been going in opposite directions since then.
Where does age adjustment make a difference?
First, I followed Deaton’s advice and downloaded death data from the CDC Wonder site. Second, I looked not just at the range 45-54 but also at the age decades before and after. Third, I looked at non-Hispanic whites, also at Hispanic whites, also at African Americans.
Then I computed the raw and age-adjusted death rates for each decade of age for each group, to get a sense of where age adjustment matters.
I plotted death rates since 1999, and here’s what I found:
It turns out that the only place where a lack of age adjustment really changes the story is . . . non-Hispanic whites aged 45-54. Too bad about that! But good that we checked.
Of course I may well have some “gremlins” in my analyses too. Anyone who wants can and should feel free to go to the data and find out what I garbled or missed.
Bring on the data
Finally, I broke down the numbers by sex and single year of age. Here’s what happened from 1999-2015 among all three ethnic groups:
And here’s a summary:
That pattern among 45-54-year-olds? It was happening in the younger decade too.
One more time
Let me emphasize that this is all in no way a “debunking” of the Case and Deaton paper. Their main result is the comparison to other countries, and that holds up just fine. The place where everyone is confused is about the trends among middle-aged non-Hispanic white Americans.
The story being told is that there was something special going on, with an increase in mortality in the 45-54 age group. Actually what we see is an increasing mortality among women aged 52 and younger—nothing special about the 45-54 group, and nothing much consistently going on among men. Perhaps someone can inform Douthat and Krugman and they can modify their explanations accordingly. I’m sure they’ll be up to the task.