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标题：The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999–2015
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作者：Elizabeth M. Stein , MD, MS ; Keith P. Gennuso , PhD ; Donna C. Ugboaja , BS 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2017
卷号：107
期号：10
页码：1541-1547
DOI：10.2105/AJPH.2017.303941
语种：English
出版社：American Public Health Association
摘要：Objectives. To evaluate trends in premature death rates by cause of death, age, race, and urbanization level in the United States. Methods. We calculated cause-specific death rates using the Compressed Mortality File, National Center for Health Statistics data for adults aged 25 to 64 years in 2 time periods: 1999 to 2001 and 2013 to 2015. We defined 48 subpopulations by 10-year age groups, race/ethnicity, and county urbanization level (large urban, suburban, small or medium metropolitan, and rural). Results. The age-adjusted premature death rates for all adults declined by 8% between 1999 to 2001 and 2013 to 2015, with decreases in 39 of the 48 subpopulations. Most decreases in death rates were attributable to HIV, cardiovascular disease, and cancer. All 9 subpopulations with increased death rates were non-Hispanic Whites, largely outside large urban areas. Most increases in death rates were attributable to suicide, poisoning, and liver disease. Conclusions. The unfavorable recent trends in premature death rate among non-Hispanic Whites outside large urban areas were primarily caused by self-destructive health behaviors likely related to underlying social and economic factors in these communities. Recently, Case and Deaton 1 observed that middle-aged White non-Hispanic Americans have shorter lifespans, a reversal of decades of progress that has not been observed in any other industrialized nation. This trend is becoming more pronounced in working-aged adults, with newly released 2015 data showing that the overall death rate increased for the first time in a decade, particularly among those aged younger than 65 years. 2 A 2017 Centers for Disease Control and Prevention (CDC) publication 3 highlighted increased mortality rates among rural communities in the United States compared with urban locales. Missing from these noteworthy observations were the roles of place and race together—specifically, differences between urban and rural communities and among different racial groups, which might be driven by underlying social and economic factors. Recently, the County Health Rankings 4 2016 Key Findings Report 5 showed that rural residents have a higher risk for premature mortality relative to urban and suburban residents. Similarly, Chetty et al. 6 investigated the gap in mortality between high- and low-income Americans and found that geography was highly correlated with health in low-income Americans, with the mortality gaps between rich and poor narrowing in some regions while widening in others. However, there is a lack of a deeper examination of the causes of premature death among rural populations in the United States, as well as an investigation into which demographic populations in each area are at risk for adverse trends in health over time. In this study, we examined death rates in 4 different levels of urbanization in working-age, non-Hispanic White, non-Hispanic Black, and Hispanic adults. To describe how the deaths of each subpopulation changed over a recent 16-year period, we compared trends in death rates from 1999 to 2001 to those from 2012 to 2015 for each level of urbanization (large urban, suburban, small or medium metropolitan, and rural). Lastly, we identified the leading causes of death that resulted in these changes in death rates over time.