A study published las year by two Princeton University researchers found that mortality rates for less-educated, middle-aged whites had increased by 22% between 1999 and 2013. The research claimed that the cause was driven by conditions associated with drug abuse, overdoses and liver disease, but a new report from the New York-based Commonwealth Fund, a non-profit foundation focused on health care policy and health care systems, suggests that drugs and suicides are only a part of the problem.

The new study lead by David Squires and David Blumenthal suggests that the culprit could be a stagnant progress against heart disease and other common illnesses as well as population’s decline in social and economic status.

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Poor White sharecroppers in Alabama, 1936. Credit: Wikipedia

Data from the CDC indicates that between 1999 and 2014 mortality rates in the U.S. increased for white Americans aged 22 and 56. Before that, death rates had been falling by nearly 2 percent each year since 1968. The study went through this data and saw that only 40% of the deaths were due to suicide and substance abuse, the rest was attributable to heart disease, diabetes, and respiratory disease.

Squires and Blumenthal think the caused could be lead by worsening economic standing of uneducated, middle-aged whites. They wrote that on a range of social and economic indicators, middle-aged whites have been falling behind in the 21st century as they have lower incomes, fewer are employed, and fewer are married. The research found that the higher death rate for the group was concentrated among whites without four-year college degrees.

The death gap was most pronounced in seven southern states, which included West Virginia, Mississippi, Oklahoma, Tennessee, Kentucky, Alabama and Arkansas. This states presented a much higher rates compared to New York, New Jersey, California, Connecticut, Minnesota, Massachusetts and Illinois.

The states of Alabama, Mississippi, and Tennessee presented the worst rates among non-Hispanic whites. Each state had between 152 and 116 extra deaths for every 100,000 people. Georgia, however, fared a bit better with 49 extra deaths per 100,000, according to Commonwealth researchers. Only Texas, Virginia, Florida and Maryland had lower rates among the Southern states.

Commonwealth said its findings increase concerns about the continuing lack of health insurance. Some states with the highest mortality rates did not expand their Medicaid programs to low-income adults. But the research believes that insurance expansion alone won’t close the mortality gap.

Source: The Atlantic