Apr 11, 2024 - Health

Deaths of despair now highest among Black and Indigenous Americans

Annual deaths of despair reported per 100k people
Reproduced from a JAMA Psychiatry report; Note: Deaths of despair include suicide, drug overdose and alcoholic liver disease; Chart: Axios Visuals

Middle-aged Black and Native Americans have higher death rates from alcoholic liver disease, overdoses and suicide than white Americans, dispelling longstanding narratives about what are collectively referred to as "deaths of despair."

Why it matters: New research in JAMA Psychiatry underscores how much the flow of illicit drugs, unequal access to the health system and worsening economic conditions have weighed on these minority groups.

  • And it notes that for all of the attention the phenomenon has received, the U.S. is still headed in the wrong direction.

The big picture: The original deaths of despair analysis — published nearly a decade ago — highlighted rising death rates among middle-aged white people in the U.S. between 1999 and 2013, a phenomenon unique to the U.S. and especially prevalent among those with less education.

  • It attributed the trend to declining social and economic conditions and a perceived loss of status.
  • But that study ignored the even higher mortality rates from these causes among American Indian or Alaska Native populations. And the gap between Black and white Americans during the early 2000s was erased post-COVID-19.
  • Most of the inequalities stem from drug- and alcohol-related causes, the JAMA study n0tes.
  • "Some things have changed and some things we're realizing we were wrong about in the mainstream narrative," said UCLA researcher Joseph Friedman, one of the study's authors. "In any way you cut it, [it] is not accurate to say deaths of despair are highest among white individuals."

By the numbers: In 2013, the midlife mortality rate for suicide, drug overdose, and alcoholic liver disease among white Americans stood at 72 per 100,000 people — double the rate for Black Americans.

  • Since then, the mortality rate has nearly tripled among Black Americans, rising to 104 per 100,000 people in 2022. The death rate among white Americans rose to 103 per 100,000 people.
  • Also in 2022, midlife mortality from those causes among American Indian or Alaska Natives was 242 per 100,000 people.
  • These increases among people of color are connected to such factors as different access to safety resources amid an increasingly toxic illicit drug supply, more polysubstance use, worsening economic conditions and stark disparities accessing mental health and substance use treatment, the authors write.

Between the lines: The nature of the opioid epidemic has drastically changed since the original study was published, with heroin and then fentanyl replacing prescription opioids as the prime drivers.

  • As the epidemic has evolved and become deadlier, the demographics of communities most at risk have changed as well.
  • "Deaths of despair as a concept, I think, has really had drug overdose as its core," Friedman said. "And for that cause of death, we're seeing that Black and Native Americans are now disproportionately represented."
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