Premature Midlife Deaths Increase in US Whites and Native Americans

Dr. Meredith Shiels

Dr. Meredith Shiels Interview with:
Dr Meredith S Shiels

Division of Cancer Epidemiology and Genetics
National Cancer Institute
Bethesda, MD What is the background for this study?

Response: In most high-income countries, premature death rates have been declining, due to the overwhelming successes of public health efforts to prevent and treat chronic disease. The US is a major outlier, where death rates overall have plateaued, or even increased, as reported recently by our sister agency, the Centers for Disease Control and Prevention. Of particular concern are recent reports of increasing death rates among Americans during mid-life.

To expand upon prior findings, we focused on premature death, which we defined as death occurring between the ages of 25 and 64. We examined finely detailed death certificate data for the entire U.S. population and described changes in death rates during 1999-2014 by cause of death, sex, race, ethnicity, and geography. To provide context to our findings, we compared trends in death rates in the U.S. to England and Wales and Canada. What are the main findings?

Response: Our main finding was that death rates among 25-64 year-olds have declined in the United States among Hispanics, blacks, and Asian and Pacific Islanders, consistent with declines in England and Wales and Canada. In stark contrast, premature mortality has increased among some age groups of whites and American Indian and Alaska Natives. What should readers take away from your report?

Response: Declining rates of premature death among Hispanic, black, and Asian and Pacific Islander men and women were due mainly to fewer deaths from cancer, heart disease, and HIV over the time period of the study, reflecting successes in public health efforts to reduce tobacco use and medical advances to improve diagnosis and treatment. In spite of large declines in the death rate among black men and women, mortality remains 50% higher than white men and women.

Whites also experienced fewer premature deaths from cancer and, for most ages, fewer deaths from heart disease over the study period. However, overall premature death rates for white and American Indian and Alaska Native men and women were driven up by dramatic increases in deaths from accidents, which were primarily drug overdoses, as well as from suicide and liver disease. The CDC has shown that the increase in drug overdose deaths is largely driven by overdoses involving opioids.

There is an urgent need for aggressive efforts to prevent premature mortality by targeting emerging causes of death through expanded access to quality medical care for prevention and treatment of substance use disorders and mental illness, in addition to continued efforts against cancer and heart disease. What recommendations do you have for future research as a result of this study?

Response: This work highlights populations in the US that most urgently require interventions to prevent premature deaths. Further studies are needed to identify appropriate public health strategies to advance this goal.

The study also highlights populations where prevention and treatment have been extraordinarily successful—in particular, for HIV, cancer and heart disease. These still remain leading causes of premature death and more research is needed to inform efforts to further reduce premature mortality from these causes. Thank you for your contribution to the community.


Trends in premature mortality in the USA by sex, race, and ethnicity from 1999 to 2014: an analysis of death certificate data
Shiels, Meredith S et al.
The Lancet , Volume 0 , Issue 0 ,

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Last Updated on January 27, 2017 by Marie Benz MD FAAD