1 University of Michigan, Ann Arbor, MI, USA.
2 National Bureau of Economic Research, Cambridge, MA, USA.
J Health Soc Behav. 2019 Jun;60(2):222-239. doi: 10.1177/0022146519849932.
Discussion of growing inequity in U.S. life expectancy increasingly focuses on the popularized narrative that it is driven by a surge of "deaths of despair." Does this narrative fit the empirical evidence? Using census and Vital Statistics data, we apply life-table methods to calculate cause-specific years of life lost between ages 25 and 84 by sex and educational rank for non-Hispanic blacks and whites in 1990 and 2015. Drug overdoses do contribute importantly to widening inequity for whites, especially men, but trivially for blacks. The contribution of suicide to growing inequity is unremarkable. Cardiovascular disease, non-lung cancers, and other internal causes are key to explaining growing life expectancy inequity. Results underline the speculative nature of attempts to attribute trends in life-expectancy inequity to an epidemic of despair. They call for continued investigation of the possible weathering effects of tenacious high-effort coping with chronic stressors on the health of marginalized populations.
关于美国预期寿命不断扩大的不平等现象的讨论越来越关注一个流行的说法,即这种不平等现象是由“绝望死亡”的激增所驱动的。这个说法符合经验证据吗?利用人口普查和生命统计数据,我们应用寿命表方法,计算了非西班牙裔黑人和白人在 1990 年和 2015 年,年龄在 25 岁至 84 岁之间,按性别和教育程度划分的特定原因导致的生命损失年数。药物过量确实对白人(尤其是男性)的不平等现象扩大有重要贡献,但对黑人的影响微不足道。自杀对不断扩大的不平等现象的贡献并不显著。心血管疾病、非肺癌癌症和其他内部原因是解释预期寿命不平等现象不断扩大的关键。研究结果强调了将预期寿命不平等趋势归因于绝望流行病的尝试具有推测性。它们呼吁继续调查顽强的高努力应对慢性压力源对边缘化人群健康的可能风化影响。