School of Social & Family Dynamics, Arizona State University, 951 Cady Hall, Tempe, AZ 85287, USA.
Soc Sci Med. 2023 Sep;333:116153. doi: 10.1016/j.socscimed.2023.116153. Epub 2023 Aug 7.
Economic insecurity has grown in the United States since the 1970s impacting all segments of the working-class, including previously insulated sub-groups such as non-Hispanic whites. Moreover, the white working-class has experienced a surge in socio-cultural isolation, and disengagement with societal institutions. This analysis focuses on the health consequences of these developments, with a particular emphasis on the rising "deaths of despair" (suicide, drug poisoning, alcohol related). These deaths have been increasing since the mid-1990s and, at least until recently, tended to be clustered amongst whites without a four-year college degree. Various competing explanations have been put forth, emphasizing distinct factors such as material conditions, socio-cultural dynamics, and accessibility to opioids. Using a series of linear models this analysis examines the county-level association between economic precarity, white working-class population size, opioid accessibility, and deaths of despair. Results affirm the net effect of each predictor and illuminate an interactive relationship between opioid accessibility and precarity, as well as an interactive relationship between all three predictors. By undertaking an interdisciplinary synthesis of existing research, this study contributes to the understanding of the social determinants of mortality while providing crucial insights into an ongoing crisis in contemporary America.
自 20 世纪 70 年代以来，美国的经济不安全感不断加剧，影响了工人阶级的各个阶层，包括以前绝缘的非西班牙裔白人等亚群。此外，白人工人阶级经历了社会文化隔离和与社会机构脱节的激增。本分析侧重于这些发展的健康后果，特别强调日益增加的“绝望死亡”（自杀、药物中毒、酒精相关）。自 20 世纪 90 年代中期以来，这些死亡人数一直在增加，至少直到最近，往往集中在没有四年制大学学位的白人中。提出了各种相互竞争的解释，强调了物质条件、社会文化动态和阿片类药物可及性等不同因素。本分析使用一系列线性模型，研究了经济不稳定、白人工人阶级人口规模、阿片类药物可及性和绝望死亡之间的县一级关联。结果肯定了每个预测因子的净效应，并阐明了阿片类药物可及性和不稳定性之间的相互关系，以及所有三个预测因子之间的相互关系。通过对现有研究进行跨学科综合，本研究有助于理解死亡率的社会决定因素，同时为当代美国正在发生的危机提供重要见解。
