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Are growing inequities in income and educational attainment driving down life expectancy in the United States?

Major research published last year by Princeton economists Angus Deaton and Anne Case documented a marked increase in death from all causes among middle-aged white men and women, and particularly among those with less education.

A Brookings Institution study found that not only do the rich live longer than the poor, but that the gap in longevity is widening.

And now, new numbers show an unexpected spike in the preliminary crude death rate in the U.S. for 2015. The report could bring new urgency to better understanding the relationship between inequality and mortality.

The crude death rate measures on an annual basis the number of people who die per 100,000 population. Generally, over the past quarter century, it has declined slightly year-to-year, with the Centers for Disease Control and Prevention crediting “steady but slow” progress for many of the priority public health issues, such as heart disease and motor-vehicle accidents.

When it ticked up by a tiny fraction between 2013 and 2014—821.5 deaths per 100,000 to 823.6—no one paid much attention. But when the National Center for Health Statistics (NCHS) announced preliminary numbers for 2015, an alarm sounded. The number had jumped to 841.9 deaths per 100,000.

“It’s an uptick in mortality and that doesn’t usually happen,” said Robert Anderson, the chief of mortality statistics at NCHS in an interview with The New York Times. “So it’s significant.”

There were identifiable culprits, according to the preliminary report, including substantive increases in heart disease deaths, 192.7 per 100,000 in 2014 to 196.2 last year; and Alzheimer’s, 29.3 to 34.3.

Experts said the sheer volume of heart-related deaths compared to other causes was by itself enough to help boost the overall deaths.

Cancer, also a major killer, however, remained virtually flat—185.6 in 2014, 185.1 last year.

Drug overdoses rose by a point, 14.2 to 15.3, and suicides had edged up through the end of the third quarter of 2015, 13.2 to 13.6. Chronic liver disease and cirrhosis also registered a slight gain.

The preliminary crude death rate doesn’t deal in demographics, and federal researchers cautioned that it’s too early to link the documented increase in lower-income white deaths to the jump in the total number. More will be understood when the final report is released later in the year.

But the Deaton-Case study suggested a direct causal link: “This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround. This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis.”

It’s worth noting that white Americans still outlive black Americans, though that gap has been shrinking.

The Brookings study found that men in the top 10 percent of income lived 12 years longer than men in the lower 10 percent, in terms of life expectancy at age 50, with the comparative number for women being a 10-year difference. For men who were born 20 years earlier, there was only a five-year difference in the two economic groups, and for women it was less than four years.

The preliminary crude death rate also did not break down numbers by states. But Colorado did show an increase between 2014 and 2015, although not as large as the national rise, and based upon a much smaller crude death rate.

Among Coloradans, the death rate for 2014 was 657.4 per 100,000 population. The provisional 2015 crude death rate is 667.9 per 100,000 (based on 36,356 deaths in 2015, and a population projection of 5,443,612 from the State Demography Office), according to Kirk Bol of the Colorado Department of Public Health and Environment.

“One of the reasons for difference in crude rates across geographies is that crude rates are very much influenced by the age distribution in a population,” Bol said. “Given that Colorado’s population is skewed more towards a younger population than the national population as a whole, its crude rates are typically much lower.”

The so-called “age-adjusted” death rate helps compare rates across geographies (or over time), Bol explained. Even by that measure, Colorado has a lower death rate. As the federal analysis found an age-adjusted rate of 729.5 for 2015, while the state’s provisional review found a rate of 656.5 per 100,000 in 2015.

And it’s possible that 2015’s crude death rate nationally was an aberration.

“The question is, what does it mean? We really need more data to know,” the NCHS’s Anderson told the Times. “If we start looking at 2016 and we see another rise, we’ll be a lot more concerned.”

Jim Trotter

Denver, Colo.

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