Increased Mortality and Health Risk Behaviors of Midlife White North Carolinians: A Marked Contrast to Nonwhites.

Abstract

BACKGROUND Death rates for white, middle-aged Americans are increasing after decades of steady decline. In this paper, mortality and health behavior trends are examined for midlife North Carolinians.METHODS Mortality rates were calculated for midlife whites from 2000 to 2013 for the state as a whole and in counties grouped by level of economic distress. Trend lines were used to estimate future death rates, and comparisons were made to rates for nonwhites. Current and past health risk behaviors were also analyzed.RESULTS The all-cause mortality rate for midlife whites in North Carolina was higher than the 2000 base in 11 of 13 years; white midlife mortality increased by 5.9%. In contrast, nonwhite mortality decreased by 30.6%. By 2020, midlife mortality for whites is predicted to increase by 9.1%; for nonwhites, there is a predicted decrease of 47.2%. Midlife white mortality increased most in economically distressed counties. Major contributors were suicide and liver disease. Risk factors that increased were drinking, obesity, and lack of health insurance.LIMITATIONS Mortality and risk factor data could not be analayzed by ethnicity. Deaths due to drug and alcohol poisoning were not included.CONCLUSIONS The statewide mortality rate for midlife whites in North Carolina is increasing and is in marked contrast to the decreasing rate for nonwhites. The racial disparity in this metric is likely to be eliminated by 2020, perhaps even reversed. Midlife white mortality increased most dramatically in the state's poorest counties. Policymakers should consider links between economic issues and health behaviors involved in midlife mortality and why they may affect whites and nonwhites differently.