High and Rising Working-Age Mortality in the US: A Report From the National Academy of Sciences, Engineering, and Medicine

May 10, 2021

In March, a report issued by the National Academies of Sciences, Engineering, and Medicine revealed that young and middle-aged adults (25-64 years old) in the U.S. have been dying at higher rates since 2010. High and Rising Mortality Rates Among Working-Age Adults says that rising death rates are striking working-age Americans, whose risk of dying from certain conditions — such as drug overdoses or hypertensive heart disease — has been climbing since the 1990s.

“We’re losing more and more Americans in the prime of their lives, in their most productive years, and in their parenting years,” said Kathleen Mullan Harris, James E. Haar Distinguished Professor of Sociology, University of North Carolina, Faculty Fellow at the Carolina Population Center, and chair of the committee that wrote the report. “Our committee was stunned by this mounting crisis, which will only get worse. The most troubling themes in our report — higher mortality than our peer countries; major racial and ethnic, socio-economic, and geographic disparities; lack of access to health insurance and care — have all been exacerbated by the pandemic.”

Mullan Harris is the lead author of a May 10, 2021 Viewpoint published in JAMA based on the report. The viewpoint closely follows the report findings, which describe how three causes of death — (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases — are chiefly responsible for the average working-age mortality rates.

To address working-age mortality and advance research and data collection, the report recommends, among other actions:

Policymakers should address substance use disorders and take lessons from the opioid epidemic to implement policies to prevent future crises, such as strengthening regulatory control and monitoring of prescription drugs and improving access to substance use and mental health services.
Obesity prevention programs should start early in life and target children and teens most at risk for obesity, including racial and ethnic minorities, people living in poverty, and women.
States that have not done so already should expand Medicaid coverage under the Affordable Care Act.
Government and private organizations should fund research on more effective ways to prevent substance use disorders, reduce obesity, improve heart health, enhance behavioral health services for mental illness, and help those struggling to stop smoking or to obtain effective treatments for chronic diseases.
Government and private organizations should encourage creative research strategies that bring together different disciplines to unpack the complex influences on death rates, such as the role of social, economic, and cultural factors at the national, state, community, family, and individual levels.
To reduce and ultimately eliminate racial/ethnic and other socio-economic inequalities that continue to drive racial/ethnic disparities in U.S. working-age mortality, policymakers and decision-makers at all levels of society will need to dismantle structural racism and discriminatory policies of exclusion in areas such as education, employment and pay, housing, lending, civic participation, criminal justice, and health care.

The study — undertaken by the Committee on Rising Midlife Mortality Rates and Socio-economic Disparities — was sponsored by the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation. The National Academies are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Parts of this brief were originally published by the National Academics of Sciences, Engineering and Medicine.