Abstract
Midlife non-Hispanic white mortality in the United States is rising, particularly in small metro and rural counties. This article responds to calls for county-level studies. We examine social determinants of morbidity and mortality among adult non-Hispanic whites in Yavapai County, Arizona, as part of an integrative study. We report overall mortality trends in Yavapai County using CDC Wonder data and then examine social determinants of reported physical health and mental distress in Yavapai County data using 6 years (2011–2016) of the Arizona Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS includes 1,024 non-Hispanic white respondents aged 25–64. We also present data from the recently established Yavapai County Overdose Fatality Review Board (YCOFRB). Mortality trends indicate that suicide and drug and alcohol-related mortality have all increased since 1999. These increases affect all 5-year age groups from 25 to 64 and both men and women. BRFSS data show that low education and unemployment, but not number of children or home ownership, are significantly associated with worse reported health and frequent mental distress in multivariate analyses. The YCOFRB point to the importance of homelessness and mental health. The mortality crisis in Yavapai County is not restricted to midlife or to drug-related deaths. The unemployed and those with low levels of education are particularly at risk. There is a need for integrative approaches that use local data to elucidate social determinants of morbidity and mortality and to reveal structural determinants.
Similar content being viewed by others
References
Case, A., & Deaton, A. (2017). Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity, pp. 397–476.
Schmid, C. H. (2016). Increased mortality for white middle-aged Americans not fully explained by causes suggested. Proceedings of the National Academy of Sciences of the USA, 113(7), 2912.
Zajacova, A., & Karas, J. (2017). Physical functioning trends among US women and men age 45–64 by education level. Biodemography and Social Biology, 63(1), 21–30.
Manchikanti, L., et al. (2012). Opioid epidemic in the United States. Pain Physician, 15, ES9–ES38.
Muennig, P. A., Reynolds, M., Fink, D. S., Zafari, Z., & Geronimus, A. T. (2018). America’s declining well-being, health, and life expectancy: Not just a white problem. American Journal of Public Health, 108(12), 1626–1631.
Notzon, F. C., Komarov, Y. M., Ermakov, S. P., Sempos, C. T., Marks, J. S., & Sempos, E. V. (1998). Causes of declining life expectancy in Russia. Journal of the American Medical Association, 279(10), 793–800.
Parsons, M. (2014). Dying unneeded: The cultural context of the Russian mortality crisis. Nashville: Vanderbilt University Press.
Montez, J. K., & Zajacova, A. (2014). Why is life expectancy declining among women in the United States ? American Journal of Public Health, 104(10), 5–7.
Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences of the USA, 112(49), 15078–15083.
Diez Roux, A. V. (2017). Despair as a cause of death: More complex than it first appears. American Journal of Public Health, 107(10), 1566–1567.
Masters, R. K., Tilstra, A. M., & Simon, D. H. (2017). Mortality from suicide, chronic liver disease, and drug poisonings among middle-aged U.S. white men and women, 1980–2013. Biodemography and Social Biology, 63(1), 31–37.
Montez, J. K., & Berkman, L. F. (2014). Trends in the educational gradient of mortality among US adults aged 45 to 84 years: Bringing regional context into the explanation. American Journal of Public Health, 104(1), 82–90.
US Census Bureau. American FactFinder. [Online]. Retrieved from https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml.
CDC and NCHS. (2018). Underlying cause of death 1999–2016 on CDC WONDER Online Database, released December, 2018. [Online]. Retrieved from http://wonder.cdc.gov/ucd-icd10.html.
Klein, R. J., Proctor, S. E., Boudreault, M. A., & Turczyn, K. M. (2002). Healthy people 2010 criteria for data suppression. Statistical Notes, 24, 1–12.
Korn, E. L., & Graubard, B. I. (2011). Analysis of health surveys. New York: Wiley.
Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38(1), 21–37.
Barger, S. D., Cribbet, M. R., & Muldoon, M. F. (2016). Participant-reported health status predicts cardiovascular and all-cause mortality independent of established and nontraditional biomarkers: Evidence from a representative US sample. Journal of the American Heart Association, 5, 1–9.
Benjamins, M. R., Hummer, R. A., Eberstein, I. W., & Nam, C. B. (2004). Self-reported health and adult mortality risk: An analysis of cause-specific mortality. Social Science and Medicine, 59, 1297–1306.
Cook, J., et al. (1998). Self-reported frequent mental distress among adults—United States, 1993–1996. Morbidity and Mortality Weekly Report, 47(16), 325–331.
Barros, A. J. D., & Hirakata, V. N. (2003). Alternatives for logistic regression in cross-sectional studies: An empirical comparison of models that directly estimate the prevalence ratio. BMC Medical Research Methodology, 3, 21.
Minton, J., Green, M., McCartney, G., Shaw, R., Vanderbloemen, L., & Pickett, K. (2017). Two cheers for a small giant? Why we need better ways of seeing data: A commentary on: ‘Rising morbidity and mortality in midlife among White non-Hispanic Americans in the 21st century’. International Journal of Epidemiology, 46(1), 356–361.
Macintyre, S., Hunt, K., & Sweeting, H. (1996). Gender differences in health: Are things really as simple as they seem? Social Science and Medicine, 42(4), 617–624.
Seedat, S., et al. (2009) Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry, 66(7), 785–795.
Krueger, P. M., Tran, M. K., Hummer, R. A., & Chang, V. W. (2015). Mortality attributable to low levels of education in the United States. PLoS ONE, 10(7), 1–13.
Montez, J. K., Hummer, R. A., Hayward, M. D., Woo, H., & Rogers, R. G. (2011). Trends in the educational gradient of U.S. adult mortality from 1986 to 2006 by race, gender, and age group. Research on Aging, 33(2), 145–171.
Schwartz, C. R., & Mare, R. D. (2005). Trends in educational assortative marriage from 1940 to 2003. Demography, 42(4), 621–646.
McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social isolation in America: Changes in core discussion networks over two decades. American Sociological Review, 71, 353–375.
Stone, W. (2016). Residents Call for Regulation of Sober Living Homes in Arizona. National Public Radio, 2016. [Online]. Retrieved from https://www.npr.org/2016/08/22/490969839/residents-call-for-regulation-of-sober-living-homes-in-arizona.
Basta, K. L., & Bridge, D. (2018). Arizona balance of state continuum of care sheltered & unsheltered point in time report, 2018.
Zoorob, M. J., & Salemi, J. L. (2017). Bowling alone, dying together: The role of social capital in mitigating the drug overdose epidemic in the United States. Drug and Alcohol Dependence, 173, 1–9.
Pierce, J. R., & Schott, P. K. (2016). Trade liberalization and mortality: Evidence from U.S. counties. NBER Working Paper Series, 22849, 1–66.
Monnat, S. M. (2018). Factors associated with county-level differences in U.S. drug-related mortality rates. American Journal of Preventive Medicine, 54(5), 611–619.
Funding
MA Parsons was supported in this research by the National Science Foundation Cultural Anthropology Program and Sociology Program (#1658528). SD Barger was funded in part by the Southwest Health Equity Research Collaborative NIH U54MD012388. The views expressed in this article do not represent those of the National Science Foundation or the National Institutes of Health.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
We have no conflicts of interest or financial conflicts to report.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Parsons, M.A., Barger, S.D. The US Mortality Crisis: An Examination of Non-Hispanic White Mortality and Morbidity in Yavapai County, Arizona. J Community Health 44, 661–667 (2019). https://doi.org/10.1007/s10900-019-00648-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10900-019-00648-3