Local Economic Hardship and Its Role in Life Expectancy Trends

Published: 2018


Recent research has found, in some groups of Americans, dramatic increases in deaths due to drug overdose and suicide and an overall stagnation of trends toward increased longevity. This study examines the link between mortality of older working age (45 to 64) adults and local economic downturns in the U.S. to evaluate the role of economic shifts in various causes of death and their related mortality trends. Specifically, we estimate regression models to test the hypotheses that the longevity effects of poor economic prospects are reflected through (1) increased suicide, drug overdose, and other “deaths of despair” and (2) other causes of death linked to exposure to economic and social stress such as heart and cerebrovascular disease. To avoid the problem of endogeneity of local economic conditions to mortality conditions, we measure the local economic shock of lost employment with predicted employment based on baseline industrial composition and national trends in employment by industry. We find evidence consistent with prior research that among non-Hispanic white adults, midlife mortality has increased since 1990, particularly among those with low educational attainment. We also find that “deaths of despair” are important contributors to that trend. However, we find that while distress in local, area economies does predict increased mortality for chronic disease, it predicts decreased mortality from suicides, opioids, and other substance abuse. This finding suggests caution in the application of the construct of despair in explaining recent mortality patterns.

Key Findings

    • Reversing the trend for much of the last century, death rates of older working aged (45 to 64) non-Hispanic whites have increased in recent years, especially among low-education women. Much of this increase can be attributed to suicide and the abuse of opioids and other substances, a group of causes often called “deaths of despair.”
    • Based on comparisons of mortality trends across local area labor markets with different industrial compositions, increases in all-cause death rates appear to be concentrated in areas facing the worst economic distress.
    • This pattern appears to be driven by chronic disease and cancer, which have fallen most in economically stable areas. This finding is consistent with the “weathering” hypothesis that prolonged exposure to stress increases allostatic load, leading to increased incidence of cancer and cardiovascular disease.
    • Increases in “deaths of despair” do not follow this pattern. We find significant effects in the other direction, with larger increases in areas with stronger economies, raising questions about the construct of despair.


Bound, John, Arline T. Geronimus, Timothy A. Waidmann, and Javier M. Rodriguez. 2018. “Local Economic Hardship and Its Role in Life Expectancy Trends,” Ann Arbor MI: University of Michigan Retirement Research Center (MRRC) Working Paper, WP 2018-389. https://mrdrc.isr.umich.edu/publications/papers/pdf/wp389.pdf