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Int J Epidemiol. 2018 Dec 1. doi: 10.1093/ije/dyy255. [Epub ahead of print]

Recent trends in US mortality in early and middle adulthood: racial/ethnic disparities in inter-cohort patterns.

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Sanford School of Public Policy, Duke University, Durham, NC, USA.
Department of Sociology, Ohio State University, Columbus, OH, USA.
Department of Sociology, Lineberger Cancer Center, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Sociology and Social Science Research Institute, Duke University, Durham, NC, USA.



A striking increase in the all-cause mortality of US middle-aged non-Hispanic Whites in the past two decades has been documented by previous studies. The inter-cohort patterns in US mortality, as well as their racial/ethnic disparities, are still unclear.


Using official mortality data, we study US annual mortality rates for ages 25-54 from 1990 to 2016 by gender and race/ethnicity. We conduct an age-period-cohort analysis to disentangle the period and cohort forces driving the absolute changes in mortality across cohorts. Nine leading causes of death are also explored to explain the inter-cohort mortality patterns and their racial/ethnic disparities.


We find cohort-specific elevated mortality trends for gender- and race/ethnicity-specific populations. For non-Hispanic Blacks and Hispanics, Baby Boomers have increased mortality trends compared with other cohorts. For non-Hispanic White females, it is late-Gen Xers and early-Gen Yers for whom the mortality trends are higher than other cohorts. For non-Hispanic White males, the elevated mortality pattern is found for Baby Boomers, late-Gen Xers, and early-Gen Yers. The mortality pattern among Baby Boomers is at least partially driven by mortality related to drug poisoning, suicide, external causes, chronic obstructive pulmonary disease and HIV/AIDS for all race and gender groups affected. The elevated mortality patterns among late-Gen Xers and early-Gen Yers are at least partially driven by mortality related to drug poisonings and alcohol-related diseases for non-Hispanic Whites. Differential patterns of drug poisoning-related mortality play an important role in the racial/ethnic disparities in these mortality patterns.


We find substantial racial/ethnic disparities in inter-cohort mortality patterns. Our findings also point to the unique challenges faced by younger generations.


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