Tag Archives: suicide

Fall in life expectancy for white Americans

Newly released 2014 data from the National Center for Health Statistics on life expectancy showed a worrisome decline in life expectancy for whites in the US, to 78.8 years in 2014 from 78.9 in 2013.

The good news is that, in contrast, life expectancy increased by 0.2 years for the Hispanic population (from 81.6 to 81.8 years) and by 0.1 years for the non-Hispanic black population (from 75.1 to 75.2). This continues a trend of a decreasing gap in life expectancy between black and white populations, with improving black life expectancies attributed to decreases in death rates due to heart disease, cancer, HIV disease, unintentional injuries, and perinatal conditions.db218_fig1

Life expectancy rates had steadily for decades, then flattened in 2010-2013. joi150117f1The decline in life expectancy is driven by increased death rates among young and middle-aged whites (mid 20’s to mid 50’s), especially among those with no more than a high school education.  A recent study attributed the rise in mortality in this group  to rising rates of suicide, liver disease and drug overdoses.

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Life expectancy has dipped before–most recently in 2005, the year of a severe influenza epidemic.

 

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Rising death rates in young white adults due to overdoses

A New York Times analysis of CDC data released this week showed that, in contrast to falling death rates among black and Hispanic adults,

drug overdoses are driving up the death rate of young white adults in the United States to levels not seen since the end of the AIDS epidemic more than two decades ago

The analysis shows that the rise in white mortality extends well beyond the 45- to 54-year-old age group reported in November by Princeton economists Angus Deaton, who won the 2015 Nobel Memorial Prize in Economic Science, and Anne Case. They reported that death rates among middle-aged white Americans are rising, unlike those in every other age, race and ethnic group–a rise driven by an epidemic of suicides and afflictions stemming from substance abuse: alcoholic liver disease and overdoses of heroin and prescription opioids.

The New York Times analysis’s drug overdose numbers show an unrelenting rise in substance abuse related deaths. From 1999 to 2014, the overdose rate for whites ages 25 to 34 rose by a factor of five and the rate for 35- to 44-year-old whites tripled. The numbers cover both illegal and prescription drugs.Screen Shot 2016-01-20 at 12.06.35 PM

The Times analysis shows that death rate among young whites rose for every age group over the five years before 2014.  Educational attainment is also a risk factor for overdose deaths: it rose faster by any measure for the less educated, by 23 percent for those without a high school education, compared with only 4 percent for those with a college degree or more.

The opioid epidemic is also varied geographically across the country. The New York Times provides an interactive map at this site showing the spread of the opioid overdose death epidemic across the country from 2003 through 2014.Screen Shot 2016-01-20 at 12.01.37 PM.png
For more on this topic and a local, Colorado-based approach to addressing it, please see my earlier blog post here.

On Doctors Who Have Depression

Also appearing in the New York Times Upshot column, this Incidental Economist blog post on the prevalence of depression, addiction and suicidal thoughts among do2up-healthdepress-illo-promo-master180-v4ctors provides a great overview of the literature.  The post is also compelling because the author draws on his own personal experience with this condition during his own residency, including this moving post about secondary trauma experienced (repeatedly) by many physicians.

Source: Silence Is the Enemy for Doctors Who Have Depression

Please see my related post on prevalence of depression among medical residents here.

Public health approach to reducing firearms-related suicide

A New York Times opinion piece today gives another perspective on gun violence prevention.  In an earlier post, I had focused on the public health approach to reducing gun violence through targeting mass shootings.  Although mass shootings occur more than once daily in this country, the rate of gun-related suicide is far higher: about 20,000 suicides by gun per year, or about ⅔ of all people killed by guns.  14mon1-blog427

A common argument about restricting access to firearms for people with suicide risk is that there’s no point to locking up a home’s firearms because people in crisis or with suicidal impulses will find some way to get a gun, or will just find another way to kill themselves.  In reality, most suicides are often impulsive, meaning that there’s a very short time between the decision and the action, and 90 percent of people who survive suicide attempts do not eventually die by suicide.

Suicide is largely preventable through means restriction–the fewer guns there are at the time of a suicidal thought, the lower the rate of successful suicide.

Rising prevalence of depressive symptoms among medical residents

This week’s meta-analysis in JAMA shows that medical residents have high rates of depression.  Earlier this year, JAMA Psychiatry published recommendations for screening for depression and suicide risk among physician trainees.

Source: One in four new doctors may be depressed, and their patients may suffer because of it

Please see my related post here.

Mass shootings as a public health issue

I agree with the New York Times editorial board’s response to the most recent mass shootings, as well as Ronald Reagan–that these atrocities–atrocities that occur more than once daily in this country–are not beyond the power of government and politicians to stop.  Times columnist Nicholas Kristof points out that we urgently need to develop public health policies that focus not on eliminating guns (an unrealistic goal given the current social and political milieu) but on reducing gun deaths. As a health care provider and researcher, I like that he goes beyond rhetoric, proposing a public health approach.  Public health approaches to gun violence prevention are favored by a large majority of Americans from both parties8-12-2015-3-58-40-PM

  • Assault weapon and large-capacity ammunition clip policies
  • Prohibited person policies
    • a 10-year prohibition on possessing guns for anyone convicted of domestic violence, assault or similar offenses
  • Background check policies
    • universal background checks
  • tighter regulation of gun dealers
    • allowing the information about which gun dealers sell the most guns used in crimes to be available to the police and the public so that those gun dealers can be prioritized for greater oversight
  • other policies
  • other technologies
    • invest in “smart gun” technology, such as weapons that fire only with a PIN or fingerprint.
    • adopt microstamping that allows a bullet casing to be traced back to a particular gun

Another impediment to using public health tools to approach policy prioritization in reducing gun violence is the Congressional ban on CDC and NIH research on firearm violence.  A coalition of physician groups has urged the ban be lifted. Even the ex-Congressman who introduced this ban, former Rep. Jay Dickey (R-Ark.), has since called for the ban to be lifted.

Although this post focuses on gun violence involved in mass shootings, the leading cause of gun violence death is suicide.  Suicide is largely preventable through means restriction–the fewer guns there are at the time of a suicidal thought, the lower the rate of successful suicide.

The Washington Post has also covered gun violence recently, pointing out the racial disparities in causes of gun related deaths. Among whites, 77 percent of gun deaths are suicides, but among black Americans, 82 percent of gun deaths are homicides.

Where do you begin to help the public health campaign against gun violence?  One first stop is Organizing for Action’s gun violence prevention site. It contains several tools that you can use to take easy, online steps to reduce gun violence. It is a party affiliated web link. If you know of a good bipartisan or nonpartisan site for getting involved in doing more to prevent gun related violence, please share it in comments.