Black and Native Americans Overwhelmed by "Deaths of Despair," UCLA Health Study Finds

A new analysis revealed a concerning trend in mortality rates among middle-aged Americans, with mortality rates from "deaths of despair" surpassing previous assumptions and disproportionately impacting Black and Native American populations.¹

Addictive substances, including alcohol, cigarettes and drugs

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UCLA Health investigators published the analysis in a JAMA Psychiatry research letter that challenges the prevailing narrative surrounding deaths of despair and emphasizes the urgent need for targeted interventions to address mental health and substance use disorders within these communities.

The term "deaths of despair" encompasses fatalities resulting from suicide, drug overdose, and alcoholic liver disease, often associated with underlying mental health issues and substance abuse. Initially, this phenomenon garnered significant attention following a 2015 study² that highlighted rising mortality rates among middle-aged white Americans.

Earlier this year, a study published in the Proceedings of the National Academy of Sciences expanded on what constitutes a death of despair by analyzing data (1997–2014) from multiple sources.³ However, by including more recent years (1999–2022) in the investigation, the latest findings uncovered a startling shift in the landscape of despair-related mortality.

Contrary to previous assumptions, the analysis found that mortality rates from deaths of despair among middle-aged Black Americans exceeded those of their white counterparts in 2022. Additionally, Native Americans experienced disproportionately high rates of such deaths, surpassing both Black and white Americans by a significant margin—a population that was excluded from the 2015 study and many of the follow-ups.

“The findings reinforce the notion that we need to invest in services that can address these issues and, ultimately, we need much more comprehensive access to low-barrier mental health care and substance use treatment in the U.S.,” study coauthor Joseph Friedman, PhD, MPH, of the David Geffen School of Medicine at UCLA, said in statement.⁴ “And we need to specifically make sure those treatments, services and programs are implemented in a way that is accessible for communities of color and will actively work to address inequality.”

The study's analysis, based on publicly available data from the CDC, demonstrated that deaths of despair over the past decade tripled among Black Americans, with a sharp increase observed from 2015 onwards. Similarly, Native American and Alaska Native populations consistently experienced the highest mortality rates from suicide, alcoholic liver disease, and drug overdose compared with their Black and White counterparts.

The researchers attribute the escalating rates of deaths of despair among Black and Native American populations to a complex interplay of factors, including limited access to health care and social services, the proliferation of toxic illicit drugs like fentanyl, and worsening economic insecurity. They also acknowledged the COVID-19 pandemic has exacerbated existing disparities, further supporting the need for targeted interventions to address these inequities.

In light of these findings, the researchers advocate for culturally appropriate interventions aimed at reducing disparities in access to mental health and substance use treatment programs. By addressing the underlying social and economic determinants contributing to despair-related mortality, policymakers and healthcare professionals can work towards mitigating this alarming public health crisis and promoting equitable health outcomes for all Americans.

References

1. Friedman J, Hansen H. Trends in deaths of despair by race and ethnicity from 1999 to 2022. JAMA Psychiatry. Published April 10, 2024. doi:10.1001/jamapsychiatry.2024.0303

2. Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci USA. 2015;112(49):15078-83. doi:10.1073/pnas.1518393112

3. Grossi G. High rates of "deaths of despair" observed among White Americans. The American Journal of Managed Care^®. Published February 7, 2024. https://www.ajmc.com/view/high-rates-of-deaths-of-despair-observed-among-white-americans

4. ‘Deaths of despair’ among Black Americans surpassed those of White Americans in 2022. News release. UCLA Health. Published online April 8, 2024. Accessed April 8, 2024. https://www.newswise.com/articles/deaths-of-despair-among-black-americans-surpassed-those-of-white-americans-in-2022