Does despair drive increases in white mortality, or did the narrative get ahead of the data?

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ID: 329332
2026
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Abstract
The aim of this study is to test the central claim of the "deaths of despair" theory: that rising despair among midlife white Americans has driven increases in all-cause mortality, particularly in those with low education. We analyzed time series of annual all-cause mortality rates per 100,000 (N=92,700 individuals) and despair (N=88,872 individuals) among US midlife (aged 45-54) adults from the CDC and NIH between 1999-2015. The association between changes in despair and changes in mortality rates were estimated via Bayesian autoregressive models with AR(1) errors. Race/ethnicity and education-specific estimates were obtained via marginal standardization. All-cause mortality increased by 7.49 per 100,000 only among midlife white adults, with a larger increase among those with low education (51.4 per 100,000). Despair prevalence did not increase exclusively among midlife white adults, increasing by 0.13% (-0.03%; 0.29%) and 0.12% (-0.27%; 0.51%) among white and Black midlife adults. The observed increases in despair among whites in midlife were not associated with increases in mortality rates (-0.12 per 100,000; 95%UI=-0.54; 0.29). These findings directly challenge the central claim of this theory and highlight the need to move beyond the white despair narrative to explain US mortality trends.
Reference Key
openalex_W7213877420 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Luís Segura, Rodrigo Zepeda-Tello, Seth J Prins, Silvia Saboia Martins
Journal american journal of epidemiology
Year 2026
DOI
10.1093/aje/kwag235
URL
https://doi.org/10.1093/aje/kwag235
Keywords Keywords not found

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