Paper Notes

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Case and Deaton (2021)

the suicide rate itself, which rose by 36 percent from 1999 to 2019 among those aged 25-74 (age-adjusted). It is

currently at its highest level since 1938, United States Congress Joint Economic Committee (2019), and its continued rise in the US stands in contrast to other countries as well as to the world as a whole, where suicide rates have been falling since 2000, Ritchie et al. (2021). Contrary to what was long believed, suicide rates in the US are higher among those with less education. While the age-adjusted suicide rate almost doubled from 1992 to 2019 among WNHs ages 25–74 without a BA, increasing from 17.6 to 31.1 per 100,000, there was almost no increase among those with the degree. Suicide rates were declining between 1990 and 2010 for less-educated Hispanics and BNHs, but rates began to rise after 2010, increasing from 7 to 10 per 100,000 (age-adjusted 25-74) between 2010 and 2019.

  • Why are suicide rates so much higher for whites than for black and hispanics?
  • Why was suicide so high in 1938?

Case et al (2020) find, in both NHIS and Gallup data for the US, but not

in data from Europe, that pain is lower among the elderly than among those in midlife when viewed in any given year, a biological improbability that is resolved by examining successive birth cohorts to show that those currently in midlife in the US have had higher pain levels throughout their lives than did the now elderly.

  • It is also improbable that the younger generation, with less blue-collar work, really hurts more. Must just be perception.

We believe that these statements, like NASEM’s (2021) conclusion, are false. Pain prevalence has been rising in the US at least since the early 1990s, especially among less educated Americans.

  • What blatant assertion! We expect some justification to follow, but there is none.

. When opioid overdoses rose rapidly in the US in the late 1990s, the vultures were the pharma companies and their political enablers but, by that time, less-educated Americans had suffered a quarter-century of job loss, wage-decline, union loss, rising morbidity, failing marriages, and much more. What caused the Opium Wars? What caused America’s opioid epidemic? Like many such questions in history and social science, there does not have to be a single or even fundamental cause.

  • They are arguing that the opioid pills weren't the cause of the epidemic; it was poverty. Stupid.

Olfson et al. (2021) also document at the individual level the hazards associated with factors that we have shown are trending adversely for those without a college degree, not being employed—which is not the same as being unemployed—marital status other than being married, functional disabilities of various kinds, and low income. Olfson M, Cosgrove C, Altekruse SF, Wall MM, Blanco C. 2021. Deaths of despair: adults at high risk for death by suicide, poisoning, or chronic liver disease in the US. Health Aff 40(3):505-12

  • I wonder how much the decline in marriage explains death rates from overdoses, suicide, and accidents.

it is the BA that makes the difference, with similar higher hazards for high school or less and for some college; some college helps, but outcomes are closer to those with a high-school degree than to those with a four-year college degree.

Rural residence is protective against drug deaths and liver disease, but a risk factor for suicide

. In most of the countries, age-adjusted mortality rates fell from c1980 to 2014 for all three education levels, and in many countries fell by more for less-educated than for more educated people. But because the larger decreases for the less-educated started from higher baseline mortality rates, the percentage declines in mortality were smaller for the less educated group—a widening in relative mortality inequality while absolute mortality inequality decreased.

drug overdoses reached 93,331 in 2020, more than 20,000 deaths higher than the previous record of 70,630 in 2019.

The provisionally estimated suicide rate in 2020 was lower than in 2019, with 44,834 deaths as opposed to 47,511 deaths, lower than in any year since 2015, Ahmad & Anderson (2021). Compared with previous years, the decline seems to have been strongest in April and May, slowly reverting to the 2016-2019 average by the middle of the year, R