IDEAS home Printed from https://ideas.repec.org/a/dem/demres/v51y2024i7.html

Socio-behavioral factors contributing to recent mortality trends in the United States

Author

Listed:
  • Samuel Preston

    (University of Pennsylvania)

  • Yana Vierboom

    (Max-Planck-Institut für Demografische Forschung)

  • Mikko Myrskylä

    (Max-Planck-Institut für Demografische Forschung)

Abstract

Background: We investigate the contribution of socio-behavioral factors to changes in US adult mortality over the period 1997–2019 using National Health Interview Surveys for the years 1997–2018 linked to death records through 2019. The variables studied include alcohol consumption, cigarette smoking, health insurance coverage, educational attainment, mental distress, obesity, and race/ethnicity. We evaluate the contribution of each socio-behavioral variable to mortality change by estimating the mortality risks associated with each variable in a hazards model and applying the risks to changes in the variable’s distribution. Results: When all variables are included in the model, we find that reductions in cigarette smoking and increases in educational attainment are the largest contributors to recent mortality improvements, accounting between them for 66% of mortality improvements. The contribution of educational attainment nearly doubles when variables that may be considered downstream to it are omitted from the analysis. In a secondary analysis, we compare two subperiods to investigate whether the variables can account for a widely observed slowdown in the rate of mortality reduction that occurred within the period of study. Rising levels of psychological distress, combined with very high risks associated with distress, contributed substantially to the slowdown. However, most of the slowdown remains unaccounted for. Contribution: We develop and apply a rigorous method to identify the role of many socio-behavioral factors in recent mortality change in the United States. Results highlight the role of a behavioral change (declines in smoking) and a broad social advance (educational expansion).

Suggested Citation

  • Samuel Preston & Yana Vierboom & Mikko Myrskylä, 2024. "Socio-behavioral factors contributing to recent mortality trends in the United States," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 51(7), pages 191-214.
    • Handle: RePEc:dem:demres:v:51:y:2024:i:7
    DOI: 10.4054/DemRes.2024.51.7
    as

    Download full text from publisher

    File URL: https://www.demographic-research.org/volumes/vol51/7/51-7.pdf
    Download Restriction: no
    File URL: https://libkey.io/10.4054/DemRes.2024.51.7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Richard G. Rogers & Patrick M. Krueger & Richard Miech & Elizabeth M. Lawrence, 2013. "Lifetime abstainers and mortality risk in the United States," Vienna Yearbook of Population Research, Vienna Institute of Demography (VID) of the Austrian Academy of Sciences in Vienna, vol. 11(1), pages 165-183.
    2. Fenelon, Andrew, 2013. "Revisiting the Hispanic mortality advantage in the United States: The role of smoking," Social Science & Medicine, Elsevier, vol. 82(C), pages 1-9.
    3. Wilper, A.P. & Woolhandler, S. & Lasser, K.E. & McCormick, D. & Bor, D.H. & Himmelstein, D.U., 2009. "Health insurance and mortality in US adults," American Journal of Public Health, American Public Health Association, vol. 99(12), pages 2289-2295.
    4. Nathan Keyfitz, 1977. "What difference would it make if cancer were eradicated? An examination of the taeuber paradox," Demography, Springer;Population Association of America (PAA), vol. 14(4), pages 411-418, November.
    5. Anne Case & Angus Deaton, 2017. "Mortality and Morbidity in the 21st Century," Brookings Papers on Economic Activity, Economic Studies Program, The Brookings Institution, vol. 48(1 (Spring), pages 397-476.
    6. Angus Deaton & Anne Case, 2022. "The Great Divide: Education, Despair, and Death," Annual Review of Economics, Annual Reviews, vol. 14(1), pages 1-21, August.
    7. Joseph T. Lariscy & Robert A. Hummer & Richard G. Rogers, 2018. "Cigarette Smoking and All-Cause and Cause-Specific Adult Mortality in the United States," Demography, Springer;Population Association of America (PAA), vol. 55(5), pages 1855-1885, October.
    8. Samuel Preston & Andrew Stokes & Neil Mehta & Bochen Cao, 2014. "Projecting the Effect of Changes in Smoking and Obesity on Future Life Expectancy in the United States," Demography, Springer;Population Association of America (PAA), vol. 51(1), pages 27-49, February.
    9. Keyes, C.L.M. & Simoes, E.J., 2012. "To flourish or not: Positive mental health and all-cause mortality," American Journal of Public Health, American Public Health Association, vol. 102(11), pages 2164-2172.
    10. Andrew Stokes & Samuel H. Preston, 2016. "How Dangerous Is Obesity? Issues in Measurement and Interpretation," Population and Development Review, The Population Council, Inc., vol. 42(4), pages 595-614, December.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Jacob Martin & Carlo Giovanni Camarda & Timothy Riffe, 2025. "Spatial Trends in Mortality Convergence: The Cases of France, Italy, and Spain, 1975–2019," European Journal of Population, Springer;European Association for Population Studies, vol. 41(1), pages 1-28, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Samuel H. Preston & Yana C. Vierboom & Mikko Myrskylä, 2023. "Socio-behavioral factors contributing to recent mortality trends in the United States," MPIDR Working Papers WP-2023-019, Max Planck Institute for Demographic Research, Rostock, Germany.
    2. Enghin Atalay, 2024. "A twenty-first century of solitude? Time alone and together in the United States," Journal of Population Economics, Springer;European Society for Population Economics, vol. 37(1), pages 1-33, March.
    3. Carol Graham & Sergio Pinto, 2019. "Unequal hopes and lives in the USA: optimism, race, place, and premature mortality," Journal of Population Economics, Springer;European Society for Population Economics, vol. 32(2), pages 665-733, April.
    4. Matthew Calver, 2016. "Measuring the Appropriate Outcomes for Better Decision-Making: A Framework to Guide the Analysis of Health Policy," CSLS Research Reports 2016-03, Centre for the Study of Living Standards.
    5. Frank Trovato, 2020. "The Immigrant Mortality Advantage in Canada, 2001 and 2011," Journal of International Migration and Integration, Springer, vol. 21(2), pages 351-379, June.
    6. Sarah E. Dehry & Patrick M. Krueger, 2023. "Excess Deaths in the United States Compared to 18 Other High-Income Countries," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(2), pages 1-14, April.
    7. Anthony R. Bardo & Jason L. Cummings, 2023. "Life, Longevity, and the Pursuit of Happiness: The Role of Disability in Shaping Racial and Sex Disparities in Living a Long and Happy Life," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 42(4), pages 1-26, August.
    8. Wijesinghe, M.D.J.W. & Cameron, Michael P. & Olivia, Susan & Oxley, Les, 2025. "State level differences in life expectancy and lifespan inequality: Is it a matter of socioeconomic inequalities?," Economics & Human Biology, Elsevier, vol. 59(C).
    9. David McCarthy, 2021. "80 will be the new 70: Old‐age mortality postponement in the United States and its likely effect on the finances of the OASI program," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 88(2), pages 381-412, June.
    10. Li, Han & Li, Hong & Lu, Yang & Panagiotelis, Anastasios, 2019. "A forecast reconciliation approach to cause-of-death mortality modeling," Insurance: Mathematics and Economics, Elsevier, vol. 86(C), pages 122-133.
    11. Dana P. Goldman & Benjamin G. Cohen & Jessica Y. Ho & Daniel L. McFadden & Martha S. Ryan & Bryan Tysinger, 2021. "Improved survival for individuals with common chronic conditions in the Medicare population," Health Economics, John Wiley & Sons, Ltd., vol. 30(S1), pages 80-91, November.
    12. Ruhm, Christopher J., 2025. "Mental health and mortality trends in the United States," Journal of Health Economics, Elsevier, vol. 102(C).
    13. Borovičková, Katarína & Macaluso, Claudia, 2025. "Heterogeneous job ladders," Journal of Monetary Economics, Elsevier, vol. 150(C).
    14. Anne Case & Angus Deaton, 2023. "Accounting for the Widening Mortality Gap Between Adult Americans with and without a BA," NBER Working Papers 31236, National Bureau of Economic Research, Inc.
    15. Lowenstein, Christopher, 2024. "“Deaths of despair” over the business cycle: New estimates from a shift-share instrumental variables approach," Economics & Human Biology, Elsevier, vol. 53(C).
    16. Louis‐Philippe Beland & Jason Huh & Dongwoo Kim, 2024. "The effect of opioid use on traffic fatalities," Health Economics, John Wiley & Sons, Ltd., vol. 33(6), pages 1123-1132, June.
    17. Alexander Cheung & Joseph Marchand & Patricia Mark, 2022. "Loss of Life and Labor Productivity: The Canadian Opioid Crisis," The ANNALS of the American Academy of Political and Social Science, , vol. 703(1), pages 303-323, September.
    18. Högberg, Björn & Scarpa, Simone, 2025. "Widening disparities in all-cause and despair-related mortality among Swedish youths: Disentangling selection and causation," Social Science & Medicine, Elsevier, vol. 377(C).
    19. Eunsoo Timothy Kim & Bo-Hyeong Jane Lee & Rae Jean Proeschold-Bell, 2025. "Does Flourishing Mental Health Improve Perceived Quality of Life?," Journal of Happiness Studies, Springer, vol. 26(6), pages 1-13, August.
    20. Dow, Wiiliam H & Godoey, Anna & Lowenstein, Christopher A & Reich, Michael, 2019. "Can Economic Policies Reduce Deaths of Despair? Working Paper #104-19," Institute for Research on Labor and Employment, Working Paper Series qt14f015df, Institute of Industrial Relations, UC Berkeley.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • J1 - Labor and Demographic Economics - - Demographic Economics
    • Z0 - Other Special Topics - - General

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:dem:demres:v:51:y:2024:i:7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Editorial Office (email available below). General contact details of provider: https://www.demogr.mpg.de/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.