Despair as a Cause of Death: More Complex Than It First Appears

Recent analyses have documented the alarming fact that, in the United States, mortality declines have stalled or even reverted in some population groups over the past few years.1 3 Studies have described increases in death rates among middle-aged Whites and especially among Whites with a high-school education or less, primarily attributable to drug overdoses, suicides, and alcohol-related liver disease.2 Perhaps the most influential of these was a study by Case and Deaton2 that received extensive press coverage. OUTSTANDING QUESTIONS Although in their original article Case and Deaton2 did not report analyses by gender, and Stein et al. do not examine differences by gender either, other analyses have found that the increase in death rates in Whites is more pronounced in women than in men.3,6 The presence of this type of gendered response could cast some doubt on the somewhat male-dominated labor market-related despair explanations. The next step is to determine what can be done, not only to reverse the worrisome increase in death rates among Whites, but also to eliminate the profound health inequities by race, social class, and geography that have characterized our society for so long. .4JPH Ana V. Diez Roux, MD, PhD, MPH Correspondence should be sent to Ana V. Diez Roux, MD, PhD, Dean, Dornsife School of Public Health, 3215 Market St, Philadelphia, PA 10146 (e-mail: avd37@drexel.edu).