Following decades of improvement in functioning and a decline in disability among the U.S. population aged 65 or older, newer cohorts approaching middle-age (ages 40–59) and “young old” (ages 60–69) began to experience increasing functional limitations and disability starting in the late 1990s. The worsening disability trend is accompanied by increasing mortality rates in middle age around the early 2000s, which were thought to be driven by rising “deaths of despair” (drug-, alcohol-, and suicide-related mortality) combined with slowdowns in progress in heart disease mortality. Suicide, cirrhosis of the liver, and fatal drug overdoses suggest that victims are likely suffering from psychological distress. The rising mortality rate narrative initially was only applied to the White population. Subsequent research, however, suggests it is not restricted to that population subgroup.
According to an article appearing in the November 2021 issue of the American Journal of Epidemiology, important research gaps remain. An example is that studies only look at the end of the morbidity process, which begins for populations with the physiological dysregulation (PD) indicated by a number of biological risk factors and followed by subsequent diagnosis of diseases, functioning loss, disability, frailty, and death. Mental illness (e.g., anxiety and depression) and health behaviors also precede the onset of disability and mortality. Thus, it is essential to investigate whether the unfavorable trend in morbidity and mortality in recent decades should be attributed to health behavior changes driven by psychological distress, deterioration of innate physiological functioning, or both. As a means of addressing various gaps, a comprehensive investigation is described of the trends of physiological status, mental health, and health behaviors by race and sex across a century of birth cohorts that were classified on the basis of nine generations. These researchers found that the worsening physiological and mental health profiles among younger generations imply a challenging morbidity and mortality prospect for the United States, one that might be particularly inauspicious for Whites.