Perceived loss of social status linked to rising mortality rate of white Americans

November 21/2019

By: Nicole Bodnar

The rising mortality rates of white Americans is due to a perceived loss of social status, not socioeconomic disadvantage, according to a provocative new study led by researchers at the Dalla Lana School of Public Health (DLSPH).

“This is a startling finding,” said Arjumand Siddiqi, Associate Professor of Epidemiology at DLSPH and lead author on the study.

Professor Arjumand Siddiqi

“For perhaps the first time, we’re suggesting that a widespread population health phenomenon can’t be explained by actual social or economic status disadvantage, but instead is driven by a perceived threat to status,” said Siddiqi, who also holds an academic appointment at the Gillings School of Global Public Health at the University of North Carolina – Chapel Hill.

Since the beginning of the nation’s history, black mortality rates have been higher than white mortality rates in the United States. However, since 1999, the mortality fortunes of working-age whites have undergone a reversal, while black mortality rates — like mortality rates of all other groups and all high-income countries of Europe and North America — continue to fall.

The paper, Growing sense of social status threat and concomitant deaths of despair among whites, published in the December 2019 edition of Population Health examined administrative mortality and social survey data from 2000 to 2016.

Researchers analyzing the data found an increase in mortality of 0.50 to 4.92 per cent for working-age adults — women and men — between the ages of 25 and 54 across all education levels. The worst outcomes are concentrated in the lowest education group, but signs of damaging trends can be seen through all educational levels. Prior to 1999, mortality rates of white Americans were declining by two per cent each year, on average.

“The anxiety of whites is coming from a misperception that their dominant status in society is being threatened, which is manifesting in multiple forms of psychological and physiological stress,” said Siddiqi.

These psychological and physiological stressors are resulting in more deaths of despair — those due to alcohol consumption, opioid use, drug overdose and suicide — and to a lesser extent, rising chronic disease, including hypertension and obesity. This widespread decline in health status is actually consistent with — and may even reinforce — a despair-based explanation for worsening white health, explains Siddiqi.

“Status is a major predictor of health so our team hypothesized that it was a perception among whites that blacks are economically catching up to them, when in fact income inequality and other socioeconomic factors continue to affect black Americans more unfavourably,” said Siddiqi.

Another important finding uncovered by Siddiqi and her research team is the association between rising white mortality and a growing share of Republican voters. From 2000 — when white mortality started to rise — to 2016, there was an increase in the proportion of Republican voters.

The 2016 election illuminated a growing sense of a racial threat being experienced by white Americans and survey data show that voting for Trump was associated with anxieties about growing racial diversity within the United States, and an increase in the interdependence of the United States with a broader globalizing world.

“With the very real rise in economic instability over the last several decades, we’d expect mortality rates to rise in the most socioeconomically disadvantaged groups of all races,” said Siddiqi.

“But this is not the case. Instead we’re seeing a striking reversal among working-age whites, which seems to be driven principally by anxiety among whites about losing social status to blacks, even in the absence of evidence, which is a newly identified population health phenomenon that requires further research.”