@article{87b592314d484fc2983dcd3daa5eb099,
title = "Economic insecurity and deaths of despair in US counties",
abstract = "Recent research has implicated economic insecurity in increasing midlife death rates and {"}deaths of despair,{"} including suicide, chronic liver disease, and drug and alcohol poisoning. In this ecological longitudinal study, we evaluated the association between changes in economic insecurity and increases in deaths of despair and midlife all-cause mortality in US counties during 2000-2015. We extended a previously developed measure of economic insecurity using indicators from the Census and Federal Reserve Bank in US counties for the years 2000 and 2010. Linear regression models were used to estimate the association of change in economic insecurity with change in death rates through 2015. Counties experiencing elevated economic insecurity in either 2000 or 2010 had higher rates of deaths of despair and all-cause midlife mortality at baseline but similar rates of increase in deaths of despair from 2001 to 2015 compared with counties with stable low economic insecurity. Counties in the highest tertile of economic insecurity in 2000 and 2010 had 41% (95% confidence interval: 1.36, 1.47) higher midlife mortality rates at baseline and a rate of increase of 2% more per 5-year period (95% confidence interval: 1.00, 1.03) than counties with stable low economic insecurity. Economic insecurity may represent a population-level driver of US death trends.",
keywords = "United States, all-cause mortality, death, drug and alcohol poisoning, economic insecurity, liver disease, suicide",
author = "Knapp, {Emily A.} and Usama Bilal and Dean, {Lorraine T.} and Mariana Lazo and Celentano, {David D.}",
note = "Funding Information: Author affiliations: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Emily A. Knapp, Lorraine T. Dean, Mariana Lazo, David D. Celentano); Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania (Usama Bilal); Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania (Usama Bilal); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Lorraine T. Dean); Department of Oncology, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Lorraine T. Dean); Department of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland (Mariana Lazo); and Department of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland (David D. Celentano). E.A.K. was supported by the Clinical Research and Epidemiology in Diabetes and Endocrinology training grant (T32DK062707). L.T.D. was supported by the National Institute of Mental Health (grant R25MH083620), the National Cancer Institute (grant K01CA184288), the Sidney Kimmel Cancer Center (grant P30CA006973), and the Johns Hopkins University Center for AIDS Research (grant P30AI094189). M.L. was supported by grants from National Institutes of Health during the conduct of the study; a grant from National Kidney Foundation, outside the submitted work; and funding from the National Institutes of Health (grant 5U10AA025286) to Johns Hopkins University. U.B. was partially supported by the Office of the Director of the National Institutes of Health (grant DP5OD26429) and by a Johns Hopkins Center for a Livable Future-Lerner Fellowship. D.D.C. was supported by the National Institutes of Health (grants 1U01DA036297, P30AI094189, R01DA012568, R01DA0430898, 1U24OD023382, R012DA041034, and 1U01DA040325) and a contract with Deloitte from the Ministry of Public Health, State of Qatar. Conflict of interest: none declared. Publisher Copyright: {\textcopyright} 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.",
year = "2019",
month = dec,
day = "31",
doi = "10.1093/aje/kwz103",
language = "English (US)",
volume = "188",
pages = "2131--2139",
journal = "American Journal of Epidemiology",
issn = "0002-9262",
publisher = "Oxford University Press",
number = "12",
}