Missing Texans and Deaths of Despair

At a recent?conference?hosted by the Brookings Institute in late September, Economists Anne Case and Angus Deaton shared results from their most recent?investigation into how Americans are dying. The main takeaway from their research was that in the most powerful country in the world, the health and well-being of the United States continue to decline as more Americans are dying from a host of preventable causes, namely drug overdoses, suicides, alcohol, and homicides in addition to the usual “chronic” culprits such as heart disease and cancer, which still take more American lives. And as Anne Case highlighted in an interview,?“GDP may be doing great, but people are dying in increasing numbers, especially less-educated people.”

Deaths from drug overdoses, suicides, and alcohol have been termed?Deaths of despair?by Case and Deaton, who found that such deaths were primarily afflicting working-class non-Hispanic whites, but that since then, additional studies have shown that deaths from drug overdoses, suicide, and alcohol-related diseases have expanded beyond the original sociodemographic and geographic populations to affect younger people, racial and ethnic minorities, urban communities, and those without a high school degree.?

Similarly, I find that deaths of despair are rising in a state that continues to grow, diversify, and age. My research, which I recently presented at the?51st Annual Meeting of the Southern Demographic Association, shows that between 2000 and 2020, almost 179,000 Texans died from drug overdoses, suicides, and alcohol-induced causes, a?155%?increase in mortality for Texans aged 15 and older. The relative increase observed in working-aged Texans echoes national trends, where deaths of despair in the United States similarly increased by 160%, from 75,713 deaths in 2000 to 197,033 deaths in 2020.?

So, what are the implications? Well, for one, we are losing people when they are at their most productive, which I describe as?"Missing Texans." So,?beyond the emotional toll and grief brought on by the loss of these lives, there are also long-term implications as these individuals can no longer contribute to the social and economic of their community. For example, based on my analysis in 2020 alone, deaths from these three causes were responsible for 363,000 years of potential life lost (YPLL) – a measure of how long someone might live had they not died from these three causes. Drug overdoses alone were responsible for 140,242 YPLL, accounting for almost 40% of the total burden of life lost to these causes. The nearly 179,000 thousand lives lost are practically the equivalent of having two Texas cities the size of Georgetown (pop. 86,505), Bryan (pop. 87,793), or Temple (pop. 89,455) and Mission (pop. 86,634) vanish in a 20-year timespan.

Another implication is that the rising deaths from despair in the Texas population driven by the rapid uptick in drug overdoses signify rising demographic risk. Deaths from these three causes were also more likely to occur among males (71%), non-Hispanic Whites (63%), and Texans aged 45-64. I also found that drug overdose deaths in working-aged Texans rose by over 200% during this period, followed by deaths from alcohol-related illnesses (48%) and suicide (33%). Nearly 3 in 10 deaths occurred among Hispanics, and over the same period, the death rate among younger Texas aged 25-34 rose by almost 140%. The death rate also increased by over 100% for those aged 55-64.?

And so, deaths of despair are not just a problem in West Virginia or Ohio but also for Texas. Especially when we look at rising drug overdoses and their contribution to deaths in the population. In 2021, there were over 106,000 drug overdose deaths in the United States, a rate of 34.1 per 100,000 people, with the most?current wave of drug deaths driven by highly lethal synthetic opioids. In Texas, the Relative increase in opioid-related deaths was?450% (from 376 deaths in 2000 to 2,071 in 2020). By 2020, opioids accounted for half of all drug overdose deaths in Texas,?increasing by almost one-third over the study period?(32% increase, from 38% of all deaths in 2000 to 50% by 2020)?and further demonstrates the contribution to premature death that opioids are having on the Texas population.?

So, amid Texas's bright and sunny economic veneer, something is amiss in the lives of Texans whose state politics also might not be helping. As Jonathan Metzl describes in his book?Dying of Whiteness: How Racial Resentment is Killing America’s Heartland, - despair, distrust, and resentment at the perceived loss of status and privilege can brew a perfect political storm where citizens can vote against their health and well-being. Metzl observes that the impact of such sentiment includes the loosening of gun laws in Missouri, repeal and reduction in medical care coverage based on fears of having to provide welfare services for the ‘other’ in Tennessee, and the defunding of schools and social service agencies to help eliminate the tax burden in Kansas.

The result? A weakened social, health, and public safety net for residents, especially those most in need of these services. Texas has a history of conservative policies and limited government that have led to cuts in social services, including a refusal to expand medical care coverage for the poorest Texans. Texas also generally ranks at the bottom for states for health and access to medical care. These cuts have also made it more difficult for people to access mental health care, addiction treatment, and other services that can help save lives.

Older and younger Texans are increasingly dying from drug overdoses, suicides, and alcohol-related conditions at a time when the state's politics continue to hollow out public safety and social services for our residents. Indeed, there are eventual consequences to such actions, often long after the final gavel has fallen to close another legislative session. And at what point does despair begin to set in? Based on my findings, for the past twenty years, despair seems to have firmly taken hold in the Lone Star State, steadily shortening Texans' lives.?

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