MPIDR Working Paper

Socio-behavioral factors contributing to recent mortality trends in the United States

MPIDR Working Paper WP-2023-019, 32 pages.
Rostock, Max Planck Institute for Demographic Research (April 2023)
Open Access


We investigate the contribution of socio-behavioral factors to changes in US adult mortality over the period 1997-2019, using National Health Interview Surveys (NHIS) for years 1997-2018 linked to death records through 2019. The variables studied include alcohol consumption, cigarette smoking, health insurance coverage, educational attainment, mental distress, obesity, and race/ethnicity. We evaluate the contribution of each socio-behavioral variable to mortality change by estimating the mortality risks associated with each variable in a hazards model and applying the risks to changes in the variable’s distribution. We find that reductions in cigarette smoking and increases in educational attainment are the largest contributors to recent mortality improvements, accounting between them for 67% of mortality improvements. In a secondary analysis, we compare two subperiods to investigate whether the variables can account for a widely-observed slowdown in the rate of mortality reduction that occurred within the period of study. Rising levels of psychological distress, combined with very high risks associated with distress, were responsible for 13% of the slowdown. However, most of the slowdown remains unaccounted for.

The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.