'Deaths of despair' among Black Americans surpassed those of white Americans in 2022

A new analysis by researchers at UCLA Health found that mortality rates of middle-aged Black Americans caused by the "deaths of despair"—suicide, drug overdose and alcoholic liver disease—surpassed the rate of white Americans in 2022. Native Americans also had more than double the rate of both Black and white Americans that year.

The results of the research, published in the journal JAMA Psychiatry, are the latest from UCLA Health to counter a nearly decade-old narrative that "deaths of despair" have primarily impacted white Americans.

The "deaths of despair" theory rose to prominence following a 2015 study that analyzed rising midlife mortality, and decreasing life expectancy, in the U.S from 1999 to 2013.

The study became a focus of ongoing national discourse after it found white Americans had the highest mortality rates from these causes at 72.15 per 100,000 people in 2013, which was two times that of Black Americans. The findings sparked a narrative that the rising death rates were primarily impacting less educated white Americans who were experiencing a perceived loss of economic and social status.

However, data for Native Americans were not included in the 2015 study or in the many follow-up analyses it triggered. A 2023 study by UCLA Health determined that Native Americans have had a considerably higher midlife death rate from deaths of despair compared to white Americans for all available years of data 1999–2021.

In the new data analysis, UCLA Health researchers used publicly available records from the U.S. Centers for disease control to determine rates of deaths of despair through 2022 for white, Black and Native Americans ages 45–54.

The analysis found:

• The rate of deaths of despair among Black Americans (103.81 per 100,000 people) surpassed that of white Americans (102.63 per 100,000) in 2022.
• The rate among Black Americans tripled from 2013–2022 from 36.24 per 100,000 to 103.81 per 100,000 people, with 2015 onward marking a sharp increase in deaths.
• The rate for Native American and Alaska Native populations was the highest at 241.7 per 100,000 people in 2022.
• The rate of deaths of despair for Native American/Alaska Native populations has remained significantly higher than white Americans from 1999–2022.
• Native American/Alaska Native had the highest mortality rates from suicide, alcoholic liver disease and drug overdose compared to Black and white Americans.
• Deaths of despair in white Americans increased from 72.15 per 100,000 people in 2013 to 102.63 per 100,000 people in 2022.

Study co-author Joseph Friedman, Ph.D., MPH, of the David Geffen School of Medicine at UCLA, said the results highlight the sharply rising rates of premature mortality related to mental health issues and substance use disorders with large racial and ethnic inequalities.

"The findings reinforce the notion that we need to invest in services that can address these issues and, ultimately, we need much more comprehensive access to low-barrier mental health care and substance use treatment in the U.S.," Friedman said. "And we need to specifically make sure those treatments, services and programs are implemented in a way that is accessible for communities of color and will actively work to address inequality."

The data does not identify the circumstances behind these deaths, but Friedman said the increasing rates of deaths of despair largely relate to mental health and substance use disorders. Black Americans have been disproportionately affected by the drug overdose crisis. Other factors include differential access to health care and social services; an increasingly toxic illicit drug supply, namely fentanyl; and worsening economic insecurity.