Suicide, drugs, sex and other dangers of rock and/or roll
April 17, 2014 3:59 PM   Subscribe

How Americans Die - a visual tour through surprising trends in mortality among Americans in the last several decades
posted by Blazecock Pileon (58 comments total) 26 users marked this as a favorite
 
Well, that took me by surprise. Suicide is now the number one violent cause of death? Damn, that sucks.
posted by and they trembled before her fury at 4:45 PM on April 17, 2014 [1 favorite]


Looks like I picked the wrong weekend (age demographic) to stop sniffing glue.
posted by valkane at 4:46 PM on April 17, 2014 [7 favorites]


That was super interesting. The huge AIDS spike was unsurprising but sad. I had not realized that suicide was such a large factor now.
posted by Dip Flash at 4:47 PM on April 17, 2014


This has a big effect on the overall mortality rate, because old people die sooner than the young.

Is it just me, or is this sentence nonsense?
posted by lenny70 at 4:47 PM on April 17, 2014 [3 favorites]


The suicide stat was a big surprise, but what I found more interesting was the fact that spending has been flat since 2006 on nursing homes. Have we caught up with the curve of oldster baby boomers? Cuz that has some impact in the long-term care insurance industry, and they ain't talking about it.
posted by valkane at 4:49 PM on April 17, 2014 [1 favorite]


@lenny70 - I had trouble parsing that sentence too. "die sooner"? WTF - if you are 'old', then by definition you've lived longer, and therefore are dying 'later'...maybe it's that 'old' people make up a larger proportion of overall deaths?
posted by dbmcd at 4:54 PM on April 17, 2014


This has a big effect on the overall mortality rate, because old people die sooner than the young.

Is it just me, or is this sentence nonsense?


Not just you; I stared at that for a few minutes thinking, "am I just an idiot or what?" I think what they meant to say is that at any given moment, it is more likely that an old person will die than a young person. (?) Which seems kind of trivial since the likelihood of a person dying as they approach their death approaches 1.
posted by Lutoslawski at 4:54 PM on April 17, 2014 [1 favorite]


I found more interesting was the fact that spending has been flat since 2006 on nursing homes.

I'm guessing it has to do with the ongoing depression, I'm sorry, "economic slow down" which really kicked in about 2006. Consider the cost of assisted living and the flatness of interest rates and graph is no surprise at all. Sure, you could make money in stocks if you had the nerve, but by the time you're ready for seriously old age retirement living, the advice is generally to put the nest egg in something safe, and stable, like banks, or cds, or bond funds.

So thank you Federal Reserve and all those who thought, and apparently still think, that zero interest was a net good for the nation. Not for savers, not for widows and orphans, but, you know, tough noogies.
posted by IndigoJones at 4:56 PM on April 17, 2014 [2 favorites]


The rise in suicide is sad but not surprising.

Interestingly, the increase in life expectancy we've seen over the past century is not, as many think, as much of a function of human evolution or nutrition or some such, and much more largely due to some external factors, the largest being antibiotics (it isn't that people are living longer so much as fewer people are dying young, raising the average life expectancy).

The fact that men have seen the greatest increase in life expectancy over the past century is undoubtedly a function of occupation - far fewer men working in very hard labor or dangerous jobs for most of their lives, and are therefore living longer/not dying young.
posted by Lutoslawski at 4:58 PM on April 17, 2014


I just read today that the average annual cost of a long term care home is $80,000 and tops out at around $160,000 in the most expensive area (CT, I think). This seems relevant considering that fewer people are dying early of things such as heart disease and cancer, but we're subsequently seeing more cases of dementia and Alzheimers.

I also wonder what will happen to all the old-age care related infrastructure that is popping up now for the baby boomers once they've all passed on. Will it make things easier for Gen Xers as they go into old age?
posted by triggerfinger at 5:01 PM on April 17, 2014


I found more interesting was the fact that spending has been flat since 2006 on nursing homes.

I'm guessing it has to do with the ongoing depression, I'm sorry, "economic slow down" which really kicked in about 2006


They are definitely related, but the republican push for entitlement limits is also a huge factor. It's worth keeping in mind that almost half of all money spent on nursing homes is coming from medicaid, so as long as government financial assistance for elderly people is kept flat, it will have a dramatic affect on overall nursing home spending as well.
posted by Lutoslawski at 5:01 PM on April 17, 2014


Well, that's just it, isn't it? I mean the bottom line is folks dying out usually end up on a spend-down, and title 19 out so medicaid pays the rent on the bed. My real question is, have we reached a plateau, and is the crash still coming when more and more boomers get on the slide?
posted by valkane at 5:05 PM on April 17, 2014


I also wonder what will happen to all the old-age care related infrastructure that is popping up now for the baby boomers once they've all passed on. Will it make things easier for Gen Xers as they go into old age?

That and/or we'll be living in a weird dystopia with all these abandoned memory wards around where the future punk kids of millenials will squat and make their anti-apps-art.
posted by Lutoslawski at 5:05 PM on April 17, 2014 [5 favorites]


That and/or we'll be living in a weird dystopia with all these abandoned memory wards around where the future punk kids of millenials will squat and make their anti-apps-art.

Now I want to go watch Children of Men for some reason.
posted by valkane at 5:12 PM on April 17, 2014 [1 favorite]


Ah the ongoing decimation of my generation. . . first AIDS and now drugs and suicide. I wish I was more surprised.
posted by mygothlaundry at 5:23 PM on April 17, 2014 [2 favorites]


Just based on the numbers, if everyone's total lifespan magically gets 10 years added today, mortality rates will drop to 0 for ten years, then go back to normal. Because everyone got 10 more years, so the people that would die in the next ten years already died in the last ten years (before the magical gift of 10 years occured).

So yes, a short term factor that adds years to the end of people's lives are going to have a big short term effect, that becomes less extreme (in terms of how it affects mortality rates) over time.
posted by idiopath at 5:50 PM on April 17, 2014


So the drug-related fatalities going up, that's Oxycodone and/or crystal meth, right?
posted by griphus at 5:55 PM on April 17, 2014


The more I think about the suicide stat, the more it makes me think. Have all other forms of violent death shrunk so much? Isn't that a good thing?

Or has suicide increased so much?

Anyone with more statistical knowledge let me know.
posted by valkane at 5:55 PM on April 17, 2014 [1 favorite]


...but what I found more interesting was the fact that spending has been flat since 2006 on nursing homes. Have we caught up with the curve of oldster baby boomers? Cuz that has some impact in the long-term care insurance industry, and they ain't talking about it.

I have to wonder what sort of facility they consider a "nursing home". Fact is, you almost never see anything called a "nursing home" anymore. But I do see tons of assisted-living centers being built everywhere. There's not a lot of nursing going on in them, at least not by old-school nursing home standards.
posted by Thorzdad at 5:58 PM on April 17, 2014 [1 favorite]


I have to wonder what sort of facility they consider a "nursing home". Fact is, you almost never see anything called a "nursing home" anymore. But I do see tons of assisted-living centers being built everywhere. There's not a lot of nursing going on in them, at least not by old-school nursing home standards.

Assisted living can run from $500 or so a month (sometimes in addition to rent) for check ins & call buttons and meals and social activities to $5000 a month for continual care. Around here (Florida) that gets you a private room if you've got the cash.

Smaller facilities I don't know; there's one diwn the street that's a converted home with 11 beds. No idea the rates but they are all battling with halfway houses for small home licensing.

The Great Recession seems to have affected this; co worker was ops manager at one until 2006 when they canned everyone expensive.

Suicide is 'cheap' but not yet legal enough. Doesn't have to be violent but illegality doesn't help I'm guessing. Talking only from an economic perspective; emotionally of course it's a tough choice not always made with a clear head.
posted by tilde at 6:12 PM on April 17, 2014 [1 favorite]


I have to wonder what sort of facility they consider a "nursing home".

Yeah, it's confusing. There's different levels, even in "assisted living" facilities. The big buildings have everything from what looks like a hospital room to small apartments. But there's medical on staff.

If you go downtown, where the towers are, it can be pretty depressing.

The creepy thing is the rule that most insurance/medicare use for claims:

If you're getting better, that is healing back to a basic quality of life, then most stuff is covered. If you're simply getting worse, then it becomes what's called "managed care" and you're looking at a spend down and title 19 (medicaid). Unless you can afford to pay for the care yourself, or you have long-term care insurance.

But even then, there's a catch. If you're not already in the system, and you suddenly become unable to care for yourself, then they look for the nearest bed. So you might not end up in the bestest place, even if you can afford it. Unless you're rich. YMMV.

And yeah, last I heard, they were buying houses in the burbs, and turning them into 12 bed units. I know the government is doing that with assisted care, because they built one across the street from my house.

My surprise with this article was the fact that spending is flat, because last time I checked, the curve for folks entering their "final years" was a steep upward curve, or at least that's what they were teaching three years ago.
posted by valkane at 6:18 PM on April 17, 2014



The more I think about the suicide stat, the more it makes me think. Have all other forms of violent death shrunk so much? Isn't that a good thing?

Or has suicide increased so much?


It's both. Looking at 'top dot 12'* on the graphs, deaths from motor vehicle accidents have been dropping since 2006 (older cars being replaced with newer, safer ones?), firearms deaths have been dropping pretty steadily for 20 years, while suicide rates have been heavily climbing over the same period - suicide deaths are now nearly 4 times greater than firearms deaths, compared to crossover in 1996.

*goddamn, I hate modern webdesign that doesn't allow linking
posted by ArkhanJG at 6:23 PM on April 17, 2014 [1 favorite]


the fact that spending has been flat since 2006 on nursing homes

I really wish that graph went back farther than 2000, so we could get a sense of whether there's been a long-term decline, or if spending just dropped off when the economy died.

Also interesting how motor vehicle deaths took a sharp plunge around 2007 - it's tempting to speculate that's caused by people selling off cars they suddenly can't afford and taking the bus/train instead. Pretty ironic if an economic crisis makes us live longer.
posted by echo target at 6:26 PM on April 17, 2014


Assisted living can run from $500 or so a month (sometimes in addition to rent) for check ins & call buttons and meals and social activities to $5000 a month for continual care. Around here (Florida) that gets you a private room if you've got the cash.

Yup. In New York State it can run between $9000-12,000 a month. If you, or an insurance company is paying for it. If it's medicaid, the figure comes down, to like $150 a day.

So, rich people pay more, and (most) people give up all their money and property (spend down) to qualify for medicaid. And then we pay for it.
posted by valkane at 6:29 PM on April 17, 2014


It's both. Looking at 'top dot 12'* on the graphs, deaths from motor vehicle accidents have been dropping since 2006 (older cars being replaced with newer, safer ones?), firearms deaths have been dropping pretty steadily for 20 years, while suicide rates have been heavily climbing over the same period - suicide deaths are now nearly 4 times greater than firearms deaths, compared to crossover in 1996.

Thanks! That makes sense!
posted by valkane at 6:31 PM on April 17, 2014


The suicide stat didn't surprise me at all. I thought we'd covered that last year. But even that didn't surprise me after I saw this.
posted by oneswellfoop at 6:32 PM on April 17, 2014 [2 favorites]


rich people pay more, and (most) people give up all their money and property (spend down) to qualify for medicaid. And then we pay for it.

Wow, that actually sounds....reasonable
posted by echo target at 6:32 PM on April 17, 2014


But it begs the question: why aren't we worrying less about gun control and spending more time worrying about mental health?
posted by valkane at 6:32 PM on April 17, 2014 [2 favorites]


why aren't we worrying less about gun control and spending more time worrying about mental health?

I know a death is a death, but it seems more wrong that someone be murdered than that someone kill themselves. Also, with guns being the instrument in so many suicides, there's a lot of overlap where one piece of regulation could help prevent both murders and suicides. And mental health stuff is sticky - you can't compel someone to take antidepressants, and how do you identify at-risk people who refuse to seek treatment?
posted by echo target at 6:42 PM on April 17, 2014 [2 favorites]


This has a big effect on the overall mortality rate, because old people die sooner than the young.

Is it just me, or is this sentence nonsense?


It makes complete sense. Of course, it means old people die sooner than the young on average. Any person of any age might die at any time. But on average, an 80-year-old is likely to die very soon, while a 20-year-old is likely to die a long time from now.
posted by John Cohen at 6:47 PM on April 17, 2014 [2 favorites]


"Die sooner" just means "have a shorter remaining life expectancy." (For instance, I'm 33; if you'd expect me to die at 85, my remaining life expectancy is 52.)
posted by John Cohen at 6:49 PM on April 17, 2014


I think we're ten years away from seeing a boomer-related nursing home surge. The oldest boomers are in their late 60s, and most people don't need nursing care until they're older than that.
So the drug-related fatalities going up, that's Oxycodone and/or crystal meth, right?
I think it's probably more Oxycodone than meth, or maybe it's Oxycodone followed by meth or heroin when the sources of prescription pills run dry. What I've heard is that the prescription painkiller epidemic is fueling the current heroin epidemic, because people get hooked on pills and then switch to street drugs when they can't get their hands on prescription drugs anymore.

Anyway, that was super interesting. I'm wondering what's fueling the decline of deaths in the under-25 set. Reduced infant mortality? Are deaths in Vietnam counted in those pre-1970 stats?
posted by ArbitraryAndCapricious at 6:53 PM on April 17, 2014


Also, with guns being the instrument in so many suicides, there's a lot of overlap where one piece of regulation could help prevent both murders and suicides.

Yeah, okay, especially when considering oneswellfoops link, i understand the point. The harder we make it for people to kill themselves, or each other, the better.
posted by valkane at 6:55 PM on April 17, 2014


the fact that spending has been flat since 2006 on nursing homes

It would be interesting to see a breakout of ICU costs. A couple of weeks in the ICU at the end of life could cost more than five years in a nursing home.
posted by JackFlash at 7:05 PM on April 17, 2014


The harder we make it for people to kill themselves, or each other, the better.

I'm not sure I agree. I think people have the right to kill themselves. We should strive to reduce the number of people who want to kill themselves, not simply make miserable people unable to do so.
posted by Justinian at 7:37 PM on April 17, 2014 [9 favorites]


Nursing home spending has not stayed flat...It has stayed at 5.5% of total healthcare spending since 2000. Healthcare spending has risen 4% higher than inflation since about 1990. So the total amount of spending for nursing homes has gone up but as a percentage of total healthcare spending it has remained the same. If nursing home spending had stayed flat since 2006, then as a percentage of total healthcare spending nursing home spending would have fallen over 25% to 4.3%.

The text is misleading so remember to always read the Y axis.

...carry on.
posted by Luminiferous Ether at 7:37 PM on April 17, 2014 [4 favorites]


This has a big effect on the overall mortality rate, because old people die sooner than the young.

Is it just me, or is this sentence nonsense?


Yeah, it is. Obviously old people don't die sooner than people who die young.

What they mean to say is that being old makes a person more likely to die soon.

But even then, combined with the previous statements that the mortality rate is dropping and the population is aging, it doesn't hold up. If older people are more likely to die soon, shouldn't the "big effect" of an aging population be a rise in overall mortality?

Nope. 'Cause they got the causation completely backwards. In reality, lower mortality is the cause, and an aging population is the effect. You can only age if you don't die first.
posted by Sys Rq at 7:49 PM on April 17, 2014 [1 favorite]


I would assume the high suicide rate is related to the war on some terror.
posted by Western Infidels at 7:51 PM on April 17, 2014 [1 favorite]


I don't understand why everyone is so confused about the statement:
This has a big effect on the overall mortality rate, because old people die sooner than the young.

This was an explanation for the following observation: the mortality rate fell by about 17 percent from 1968 through 2010. However it didn't fall by much in the 1990s.

They argue that this is because the population is aging and say:
This has a big effect on the overall mortality rate, because old people die sooner than the young.

This seems like an obvious statement but it does explain why the mortality rate drop appears to have stalled in the 1990s. Imagine a population of 100 average Americans in the 1970s. They'd be much younger than a population of 100 average Americans in the 1990s. Thus fewer of the 100 1970s average Americans would be likely to die in the coming year (the mortality rate) than the 100 1990s average Americans, all other things being equal. Of course all other things are not equal, which is why the mortality rate drop is only stalling, rather than the mortality rate actually increasing.
posted by peacheater at 8:03 PM on April 17, 2014 [1 favorite]


(Also, it's kind of super shitty that under the caption, "And, how do suicide and drugs compare to other violent deaths across the population? Far greater than firearm related deaths, and on the rise," their supposed support for the claim about "firearm related deaths" weighs drugs and suicides against "murder by firearm" and "accidental death by firearm." I'm pretty sure suicide by firearm is a firearm related death, too.)
posted by Sys Rq at 8:05 PM on April 17, 2014 [7 favorites]


(Most suicides are in fact "firearm related.")
posted by Sys Rq at 8:24 PM on April 17, 2014 [2 favorites]


60%, I hear.

On a different note I've got to commend Data View -- that's some beautiful presentation, thanks.
posted by Rash at 9:19 PM on April 17, 2014 [3 favorites]


A third of all deaths are people over 85

That is astonishing when you think about it. And pretty awesome.
posted by fshgrl at 9:41 PM on April 17, 2014 [1 favorite]


So the drug-related fatalities going up, that's Oxycodone and/or crystal meth, right?


I checked the source (the NIH) and I think the category contains all of:
  • illegal drugs
  • legal drugs (alcohol)
  • prescription medicines (e.g. taking the wrong dose by accident, children swallowing pills...)

    So it might be "more old people getting confused by their medication"?

  • posted by alasdair at 11:43 PM on April 17, 2014 [1 favorite]


    So thank you Federal Reserve and all those who thought, and apparently still think, that zero interest was a net good for the nation. Not for savers, not for widows and orphans, but, you know, tough noogies.

    Yes, but Obama expanded medicaid eligibility and the ACA took away the asset test.

    One of the lesser trumpted features of Obamacare is that it removed all asset tests from Medicad. The only measure is taxable income and if the millions you have tucked away in T-bills doesn't generate too much cash flow (because of low interest rates) you quaiify for Medicad without any spend down whatsoever.

    But if you go on Medicaid before 55 (when you become eligible for Medicare) the state can raid those assets after your death. So there's that.
    posted by three blind mice at 1:14 AM on April 18, 2014


    In New York State it can run between $9000-12,000 a month. If you, or an insurance company is paying for it. If it's medicaid, the figure comes down, to like $150 a day.

    Of course, the catch is that, at least in my area, scant few senior care facilities accept Medicaid. This seems to be especially true with memory-care units. It's very troubling.
    posted by Thorzdad at 4:31 AM on April 18, 2014 [1 favorite]


    Obviously old people don't die sooner than people who die young.

    But in a discussion of statistics, they clearly meant "on average," and the average is not to die when you're 25 years old.
    posted by John Cohen at 5:22 AM on April 18, 2014 [1 favorite]


    That and/or we'll be living in a weird dystopia with all these abandoned memory wards around where the future punk kids of millenials will squat and make their anti-apps-art.

    I would like to see this movie.
    posted by thivaia at 5:37 AM on April 18, 2014 [3 favorites]


    The old people/young people sentence made perfect sense to me. This one, though, is inane:

    "Cars, generally killing younger people, have decreased in prevalence."
    posted by JohnLewis at 5:50 AM on April 18, 2014


    Forget the misleading sentences, what about the misleading numbers? The first five or so slides were all properly normalized death rates, then it's as if the original statistician suddenly died and their junior apprentice stepped in. The US population went up by 50% during the time period graphed; could we please consistently divide by that figure rather than reporting raw "number of deaths"?
    posted by roystgnr at 7:24 AM on April 18, 2014 [1 favorite]


    JohnLewis, what's inane about that?
    posted by enn at 8:46 AM on April 18, 2014


    Anyway, that was super interesting. I'm wondering what's fueling the decline of deaths in the under-25 set. Reduced infant mortality? 

    That would be my guess...lines up nicely with the rise and development of preemie care
    posted by sexyrobot at 8:49 AM on April 18, 2014


    I found this data presentation personally really interesting, as I've spent the last 25 years working to end HIV/AIDS deaths, and am now spending a lot more of my time working to prevent overdose deaths.

    To address the questions about drug overdose deaths -- the dramatic increase is driven by prescription opioids, such as oxycontin and vicodin. There's been a more recent, and smaller increase in heroin overdose deaths, but that's a secondary effect of the prescription opioid-related increase. Prescription rates for opioid pain meds went up dramatically, followed by an increase in non-prescription use, followed by an increase in accidental deaths due to use.

    Stimulants such as meth and cocaine are less likely to cause overdose deaths than opioids; opioids, especially when combined with alcohol, will just make you stop breathing but stimulants are less likely to kill you unless you have underlying heart or other health problems. Not saying they're good for you or that you can't die that way, just that overdose death, per se, is a less likely outcome of overuse.
    posted by gingerbeer at 9:47 AM on April 18, 2014 [1 favorite]


    JohnLewis, what's inane about that?

    Cars have not decreased in prevalence. Deaths from cars have.
    posted by Sys Rq at 9:59 AM on April 18, 2014


    Cars have not decreased in prevalence. Deaths from cars have.

    That's not true. Vehicle miles driven have been decreasing in the US for about eight years, both in absolute and in per-capita terms. Car ownership in the US has also been dropping for roughly the same period of time in per-capita terms, though the picture in absolute terms is a little fuzzier.

    But overall, I think it's entirely reasonable to say that cars have decreased in prevalence. There are fewer cars on the road per person and the cars that there are are being driven less.
    posted by enn at 10:34 AM on April 18, 2014 [2 favorites]


    Not saying this is what is happening, but don't we want suicide to be the major cause of death? Isn't that what success in reducing accidental death, disease and homicide results in?

    I quite like the idea of living until I choose not to.

    There is, of course, the counter-argument that if we also continue lowering the suicide rate accidental death will comprise virtually all death with a split argument as to whether longer lives will lead to risk-aversion or risk-taking.
    posted by PharmacistofLucifer at 11:27 AM on April 18, 2014


    But overall, I think it's entirely reasonable to say that cars have decreased in prevalence.

    I kind of agree with you, but that isn't what the sentence says. It says: "Cars, generally killing younger people, have decreased in prevalence." Firstly, cars don't "generally" kill anything. Car accidents may, but cars do not. Secondly, the adverbial clause calls into question your reading, where it is the cars that have decreased in prevalence. I read the sentence as referring to deaths from car accidents, which makes the sentence horribly written.
    posted by JohnLewis at 12:57 PM on April 18, 2014


    Again, the writing should be understood in context — this is about very broad statistical generalizations. So when it says cars generally kill younger people, that's a very concise way of compressing several points: "Cars often get into accidents; in those accidents, the car sometimes crashes into a person in such a manner as to cause the person's death; those accident victims are of all ages; however, they're especially likely to be relatively young." When you spell out every logical step like that, the writing becomes tedious and stilted. I think it was a pretty reasonable decision to be more concise.

    Everyone knows cars kill lots of people. Everyone also knows the young have longer left to live on average. I'm surprised at how ultra-literal some are being in criticizing this article.
    posted by John Cohen at 4:13 PM on April 18, 2014 [1 favorite]


    « Older Presenting the great poet and musician: Atahualpa...   |   Please enjoy this cyberpunk hacking adventure! Newer »


    This thread has been archived and is closed to new comments