Drug and alcohol use was the largest contributor to increasing mortality among working-age adults, accounting for 8% (an estimated 1.3 million) of deaths in this population between 1990 and 2017. The increase was largest among white male adults and older Black male adults.

Among working-age white adults, relative increases in mortality were largest among younger men (aged 25-44 years); those with a high school diploma or less; and residents of large metropolitan areas. Drug poisoning mortality among Black adults did not differ by education level. Although alcohol-induced mortality increased among white adults from the 1990s onward, it declined among Black and Hispanic adults in the 1990s and early 2000s but then increased after 2010.

According to the report, the drug crisis was the product of two influences: an increase in access to legal and illegal drugs and the vulnerability of certain populations.

Suicide, which accounted for 569,099 deaths among working-age adults during 1990-2017 (an average of 20,325 per year), increased primarily among white adults, especially men, and in less populated, rural areas. Few studies have established a cause for this trend. Economic stresses are a possibility; suicide is associated with economic downturns, wage stagnation, weak health-care safety nets and foreclosures. Another potential contributing factor is declining social support from churches, civic organizations and families.

Cardiometabolic diseases caused more than an estimated 4.8 million deaths among working-age adults during 1990-2017 (an average of 173,062 per year). The largest relative increases in cardiometabolic mortality occurred among younger adults (aged 24-44 years) in all racial and ethnic groups, white men and women, Black men and those living in rural areas.

The leading explanation was the increased prevalence of obesity and its cardiometabolic consequences. Second, the substantial progress from the 1970s onward achieved by cardiovascular disease prevention and more advanced treatments now may be losing momentum. Third, social, economic and cultural changes that have undermined economic security, intergenerational mobility and social support networks can adversely affect cardiometabolic health through stress-mediated biological pathways and reduced access to care.

"The recent increase in mortality among working-age adults shows no signs of receding," the report concluded. "Obesity rates are unrelenting; drug- and alcohol-related deaths and suicide rates, already high among working-age adults, increased during the COVID-19 pandemic; and the latter has made socioeconomically and racially marginalized groups even more vulnerable.

"This report discusses the need to revitalize communities that have experienced rising premature mortality by addressing the economic and social strains that made those communities vulnerable in the first place and to dismantle structural racism and discriminatory policies of exclusion that negatively affect communities of color. Although more research is needed to understand causal mechanisms, not acting to address mortality among working-age adults threatens the future well-being of families and communities."

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