Increasing mortality during the expansions of the US economy, 1900–1996

BACKGROUND: In Western countries mortality dropped throughout the 20th century, but over and above the long-term falling trend, the death rate has oscillated over time. It has been postulated that these short-term oscillations may be related to changes in the economy. METHODS: To ascertain if these short-term oscillations are related to fluctuations in the economy, age-adjusted total mortality and mortality for specific population groups, ages and causes of death were transformed into rate of change or percentage deviation from trend, and were correlated and regressed on indicators of the US economy during the 20th century, transformed in the same way. RESULTS: Statistically and demographically significant results show that the decline of total mortality and mortality for different groups, ages and causes accelerated during recessions and was reduced or even reversed during periods of economic expansion-with the exception of suicides which increase during recessions. In recent decades these effects are stronger for women and non-whites. CONCLUSIONS: Economic expansions are associated with increasing mortality. Suggested pathways to explain this deceleration or even reversal of the secular decline in mortality during economic expansions include both material and psychosocial effects of the economic upturns: expansion of traffic and industrial activity directly raising injury-related mortality, decreased immunity levels (owing to rising stress and reduction of sleep time, social interaction and social support), and increased consumption of tobacco, alcohol and saturated fats.