THE FIRST DECADES of the twenty-first century have been a challenging period for American mortality. Life expectancy in the United States ranked 30th in the world in 2010 and is much lower than in other high-income countries (World Health Organization 2017). Between 2010 and 2016, US life expectancy fell further behind other developed countries, increasing by only 0.08 years, the smallest 5-year increase since 1970 (Ho and Hendi 2018). These relatively slow mortality declines occurred against a background in which US mortality in the 1990s and 2000s was already high by the standards of other OECD countries (Ho and Preston 2010; Crimmins et al. 2011; Ho 2013; Institute of Medicine and National Research Council 2013; Palloni and Yonker 2016). At the same time, there have been large and growing geographic and socioeconomic inequalities in health and mortality within the United States (Fenelon 2013;Wang et al. 2013; Hendi 2015, 2017; Chetty et al. 2016; Montez, Sasson, and Hayward 2016a). Several recent studies of the national-level mortality stagnation have documented adverse mortality trends among middle-aged non-Hispanic whites (Kochanek, Arias, and Bastian 2016a; Squires and Blumenthal 2016; Case and Deaton 2017), particularly among women (Astone, Martin, and Aron 2015; Gelman and Auerbach 2016; Kochanek et al. 2016b) and those with lower levels of education (Hendi 2017) and income (Chetty et al. 2016). Case and Deaton (2015, 2017) drew attention to the role that “deaths of despair”—consisting of accidental poisoning (linked to the epidemic of prescription opioids and heroin), suicide, and chronic liver disease—play

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1990 年至 2016 年按都市-非都市状态和地区划分的美国非西班牙裔白人死亡率趋势

21 世纪的头几十年对于美国人的死亡率来说是一个充满挑战的时期。2010 年美国的预期寿命在全球排名第 30 位，远低于其他高收入国家（世界卫生组织 2017）。2010 年至 2016 年，美国预期寿命进一步落后于其他发达国家，仅增加了 0.08 岁，是 1970 年以来最小的 5 年增幅（Ho 和 Hendi，2018 年）。这些相对缓慢的死亡率下降发生在 1990 年代和 2000 年代美国死亡率按照其他经合组织国家的标准已经很高的背景下（Ho 和 Preston 2010；Crimmins 等人 2011；Ho 2013；医学研究所和国家研究委员会2013 年；帕洛尼和扬克尔 2016 年）。同时，美国在健康和死亡率方面存在巨大且日益严重的地理和社会经济不平等（Fenelon 2013；Wang 等人，2013 年；Hendi 2015 年，2017 年；Chetty 等人，2016 年；Montez、Sasson 和 Hayward 2016a）。最近关于国家级死亡率停滞的几项研究记录了中年非西班牙裔白人的不良死亡率趋势（Kochanek、Arias 和 Bastian 2016a；Squires 和 Blumenthal 2016；Case 和 Deaton 2017），尤其是女性（Astone、Martin , and Aron 2015; Gelman and Auerbach 2016; Kochanek et al. 2016b) 以及教育水平较低（Hendi 2017）和收入水平较低的人（Chetty et al. 2016）。Case 和 Deaton（2015 年、2017 年）提请注意“绝望之死”的作用——包括意外中毒（与处方阿片类药物和海洛因的流行有关）、自杀、