Mid-life 'Deaths of Despair' Trends in the US, Canada, and UK, 2001-2019: Is the US an Anomaly?

BackgroundOver the past decade, "deaths of despair" were strongly implicated in rising mid-life mortality in the US. Whether despair deaths and mid-life mortality trends are also changing in the peer countries such as the UK and Canada is not well known. MethodsWe compared all-cause and "despair" mortality trends at mid-life in the US, the UK (constituent nations England & Wales, Northern Ireland, and Scotland) and Canada from 2000-2019, using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64) and by sex. We examined trends in all-cause mortality and mortality by causes categorized as 1) suicides 2) alcohol-specific deaths 3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period, and cohort trends in these causes of death. ResultsThe US and Scotland both saw large increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in by comparison. Alcohol-specific deaths showed less consistent trends that did not track other "despair" causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. ConclusionsIn the UK, Scotland has suffered increases in drug-related mortality comparable to the US, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortality generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive "deaths of despair" narrative.