Geographic Trends and Disparities in Psychological Wellbeing, Health Behaviors, and Mortality in Midlife 

Principal Investigator: Jennifer Karas Montez

Active Dates: 2023 – 2028

Funding Source: NIH/NIA


The rise in U.S. midlife mortality in recent decades has been substantial, ending the increase in life expectancy around 2010 & triggering its decline after 2014. The trend has been exacerbated by the COVID-19 pandemic. One of the most telling features of the rise is its geographic pattern. It has been pronounced in Midwestern & Southern states and in rural areas & small cities. Explaining these growing geographic disparities is a necessary step toward identifying the etiologies of rising midlife mortality overall. The overarching objective of this project is to assess how state policy contexts & county economic contexts collectively predict growing geographic disparities in 1) all-cause midlife mortality, 2) major trend-driving causes of death for midlife mortality: suicide, drug overdose, alcohol-induced causes, & cardiometabolic diseases, and 3) psychosocial & health behavior risk factors for those causes of death The project answers key unresolved questions about the growing geographic disparities in midlife mortality that have been major obstacles to understanding them. One question regards the collective influence of state & local contexts. Studies tend to focus on state or local contexts, providing an incomplete explanation. We advance this work by examining state & local contexts concomitantly, which is critical because they may affect mortality via independent & synergistic processes. A second question concerns the influence of states’ policy “contexts”. States have enacted highly correlated, or “bundled”, policies which necessitates new approaches for understanding their influence on mortality. We advance this work by using innovative methods to develop annual scores for interpretable policy bundles. A third question concerns the degree to which state & local contexts collectively predict individual-level psychosocial wellbeing & health behaviors—i.e., the proximate determinants of the four major causes of death behind rising midlife mortality. Deindustrialization, declines in good jobs, & concomitant disruptions to families & communities in some places may have harmed the psychosocial wellbeing of midlife adults, particularly those without a 4-year college degree, leading to consumption of drugs, alcohol, & unhealthy food. We advance this work by examining how state & local contexts collectively predict psychosocial & health behavior risk factors for the four major causes of death.