Justin Fox: Gen Z is bucking a terrible mortality trend
Published in Op Eds
These are in many ways tough times for young adults in the U.S. The job market is turning against them, in part because employers seem to be shunting some of the work they used to give to new hires to ChatGPT and its ilk.
Housing is impossibly expensive for them in much of the country. Those who aren’t U.S. citizens, or just look as if they might not be, are — based on past age-group data on immigrant detentions and court cases — the prime targets of Immigration and Customs Enforcement raids.
Still, at least young adults in the U.S. are dying at a slower pace. The 2024 mortality numbers collected by the Centers for Disease Control and Prevention’s National Center for Health Statistics won’t be officially finalized for a while yet, but I’ve been checking the provisional updates every week, and the totals have stopped changing, so I think it's safe to say that last year’s U.S. death rate for ages 25 through 34 was the lowest since 2015.
Young adult mortality in the U.S. is still higher than it was from 1997 to 2015. The opioid epidemic was the main cause of the big increase after that, and its unexpected waning, starting in the second half of 2023, has been the primary cause of the recent decline, although the number of opioid deaths was still higher in 2024 than in any year before 2020.
Other leading causes of mortality among young adults such as traffic accidents, homicides, suicides and heart disease have all been trending downward, too, as of course have deaths from COVID-19, which has claimed the lives of 10,435 25-to-34-year-olds since 2020 but only 136 in 2024, according to the CDC’s records based on death certificates.
This mortality decline is wonderful news, and my chief aim is just to make you aware of it. Still, you would probably like to know why it’s happening. So would I, but I have yet to encounter any super-compelling explanations other than that bad societal phenomena tend to happen in waves, and life has been returning to some semblance of normal after the huge disruptions of the pandemic.
In its reports on the decline in opioid deaths, the CDC credits increased availability of and knowledge about the drug naloxone, which reverses the effects of opioid overdoses. This makes sense but also seems unlikely to have caused such a sharp turnaround on its own and can’t explain the decline in non-opioid deaths. Something of a generational effect may be at work, with millennials continuing to die at higher rates as they enter middle age than their Generation X elders did, while members of Generation Z are dying at lower rates as they enter adulthood than millennials did.
I’ll offer evidence of that in a moment, but first, the big picture. Overall U.S. mortality rates have fallen a lot since COVID-19 deaths peaked in 2021 but are still higher than before the pandemic. Also worth noting is that while COVID-19 didn’t cause nearly as big a mortality increase as the influenza in 1918, it was clearly the worst thing since.
My focus on the 25-to-34 age group grows out of an examination I did in 2021 of death rates for every 10-year age group back to the beginning of the 20th century. Mortality rates fell sharply for all ages through the mid-1950s as antibiotics, vaccines and improved sanitation saved millions of lives. The declines continued after that for children and older Americans, even accelerating for the latter group. But adults younger than 55 have had a more complicated experience.
Mortality rose or plateaued for all four age groups in the 1960s, with a rise in motor-vehicle deaths the main driver but increases also in homicide rates and, for those 35 and older, death rates from diseases linked to drinking or smoking. Those 25 to 44 experienced increases again in the 1980s and early 1990s, due mainly to HIV, and finally all the groups experienced increases or much-slowed declines in the first two decades of this century for a variety of causes, some of which economists Anne Case and Angus Deaton famously grouped together as “deaths of despair” — drug overdose, alcoholic liver disease and cirrhosis and suicide.
Most of the discussion about this has focused on the middle-aged because they have much higher mortality rates than young adults and thus have been doing most of the dying. But if you look at the trajectory over time, it’s clearly those 25 to 34 who have experienced the least improvement. In 2021, their mortality rate was the highest it had been since 1949.
COVID-19 contributed to that awful 2021 milestone, ranking fourth in the CDC’s ranking of the age group’s 15 leading causes of death behind accidents, suicides and homicides. Here’s that year’s top five, charted back to 1999.
Young adults in other wealthy countries have not had nearly as awful a time of it in recent years. Here’s how U.S. 25-34 mortality rates compare with those of three other nations for which the Human Mortality Database has numbers through 2023.
The divergence began a while ago, seemingly driven mainly by higher rates of traffic deaths and homicides in the U.S., but really took off in the past decade because of the opioid epidemic — which has boosted mortality rates somewhat less in Canada and seemingly not at all in France or Japan.
In the early days of the opioid epidemic in the U.S., the 45-to-54 age group was responsible for the largest share of deaths, with many having become addicted to prescription painkillers such as OxyContin. Later, the emphasis shifted to illegal street drugs, mainly fentanyl, and 25-to-34-year-olds became the primary victims. Since 2021, it’s been those ages 35 to 44.
The 35-to-44 age group in the U.S. now consists almost entirely of members of the millennial generation, usually deemed to be those born from 1981 to 1996. Whether there actually are such things as generations is a matter of some debate, and the organization that had been the semiofficial arbiter of when they start and end, the Pew Research Center, announced in 2023 that it was going to stop talking about them so much.
Pew did allow that it would still make generational comparisons “when we have historical data that allows us to compare generations at similar stages of life.” Thanks to mortality data by single year of age that’s readily available from the CDC back to 1999, I was able make at least partial comparisons of mortality rates for millennials with those for Gen X (born 1965-1980) and Gen Z (born 1997-2012) at the same ages. Here’s the Gen X comparison:
The period covered here for millennials includes the opioid epidemic and the pandemic, while for Gen X it’s the relatively uneventful early 2000s, so maybe this is an unfair comparison. But when millennials are lined up with members of Gen Z, it’s the latter who were navigating opioids and the pandemic while the former were sauntering through the early 2000s, yet Gen Z’s mortality rates have been lower except for the three years from 2021 through 2023.
I don’t have a great answer for what’s gone so wrong for millennials. The better outcomes so far for Gen Z, though, surely have something to do with plummeting rates of alcohol and drug use among young people. In 2000, 73% of U.S. 12th graders had consumed alcohol in the previous 12 months and 41% had taken illicit drugs, according to the Monitoring the Future surveys conducted by the Institute for Social Research at the University of Michigan. In 2024 those percentages had fallen to 42% and 26%. Clean living brings longer lives, apparently.
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This column reflects the personal views of the author and does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Justin Fox is a Bloomberg Opinion columnist covering business, economics and other topics involving charts. A former editorial director of the Harvard Business Review, he is author of “The Myth of the Rational Market.”
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