Trends in Cause-Specific Mortality by Race and Hispanic Origin, 1999–2019

Mental and Behavioral Disorders

Deaths caused by mental and behavioral disorders as a percentage of all deaths ranged in 2019 from 3.1 percent for Hispanic people to 5.1 percent among the WNH population. This section examines the four mental and behavioral disorder subcategories listed in Box 8.

Chart 29 shows the number and percentage distribution of mental and behavioral disorder deaths by subcategory for 1999 and 2019, with detail by RE group and age. Unspecified dementia was by far the primary cause of mental and behavioral disorder–related death at all ages, in 2019 constituting 60.6 percent of such deaths in the Hispanic population, 68.1 percent of those among Black people, 70.1 percent of those in the API community, and 74.3 percent of them among WNH individuals. The share of mental and behavioral disorder–related deaths caused by unspecified dementia increased over the observation period and was significantly higher at older ages than at younger ones and for women than for men. For instance, 76.2 percent of deaths caused by unspecified dementia among WNH men occurred at ages 65 or older, and for WNH women, that figure was 84.3 percent.

Chart 30 shows age-adjusted death rates for 1999–2019 by RE group, sex, and age group. Panel A shows the rates for mental and behavioral disorders overall.

Chart 30, Panel B shows that in 1999, the all-ages unspecified dementia mortality rate was highest for WNH females, followed by WNH males, Black males, and Black females. The death rates rose sharply thereafter in all RE/sex groups until 2012 or 2013, then began to decline. Nevertheless, the all-ages mortality rate in 2019 was more than twice what it had been in 1999 among the WNH, Black, and API populations, regardless of sex. In 2019, WNH females had the highest all-ages unspecified dementia mortality rate (28.2), followed by Black females (23.7), Black males (23.2), and WNH males (21.6). API males and females had the lowest all-ages unspecified dementia death rates (8.8 and 11.2, respectively).

The subcategory labeled “all other organic disorders” includes delirium not induced by alcohol and other psychoactive substances; other mental disorders caused by brain damage, dysfunction, and physical disease; personality and behavioral disorders caused by brain disease, damage, and dysfunction; and unspecified organic or symptomatic mental disorders. However, 93 percent of the deaths in this subcategory in 2019 involved vascular dementia, which occurs when an inadequate blood supply damages the brain. The share of mental or behavioral disorder–related deaths caused by all other organic disorders increased over the observation period, peaking at older ages. It was the second leading cause of mental or behavioral disorder–related death in 2019 (after unspecified dementia) among females in all RE groups as well as for API males.

Chart 30, Panel C shows that all-ages other organic disorder mortality rates rose steeply after 2004. From 1999 to 2019, the rates more than tripled among Hispanic males and females, more than quadrupled for the WNH and Black populations of both sexes, and increased by factors of 7.8 and 10.3 among API males and females, respectively. Black males had the highest all-ages other organic disorder mortality rate in 2019 (5.6), followed by WNH females, WNH males, and Black females.

The shares of all-ages mental and behavioral disorder deaths brought about by psychoactive substance use in 2019 were 6.8 percent among API people, 10.2 percent in the WNH community, 14.9 percent for Black individuals, and 20.6 percent in the Hispanic population. Among deaths attributed to psychoactive substance use, most (74.2 percent in 2019) were due to alcohol. Deaths from this cause are disproportionately higher among males than females. For instance, in 2019, psychoactive substance use accounted for 35.7 percent of all-ages mental and behavioral disorder–related deaths among Hispanic males, but only 7.5 percent of those among Hispanic females. Although psychoactive substance use typically accounts for lower percentages of mental and behavioral disorder–related deaths at older ages, it is the main cause of such deaths in the midlife years and even at younger ages. In 2019, psychoactive substance use caused 78.6 percent of mental and behavioral disorder–related deaths at ages 25–64 in the API and Black populations, 83.9 percent of those for WNH individuals, and 89.5 percent of those among Hispanic people.

Chart 30, Panel D shows that in 1999, the all-ages death rates from psychoactive substance use for Black males and females were more than double those of their WNH counterparts. Hispanic males had a higher psychoactive substance use mortality rate than WNH males, but Hispanic females had a lower mortality rate than WNH females. By 2019, the WNH RE group had the highest all-ages mortality rate both for males (6.6) and females (2.8). The all-ages mortality rate from psychoactive substance use was higher in 2019 than in 1999 among WNH and API people of both sexes and for Hispanic females. Notice, however, that the all-ages death rate from psychoactive substance use rose in all RE/sex groups during the second half of the period (2010–2019), which appears consistent with the previously mentioned trend involving deaths of despair. Male-to-female substance use mortality ratios in 2019 were 2.4 in the WNH population, 3.8 among Black individuals, 4.2 in the Hispanic community, and 4.7 for API people.

The “all other mental and behavioral disorders” subcategory includes schizophrenia, schizotypal, delusional, and other nonmood psychotic disorders; mood (affective) disorders; anxiety, dissociative, stress-related, somatoform, and other nonpsychotic disorders; behavioral syndromes associated with physiological disturbances and physical factors; adult personality and behavior disorders; and intellectual disabilities. Depending on the RE group, this residual subcategory accounted for 1.7–2.2 percent of mental and behavioral disorder–related deaths at all ages. Chart 30, Panel E shows the age-adjusted mortality rates for this subcategory.

Chart 31 shows the all-ages mental and behavioral disorder mortality rates by cause-of-death subcategory, RE group, and sex in 1999 and 2019. Overall mental and behavioral disorder mortality rates increased substantially during the 21-year period, more than doubling for WNH and API males and females as well as for Black females. In 1999, males had higher all-ages death rates than females for mental and behavioral disorders overall, regardless of RE group. In 2019, however, WNH and API females experienced higher overall mental and behavioral disorder mortality rates than their male counterparts. For all RE/sex groups other than Hispanic males, the all-ages mortality rate in 2019 from unspecified dementia alone exceeded the 1999 mortality rate for all mental and behavioral disorders combined.

Black males had higher all-ages mental and behavioral disorder mortality rates than WNH males in both years, although for different reasons. In 1999, Black males had a slightly lower mortality rate than WNH males from the combination of unspecified dementia and all other organic disorders, but a higher mortality rate associated with psychoactive substance use. In 2019, the reverse was true, with Black males experiencing a slightly lower mortality rate from psychoactive substance use than WNH males, but a higher death rate from the combination of unspecified dementia and all other organic disorders. WNH females experienced a higher mortality rate from mental and behavioral disorders overall than their Black counterparts in both years. In 1999, WNH females had higher all-ages mortality rates than Black females from both unspecified dementia and all other organic disorders, but a lower mortality rate from psychoactive substance use. In 2019, WNH females had higher mortality rates than Black females overall and for each cause-of-death subcategory. Finally, note that from 1999 to 2019, the death rate associated with psychoactive substance use declined among Black males and females and Hispanic males but increased significantly for WNH males and females.