A startling new study that shows a big spike in the death rate for a large group of middle-aged whites in the United States was rejected by two prestigious medical journals, the study’s co-author, Nobel laureate Angus Deaton, said Tuesday.

Deaton and Anne Case, both Princeton economists, received international media attention for the paper published Monday in the Proceedings of the National Academy of Sciences (PNAS). But before they submitted it there, they tried to get it published in the Journal of the American Medical Association (JAMA), Deaton said.

“We got it back almost instantaneously. It was almost like the e-mail had bounced. We got it back within hours,” said Deaton, who was interviewed in Dublin, where he was attending a conference on the Ebola crisis and global public health sponsored by Princeton University.

Deaton and Case then tried the New England Journal of Medicine, putting their work in the form of a two-page “Perspective” that summarized the alarming trend they’d discovered in government mortality statistics. Again they were rejected.

Deaton said the journal noted that their work does not explain why the historically anomalous surge in mortality occurred.

He compared the response to calling the fire department to report that your house is on fire: “And they say, 'Well, what caused the fire?' and you say, 'I don’t know,' and they say, 'Well, we can’t send the fire brigade until you tell us what caused the fire.' ”

Jennifer Zeis, media relations manager for the New England Journal of Medicine, said in an email that the journal could not comment on the fate of any submissions because "the publication process is confidential."  Jim Michalski, a spokesman for JAMA, also cited the journal's confidentiality policy. "We can neither confirm nor deny whether an author has submitted a manuscript for review, or why a manuscript may have been rejected," he wrote in an e-mail.

The two economists subsequently prepared their work for PNAS, and went through the laborious process of peer review and revision. “We were very concerned that we’d be scooped by someone else,” Deaton said.

In the meantime, Deaton won the Nobel Prize in Economic Sciences.


The research showed that the mortality rate for whites between the ages of 45 and 54 with a high school education or less rose dramatically between 1999 and 2013, after falling even more sharply for two decades before that.

That reversal, almost unknown for any large demographic group in an advanced nation, has not been seen in blacks or Hispanics or among Europeans, government data show. The report points to a surge in overdoses from opioid medication and heroin, liver disease and other problems that stem from alcohol abuse, and suicides.

Deaton said he knows that the research will be fodder for political commentary, including a conservative Web site’s analysis that blamed Obama for a trend that began during the presidency of Bill Clinton.

His analysis: “There’s this widening between people at the top and the people who have a ho-hum education and they’re not tooled up to compete in a technological economy. … Not only are these people struggling economically, but they’re experiencing this health catastrophe too, so they’re being hammered twice.”

Another economist who reviewed the study for PNAS used almost the same words.

"An increasingly pessimistic view of their financial future combined with the increased availability of opioid drugs has created this kind of perfect storm of adverse outcomes," said Jonathan Skinner, a professor of economics at Dartmouth College.

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