Marriage Increasingly Protects Against Deaths of Despair

Vice President-elect J.D. Vance’s memoir, Hillbilly Elegy, documents the toll of economic stagnation on working-class communities across America. Especially among workers with only a high school education, the growth in real median earnings has been slow. Economic stagnation, coupled with the increased availability of prescription opioids for pain, has contributed to an increase in 'deaths of despair'—deaths from drug or alcohol overdose, suicide, or alcoholic liver disease caused by heavy drinking—particularly among less-educated white men. Between 2005 and 2019, an average of 70,000 Americans each year lost their lives this way. New research from Hangqing Ruan, Melody Ge Gao, Yajie Xiong, and Philip N. Cohen shows that between 2000 and 2021, age-adjusted mortality rates increased 1.1% per year for suicide, 2.2% per year for alcohol, and 9% for drug overdose.

Hillbilly Elegy notes that one of the increasing causes of distress in working-class communities is the decline in marriage and the breakdown of the family. It is well known that marriage provides a buffer for individuals against economic and other stressors, but few studies have examined the role of marriage in the recent increase in deaths of despair. Ruan and coauthors do just that and examine the effects of marital status on age-adjusted mortality rates from alcohol, drugs, and suicide from 2000-2021.

As the figure below shows, the death rates of the unmarried were higher than the death rates of the married. They also document the expected sex differences in mortality, as the mortality rates of men were higher than among women. The higher death rates of the unmarried compared to the married and of men compared to women were found across all levels of education. In most cases, the mortality rates of married people with less education were close to those of unmarried people with a bachelor’s degree, suggesting that the protective effects of marriage are similar to the protective effects of education.

Figure 1. The mortality rates in alcohol, drug-overdose, and suicide among unmarried and married U.S. adults aged 25 and above, by education and gender

Source: Ruan, H., Gao, M. G., Xiong, Y., & Cohen, P. N. (2024). Marital Status and Deaths from Alcohol, Drug Overdose, and Suicide in the United States: 2000–2021. Socius, 10 (supplementary material).

While mortality from alcohol, drugs, and suicide rose for all groups during this period, mortality rates for unmarried men and women rose even faster. Between 2000 and 2021, alcohol-induced mortality rates were two to three times higher for unmarried people compared to married people, while mortality rates for suicide were 2.1-2.7 times higher, and drug-induced mortality rates were four to five times higher. As the figure below shows, the increase in drug-induced mortality for the unmarried population compared to the married population was particularly notable among unmarried men with a Bachelor’s degree, although unmarried men and women with less education also experienced an increase in drug-induced mortality compared to married people. 

Figure 2. The unmarried/married ratio in mortality rates from alcohol, drug overdose, and suicide for U.S. adults ages 25 and above (2000-2021), by gender and education

Source: Ruan, H., Gao, M. G., Xiong, Y., & Cohen, P. N. (2024). Marital Status and Deaths from Alcohol, Drug Overdose, and Suicide in the United States: 2000–2021. Socius, 10.

Examining the effects of race and ethnic differences on the increase in deaths of despair among the unmarried shows that particularly for drug deaths, the protective effect of marriage has increased the most for white males.

Figure 3. The unmarried/married ratio in mortality rates from alcohol, drug overdose, and suicide for U.S. adults ages 25 and above (2000-2021), by gender and race

Source: Ruan, H., Gao, M. G., Xiong, Y., & Cohen, P. N. (2024). Marital Status and Deaths from Alcohol, Drug Overdose, and Suicide in the United States: 2000–2021. Socius, 10.

These results indicate that not only does marriage protect against deaths of despair, but the positive effect of marriage has been increasing over the last 20 years. Why? One reason is that marriage is now more concentrated among higher income, better-educated people. Yet Ruan et al. show that the protective effect of marriage has become even stronger among the better educated for both men and women. This suggests that the increasing benefits of marriage are not only due to increasing selectivity by education into marriage. Furthermore, the protective effect of marriage against alcohol and drug-related deaths has increased more for men than women, and this is particularly true for white men.

In sum, there is an increasing divide in deaths of despair between the married and the unmarried, and not only because the married are more likely to be educated. This study shows that the protective effect of marriage in preventing deaths of despair is similar to the protective effect of education. This is one more reason the decline of marriage has been catastrophic, particularly for poorly educated white men. This suggests that revitalizing marriage and supporting stable families would do as much for decreasing deaths of despair as increasing levels of education.  

Rosemary L. Hopcroft is Professor Emerita of Sociology at the University of North Carolina at Charlotte. She is the author of Evolution and Gender: Why it matters for contemporary life (Routledge 2016), editor of The Oxford Handbook of Evolution, Biology, & Society (Oxford, 2018), and author (with Martin Fieder and Susanne Huber) of Not So Weird After All: The Changing Relationship Between Status and Fertility (Routledge, 2024).