Five questions with researcher Dr. Larry Sinoway about diseases of despair

Matthew G. Solovey
November 18, 2020

For the first time in nearly 100 years, life expectancy is decreasing in the United States. Two economists at Princeton, Anne Case and Angus Deaton, published a paper in 2015 that examined this concerning trend that life expectancy was not rising. Their data suggested a series of diseases, and they coined the term "diseases of despair.” They believed that these diseases were related to changes in the economy over a long period. They focused their attention on small communities and regions where a predominant industry had declined. They also thought that the 2006 to 2008 recession was a driving influence in these diseases of despair.

Dr. Larry Sinoway, director of Penn State Clinical and Translational Science Institute, is interested in this topic. He is part of a research team that collaborated with colleagues at Highmark Health Enterprise Analytics to determine the rate of diseases of despair in Pennsylvania.

A full interview with Sinoway about diseases of despair is available in episode 1 of the institute's Engage podcast. Each episode aims to help listeners learn about the research process and how Penn State is helping to improve our neighbors' and communities' health.

Q: What is causing life expectancy to decrease?

Sinoway: The decline in life expectancy in the United States seems to be driven by an increase in alcohol-related disease, suicide, and opiate addiction in 35 to 54-year-old white individuals, predominantly individuals who live in rural communities. This group of patients and this group of individuals are the focus of our efforts to understand diseases of despair. 

Q: What causes despair?

Sinoway: The causes of despair are really issues related to economic factors and social factors. The economic factors have to deal with economies that exist within small rural communities. Many of these communities have one predominant industry. In our region, a few examples of those industries would include steel, coal, and railroads. As we're aware, each of those industries has seen a shift and a change. When the economy in a region or a small-town declines, those towns' social infrastructure also declines. The number of teachers, the number of schools, the number of social services, the number of hospitals - all those things become challenged as the economy declines. 

Q: What is your project?

Sinoway: Joining with Highmark, we began a project to examine whether or not specific communities were particularly predisposed to these diseases of despair. Our colleagues at Highmark had claims data on large numbers of patients that exist through central Pennsylvania. Another aspect of this study is understanding the qualitative aspect of diseases of despair by conducting interviews of individuals with these problems or people who care for individuals who have diseases of despair. We want to get their insight into what some of the challenges are. (See a summary of the results of the first phase of the project here.)

Q: Where does the project go next?

Sinoway: Questions for the future include, are those factors that were initially described by Case and Deaton, basically economic issues and exposure to oral opiates, are those really driving influences or not? Are there other diseases that are associated with this constellation?

Q: Why is this project important to you?

Sinoway: Penn State serves our friends and neighbors throughout central Pennsylvania. Penn State is tightly interwoven with the citizens of the state. The University must be aware of and understand the problems of the people who live here. Penn State Health System and Hershey Medical Center, and the University are all located in regions with a large percentage of people we serve who are rural. Many individuals who live in small towns are the people who go to Penn State, who come to Hershey Medical Center and are patients of Penn State Health. An understanding of rural disease is critical to our mission.

About Penn State Clinical and Translational Science Institute

Penn State Clinical and Translational Science Institute provides tools, services and training to make health research more efficient at Penn State. It is an advocate for translational science at the University and is a bridge between basic scientists and clinical researchers. The institute encourages collaboration to discover new treatments, medical procedures and ways to diagnose disease. Learn more at

Last Updated November 20, 2020