County-level Structural and Relational Determinants of Deaths of Despair

• In Event: Political, Social, and Welfare Consequences of Economic Inequality (Co-sponsored by Political Sociology Section)

Abstract

Over the past two decades, the United States has experienced a marked rise in premature mortality from overdose, alcohol-related disease, and suicide, so-called “deaths of despair.” Although these deaths are widely attributed to economic decline, stagnating wages, and a dismantled social safety net (Case and Deaton 2015; 2020), the mechanisms through which structural change produces mortality remain undertheorized.

I propose that austerity-driven institutional withdrawal and rising deaths of despair are linked through what I call social withering: the erosion of core social bonds such as friendship, kinship, and intimacy under conditions of neoliberal responsibilization. Extending Patterson’s (1982) theory of social death and drawing on theories of domination (Pettit 1997), I conceptualize social withering as a cumulative and reversible shift along a spectrum from freedom toward intensified constraint. Institutional retrenchment, precarious labor (Kalleberg 2009), and the offloading of social reproduction onto privatized kin networks (Fraser 2016) reorganize everyday life, inhibiting participation in the relationships that undergird identity, wellbeing, and survival.

To empirically examine this mechanism, I estimate direct and indirect effects within a lagged county-level panel framework. I combine mortality data from CDC WONDER (2005–2024), population data from the American Community Survey (2006–2024), and infrastructure data from the Bureau of Labor Statistics Quarterly Census of Employment and Wages (2006–2025). Structural withdrawal is operationalized using per capita local government employment, disaggregated into social services and justice-sector institutions. Social withering is measured through changes in marriage and divorce rates, household size, and percent living alone. Models include county and period fixed effects to estimate how within-county changes in institutional capacity are associated with subsequent changes in relational structure and mortality. By linking mortality to the erosion of relational infrastructures, this study advances a sociological account of despair as relationally and structurally produced.

Author

• Elizabeth A. Breen, University of California-Berkeley