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THE FIRST DECADES of the twenty-first century have been a challenging period for American mortality. Life expectancy in the United States ranked 30th in the world in 2010 and is much lower than in other high-income countries (World Health Organization 2017). Between 2010 and 2016, US life expectancy fell further behind other developed countries, increasing by only 0.08 years, the smallest 5-year increase since 1970 (Ho and Hendi 2018). These relatively slow mortality declines occurred against a background in which US mortality in the 1990s and 2000s was already high by the standards of other OECD countries (Ho and Preston 2010; Crimmins et al. 2011; Ho 2013; Institute of Medicine and National Research Council 2013; Palloni and Yonker 2016). At the same time, there have been large and growing geographic and socioeconomic inequalities in health and mortality within the United States (Fenelon 2013;Wang et al. 2013; Hendi 2015, 2017; Chetty et al. 2016; Montez, Sasson, and Hayward 2016a). Several recent studies of the national-level mortality stagnation have documented adverse mortality trends among middle-aged non-Hispanic whites (Kochanek, Arias, and Bastian 2016a; Squires and Blumenthal 2016; Case and Deaton 2017), particularly among women (Astone, Martin, and Aron 2015; Gelman and Auerbach 2016; Kochanek et al. 2016b) and those with lower levels of education (Hendi 2017) and income (Chetty et al. 2016). Case and Deaton (2015, 2017) drew attention to the role that “deaths of despair”—consisting of accidental poisoning (linked to the epidemic of prescription opioids and heroin), suicide, and chronic liver disease—play

Trends in Non‐Hispanic White Mortality in the United States by Metropolitan‐Nonmetropolitan Status and Region, 1990–2016