Rock and roll may never die but music stars do, and at a faster rate than the rest of us.
The finding is not precisely new – as fans of Janis Joplin, Amy Winehouse, and Kurt Cobain can attest – but now researchers have quantified the increased risk associated with pop stardom.
It turns out that solo stars are about twice as likely to unplug early as those who play in bands, according to Mark Bellis, DSc, of Liverpool John Moores University in Liverpool, England, and colleagues.
And compared with the general population, North American stars are more likely to die than those from Europe, Bellis and colleagues reported in the online journal BMJ Open.
The image of the hard-living star has some truth in it, the researchers found, but those who died of drug and alcohol problems were more likely to have dealt with a difficult or abusive childhood than those who died of other causes.
The findings come from a retrospective cohort analysis, based on publicly available biographical data, of 1,489 pop stars who reached fame between 1956 and 2006, Bellis and colleagues reported.
The researchers included musicians working in pop/rock, punk, rap, rhythm and blues, electronica, and new age genres, but excluded those in country, blues, jazz, vocal, Celtic, folk, and bluegrass music.
For each musician, the probability of survival was compared with a cohort in the general population matched for sex and age at the time the musician achieved fame.
For example, Bellis and colleagues matched Elvis Presley, whose first album was released in January 1956, to the survival probabilities of U.S. white men who were his age at that time.
They also used Cox survival and logistic regression methods to look at risk and protective factors for survival and links between adverse childhood experiences and cause of death, respectively.
During the 50-year study period, 137 stars died (9.2% of the total), but North American stars were more likely to die. Overall, 99 of 832 North American musicians died (11.9%) compared with 38 of 657 European stars (5.8%) a difference that was significant (P<0.001).
North Americans who achieved stardom began to pay the price immediately: relative survival, compared with their post-fame matched population, fell consistently from 99.3% the year after they burst on the scene to 87.6% 40 years later (P<0.001 for trend).
In Europe, the pattern was different: Relative survival fell from 99.6% of the matched population survival in the first year, then 24 years later, to 97.6%, and then recovered, reaching population levels after 36 years.
Interestingly, solo performers in either region were about twice as likely to die early as those in a band -- 9.8% versus 5.4% in Europe and 22.8% versus 10.2% in North America, Bellis and colleagues found.
That finding "raises the issue of peer support as a protective factor," they argued.
So-called adverse childhood events – such as abuse, living with a substance abuser, and coming from a broken home or one in which there was domestic violence featured – also appear to play a role in how stars died, the researchers reported.
Of stars who died from substance use or risk-related causes, 47.2% were reported to have had at least such adverse childhood event, compared with only 25% of those dying from other causes (P<0.01).
Also, only 30.8% of dead stars who had no identifiable adverse childhood events died of substance use or risk-related causes. That rose to 41.9% of those with one adverse childhood event and 80% of those with two or more (P<0.001 for trend).
Excluding family separations – the most common such event – weakened the association but it remained significant, the researchers reported.
The study had some limitations. The authors limited their analysis to mainstream musical genres and their deﬁnition of fame may have omit individuals who achieved substantial record sales but were not included in the international polls they looked at.
Also, the exact cause of death was not always easy to identify because some accidental deaths may have been related to alcohol and drug use, but were not specified that way in biographical resources, they said.
One implication of their findings is that "some of the risks accredited to the rock and pop star lifestyle may in fact have more mundane roots akin to those leading to substance use and risk taking in wider populations," Bellis and colleagues argued.
The study had no external support. The journal said the authors did not report any competing interests.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner