Final note comes early for rockers: They're twice as likely to die at a young age, a study finds.

Shari Roan

"And as the flames climbed high into the night
To light the sacrificial rite,
I saw Satan laughing with delight
The day the music died."
- Don McLean, "American Pie"

Since the dawn of rock 'n' roll, death has been a recurring theme. But for many young musicians, lyrics that dwell on mortality are prophetic.
A new study has found that rock and pop stars are more than twice as likely to die at a young age than the rest of the population -- and more than three times as likely to die within five years of becoming famous. The unhealthful behavior that leads to such untimely deaths harms more than musicians, the researchers said. It also sets a bad example for the millions of people who
emulate them.
"Like any industry, the music industry should see the health of its participants as a priority as well as the wide effect it may have on consumers of its products," said Mark A. Bellis, the study's lead author and director of the Centre for Public Health at Liverpool John Moores University, in an interview conducted by e-mail. "It is, after all, a music industry, not a promotional tour for alcohol and drugs."
Bellis says his research team undertook the study, which claims to be the first to quantify the effect of pop music stars' live-fast-die- young culture, because the death rates in the pop industry have not been well studied and because pop stars have tremendous influence on others.
Although the researchers expected to find that musicians die younger -- after all, that is the common perception -- they were surprised to see how many of those deaths occurred near the peak of fame and that the death rate remained double that of the normal population even 25 years after the musicians became famous.
It is a rare example of a group of mostly wealthy people who do not have better health outcomes than people of lower socioeconomic status, he said. The study, published last week in the Journal of Epidemiology and Community Health, was based on more than 1,050 North American and European musicians and singers who achieved fame between 1956 and 1999. All the musicians were featured in the "All-Time Top 1000 Albums," selected in 2000. They represented a range of genres, including rock, pop, punk, rap, R&B, electronica and new age.
For each pop star, the researchers calculated total years of survival and compared the numbers with their expected survival based on a general population of people similar in gender, nationality and ethnicity.
Of the 100 pop stars who had died, the average age of death was 35 for European musicians and 42 for American stars. The study does not prove that being a pop star causes an early death, but
it's clear that elements of the lifestyle are unhealthful, says Anton H. Hart, a psychologist and psychoanalyst in New York City who counts many professional musicians among his clients.
For example, Hart says, previous research suggests a bitter downside to fame that may lead to depression, anxiety, substance abuse, risky sexual behavior and general carelessness.
"Fame fulfills grandiose wishes to be known by everyone and loved by everyone," he says. "But it's a high you keep needing again and again, and you develop a tolerance for it. It turns out to be an empty high. It's exhilarating but gives way to a sense that fame is not as fulfilling as it was assumed to be. That is a very difficult and depressing thing."
The public -- and the music industry -- reinforces the high-risk lifestyles of pop stars, Hart suggests. We want them to act outrageously -- and they try to live up to that expectation.
"Part of their role is to act out and play out what most of us are simply too inhibited to do in our own lives," he says. "That's why we love them. They can get up and move and dance and flaunt themselves and act sexual in ways we would love to do. We need these icons to live out these things that we can't live out ourselves."
Pop stars also adhere to a tradition of rejecting conformity and remaining true to themselves. Standard health advice -- limiting alcohol intake, getting an annual flu shot and exercising at least three times a week -- may fit poorly with a pop star's self-image.
"They worry about authenticity, having street cred, being real rather than a sellout," Hart says. "High-risk behavior and drugs and alcohol play into this. Looking at risk and mortality, they may say, 'To hell with it. I'm just going to live, be in the moment.' "
Other celebrity-dependent industries, such as acting and professional sports, are sensitive to how their stars are viewed as role models, Bellis said. And almost every industry adheres to laws protecting workers from job-related hazards. Pop musicians are the exception, he said. "Cultural change in any industry or population can be difficult," he said. "But it is likely that everyone would accept some measures to at least reduce deaths once the risk has been clearly identified."
Such a goal is laudable, but it wouldn't be simple, Hart says. Although the leading cause of death in Bellis' study was drug and alcohol abuse -- accounting for one in four deaths -- cancer, accidents and cardiovascular disease also ranked high, he noted.
Mamas and Papas singer Cass Elliott, for example, died of a heart attack, but obesity was probably the root cause of her early demise. Elvis Presley, dead at age 42, also had a heart attack but misused drugs and had several other health problems. Rastafarian Bob Marley was diagnosed with malignant melanoma in his toe but refused, because of his religious beliefs, to have an operation that might have cured him. The cancer spread, and the reggae icon died of it.
And there are plenty of examples of musicians who cling to the edge and live to tell about it. Rolling Stones guitarist Keith Richards, 63, has defied the odds, surviving decades of hard partying, touring and even a reported fall from a tree last year.
Others see the error of their ways. Shock rocker Alice Cooper, 59, once drank prodigious amounts of alcohol and celebrated violence at his concerts. Now he attends church, plays golf, does commercials for an office supply store -- and, one would hope, gets an annual physical.
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