Drink and drug addiction, poor mental and physical health and even the financial crisis drove up death rates among white middle aged Americans between 1999-2013.
While mortality rates fell among other sections of the U.S. population between 1999-2013, and indeed for their counterparts in other developed countries, they rose among white non-Hispanic Americans aged 45-54, with a comparable effect to the AIDS epidemic, according to Princeton academics Anne Case and Angus Deaton, in a study published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), a respected journal.
There is a danger of a "lost generation" if this trend, which is particularly pronounced among people without a college education, continues, according to the authors. In the previous two decades, the mortality rate fell by 2 percent each year on average for this group – but this trend has been reversing since 1999. While obesity rates have risen too, this accounts for "only a small fraction" of these deaths, mainly via a small rise in deaths from diabetes.
From an economic perspective, there is also the potential for greater Medicare expenses in future if this age category moves into their elderly years in worse mental and physical shape than the previous generation.
Much of this worrying trend can be accounted for by "increasing midlife distress", according to Case and Deaton.
Here, we take a look at some of the reasons for the rising death rate in this particular group.
The increased abuse of opioid painkiller medication, together with cheaper, more widely available heroin, has led to more overdoses among this group. The rate of deaths from "poisonings" (as overdoses are categorized) more than trebled between 1999-2013 in white non-Hispanics, as the trend reversed among black non-Hispanics of a similar age.
Serious mental illness, which often goes hand-in-hand with drug addiction, is also an increasing issue, with the proportion of people in this group who rate as seriously mentally ill under the Kessler scale up from 3.8 percent to 4.8 percent between 1997-99 and 2011-13.
The rate ofchronic liver disease and cirrhosis – clear signs of problem drinking - in thisgroup rose steadily after 2000.
Chronic back, neck and joint pain seems to have escalated between 1999 and 2013, with one in three white non-Hispanics aged 45-54 reporting chronic joint pain by 2011-13.
This is likely to be linked back to increased dependency on prescription drugs – although the problem could of course be much worse without these medicines.
One of the most important events in the U.S. over this time period was the credit crisis.
Oxford University researchers have previously pointed out a link to increased suicide rates and the crisis, after identifying 10,000 "economic suicides" across the U.S., Canada and Europe in 2008-10.
"Many of the baby-boom generations are the first to find, in mid-life, that they will not be better off than were their parents," the authors argue. They also point out slow earnings growth among white middle-aged Americans without a college education, as productivity slowed down – but add that this is common in many developed countries, without the same effect on mortality.