ISSN 2330-717X

Alarming Reversal: Quiet ‘Epidemic’ Has Killed Half A Million Middle-Aged White Americans


Despite advances in health care and quality of life, white middle-aged Americans have seen overall mortality rates increase over the past 15 years, representing an overlooked “epidemic” with deaths comparable to the number of Americans who have died of AIDS, according to new Princeton University research.


With data from a variety of surveys and reports, the paper reports a sharp increase in the death rate for middle-aged whites after 1998, which the researchers tie to drugs and alcohol, suicide, chronic liver disease and cirrhosis. This turnaround in mortality reverses decades of progress, the researchers write, and the same pattern is not seen in other rich countries, nor is it seen among African Americans or Hispanics in the United States.

Although death rates related to drugs, alcohol and suicides have risen for middle-aged whites at all education levels, the largest increases are seen among those with the least education, the researchers found. For those with a high school degree or less, deaths caused by drug and alcohol poisoning rose fourfold; suicides rose by 81 percent; and deaths caused by liver disease and cirrhosis rose by 50 percent.

All-cause mortality rose by 22 percent for this least-educated group. Those with some college education saw little change in overall death rates, and those with a bachelor’s degree or higher actually saw death rates decline.

In terms of lives lost, had the white mortality rate held at its 1998 value, 96,000 lives would have been saved between 1998 and 2013. If it had continued to fall at the rate of decline seen from 1978-1998, 488,500 deaths would have been avoided between 1999 and 2013. This figure is comparable to the number of deaths caused by the AIDS epidemic in America.

While this turnaround in mortality is only partly understood, the research team cites the increased availability of opioids in the late ’90s as a potential cause, with some substitution toward heroin as opioid prescription became more carefully monitored and the quality and availability of heroin rose.


Along with increased availability of opioid prescription drugs, chronic pain (for which opioids are often prescribed), and the economic crisis which began in 2008 may all have contributed to an increase in overdoses, suicide, and increased liver disease associated with alcohol abuse.

The researchers used data from the Centers for Disease Control and Prevention, the U.S. Census Bureau, individual death records, and other sources for their analysis.

From 1978-1998, the mortality rate for middle-aged white Americans fell by an average of two percent per year. This matched the average rate of decline in France, Germany, Canada, Australia, Sweden, and the United Kingdom, as well as the average over all European Union countries. Other rich countries continued to decline at about two percent per year after 1998. The mortality rate for middle-aged people in the United States began to increase by half a percent a year, starting in 1999.

In their discussion, the researchers also noted that the reversal in health trends indicates that today’s middle-aged adults will be entering their senior years and Medicare eligibility in worse health than today’s adults age 65 and older.

Anne Case, Ph.D., and Angus Deaton, Ph.D., of Princeton University, detail these findings in a study published online on November 2, 2015 in the Proceedings of the National Academy of Sciences. The analysis was funded by the National Institute on Aging (NIA), part of the National Institutes of Health.

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