Alarming trend among less-educated 45- to 54-year-olds largely thought to be a result of more suicides and the misuse of drugs and alcohol

A sharp rise in death rates among white middle-aged Americans has claimed nearly as many lives in the past 15 years as the spread of Aids in the US, researchers have said.

The alarming trend, overlooked until now, has hit less-educated 45- to 54-year-olds the hardest, with no other groups in the US as affected and no similar declines seen in other rich countries.



Though not fully understood, the increased deaths are largely thought to be a result of more suicides and the misuse of drugs and alcohol, driven by easier access to powerful prescription painkillers, cheaper high quality heroin and greater financial stresses.



The turnaround reverses decades of falling mortality rates achieved through better medical care and lifestyle choices that continue to improve public health in other groups in the US and in other nations around the world.



“This was absolutely a surprise to us. It knocked us off our chairs,” said Anne Case, an economics professor at Princeton University who worked on the study. Since discovering the trend, Case and her colleague Angus Deaton, also an economics professor at Princeton, have shared the findings with healthcare professionals. “We wanted to make sure we weren’t missing something,” Case said. “Everyone’s been stunned.”



The findings emerged from a review of national surveys in the US and six other rich industrialised countries, namely the UK, Australia, France, Germany, Sweden and Canada.



They showed that from 1978 to 1998, the mortality rate for US whites aged 45 to 54 fell by 2% a year, a figure very much in line with the celebrated improvements in health seen in the other countries.

But after 1998, the death rates of US whites began to buck the trend. While other countries saw their mortality rates continue to fall, they began to rise among middle-aged white non-Hispanic Americans by 0.5% a year. The effect was not confined to the 45- to 54-year-olds. In the 35- to 44-year-old bracket, the mortality rate stopped falling in 2000. For 55- to 59-year-olds, the fall slowed to 0.5% a year.



The rise in death rates among middle-aged white Americans means half a million more people have died in the US since 1998 than if the previous trend had continued. The death toll is comparable to the 650,000 Americans who lost their lives during the Aids epidemic from 1981 to the middle of this year, the researchers said.



Case and Deaton found that death rates from drugs, alcohol and suicides had risen for middle-aged white men and women across all educational backgrounds. But Case said the less educated bore the brunt of the trend: for those with a high school degree or a lower level of education, deaths from drug overdoses and alcohol poisoning rose fourfold, suicides by 81%, and deaths from liver disease and cirrhosis by 50%. For this least-educated group, deaths from all causes rose more than a fifth. Only for those with a bachelor’s degree or higher did overall death rates continue to decline.

The researchers cite the surge in the use of powerful opioid painkillers as one contributing factor, with drink and suicide potentially related to people needing relief from pain or mental health problems. But they suspect that financial stress is involved too, with the fall in household incomes among white non-Hispanics being particularly tough on those with no more than a high school education. “It may be that they have less hope about their ability to live a good life,” Case said.



She and Deaton warn that middle-aged Americans who are turning to drink and drugs are set to suffer more health problems than their elders unless the downwards trend can be halted.



“This is not automatic. If the epidemic is brought under control, its survivors may have a healthy old age,” they write in Proceedings of the National Academy of Sciences. “However, addictions are hard to treat and pain is hard to control, so those currently in midlife may be a ‘lost generation’ whose future is less bright than those who preceded them.”



In a statement, Deaton said: “We need to think hard about controlling the prescriptions of opioid painkillers. The Federal Drug Administration recently approved Oxycontin for kids.

“While some kids are in awful, terminal pain, and can clearly benefit from it, the scope for abuse is there, especially if pharmaceutical companies misbehave, as they have done in the past. But if what is happening is an epidemic of despair, that people on the bottom of the economic heap are being increasingly left out as inequality expands, then what we are seeing is just one more terrible consequence of slow growth and growing inequality.”



• In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 116 123. In Australia, the crisis support service Lifeline is on 13 11 14. Hotlines in other countries can be found here.

