A new paper from Princeton University shines a light on a "quiet" epidemic among white Americans in midlife. Since 1998, the mortality rate among this population has increased 0.5 percent each year, resulting in half a million deaths between 1999 and 2013. It’s more than rates of other "rich countries," like Germany and the UK, as well rates for black- and Hispanic-Americans.

Authors Anne Case and Angus Deaton cited that between 1970 and 2013, "a combination of behavioral change, prevention, and treatment brought down mortality rates for those aged 45-54 by 44 percent." These "reductions in mortality and morbidity have made lives longer and better, and there is a general and well-based presumption that these improvements will continue." Yet, despite the decline, Case and Deaton still questioned the presumption for white Americans in midlife.

So, the two analyzed a variety of surveys and reports, including the National Health Interview Surveys and National Health and Nutrition Examination Surveys. From 1978 and 1998, all-cause mortality for white people aged 45-54 fell by 2 percent each year — but after 1998, it started to increase. Had the rate held at its 1998 value, Case and Deaton said that 96,000 deaths would have been avoided from 1999-2013. And had it continued to decline from the rate it was between 1979 and 1998, half a million deaths would have been avoided during that same time period.

It's just midlife whites, too; mortality rates among white people aged 65-74 continue to fall 2 percent each year, with "similar declines in all other racial and ethnic groups."

The three causes of death for middle-aged whites are suicide, drug and alcohol poisoning, and chronic liver disease and cirrhosis, followed by lung cancer and diabetes. Though these deaths preceded the financial crisis, Case and Deaton are hesitant to rule out economic insecurity as an underlying cause of increased suicide and poisonings.

This idea is made stronger by the fact Case and Deaton found that mortality rates were higher among those with the least education compared to those with some college or a bachelor’s degree or more; households with more education are reportedly less likely to lack economic security.

Middle-aged Americans, too, self-reported higher rates of pain, psychological distress, difficulties with activity of daily living, and alcohol use — all markers for suicide. The increase in reports of poor health among those in midlife was matched by increased reports of pain; specifically, one in three whites reported chronic join pain; one in five reported neck pain, and one in seven reported sciatica.

Given the sharp increases in pain, plus the fact that Case and Deaton could not determine if increased drug and alcohol poisonings were by accident or intentional, the two wonder if these causes are fueled by an increase in prescription drug use.

Case and Deaton cited that the availability of opioid prescriptions for pain began in the late 1990s, with the Centers for Disease Control and Prevention estimating that "for each prescription painkiller death in 2009, there were 10 treatment admission for abuse, 32 emergency room visits for misuse or abuse, 130 people who were abusers or dependent, and 825 non-medical users."

In many cases, opioid prescription drug abuse is a gateway to heroin abuse and addiction. President Barack Obama recently announced The White House’s plan to drive down increased rates of overdose deaths and prescription drug abuse.

That said, Case and Deaton did not establish "whether the increase in opioid use or the increase in pain came first." Still, they suggest "tighter restrictions on prescription painkillers," noting that "broader social and economic issues are almost certainly involved."

"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," Deaton said in a press release. "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."

Source: Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences. 2015.