There was a significant rise in death rates among middle-aged white Americans between 1998-2013 as a result of drugs and alcohol, suicide and chronic liver disease and cirrhosis, according to a new study by researchers from Princeton University in New Jersey.

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Researchers say alcohol and drug abuse may be partly to blame for a rise in death rates among middle-aged white Americans between 1998-2013.

For decades, death rates in the US have been declining. But the new study, published in the Proceedings of the National Academy of Sciences, finds this has not been the case for white Americans aged 45-54.

Study authors Anne Case and Angus Deaton, of the Woodrow Wilson School of Public and International Affairs and Department of Economics at Princeton, say their findings represent an overlooked “epidemic” comparable to the number of deaths in the US caused by AIDS.

The researchers reached their findings by conducting a review of data from individual death records in the US, the American Community Surveys, the Current Population Surveys, the Human Mortality Database and the Centers for Disease Control and Prevention (CDC) Wonder Compressed and Detailed Mortality Files.

Between 1979-1998, the team identified an average 2% annual fall in mortality rates for white Americans aged 45-54 – similar to the fall in mortality rates seen in other high-income countries including Canada, Australia, Sweden, France, Germany and the UK over the same period.

However, the researchers found that the death rates for middle-aged white Americans began to rise by an average of 0.5% annually between 1998-2013.

Other developed countries maintained the 2% decline in mortality rates during this 15-year period, while death rates for blacks and Hispanics in the US fell by 2.6% annually and 1.8% annually, respectively.

The researchers calculated that if the mortality rate for middle-aged white Americans had remained at their 1998 level, around 96,000 deaths could have been avoided between 1998-2013.

What is more, if the mortality rate for this group had continued to fall at the 1979-1998 rates, the authors claim around half a million deaths could have been prevented, which they note is almost on par with the number of lives lost as a result of the AIDS epidemic, which caused around 650,000 deaths in the US between 1981 and mid-2015.

Case and Deaton attribute the rise in death rates among middle-aged white Americans to drug and alcohol poisoning, suicide and chronic liver disease and cirrhosis, noting that the death rates correlated with a rise in death rates for all of these factors between 1999-2013.

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The largest increase in death rates for middle-aged white Americans was among individuals with the lowest education; those with a high school degree or less saw a 22% rise in all-cause mortality, a four-fold increase in deaths from drug and alcohol poisoning, as well as an 81% increase in suicide deaths and a 50% rise in deaths caused by chronic liver disease and cirrhosis.

The researchers also identified a rise in obesity rates for middle-aged Americans during the 15-year period, though they say the rise was not significant enough to make a large contribution to the increase in death rates.

While the authors are unable to pinpoint the exact drivers behind their findings, they suggest a rise in chronic pain between 1997-2013 and wider availability of opioid prescription drugs from the mid-1990s to treat such pain may have played a role.

However, the researchers say their data cannot determine whether the pain epidemic or opioid use came first. “Pain prevalence might have been even higher without the drugs, although long-term opioid use may exacerbate pain for some, and consensus on the effectiveness and risks of long-term opioid use has been hampered by a lack of research evidence,” they explain.

The authors also note that the economic crisis – which began in 2008 – may have played a role in drug overdoses, increases in liver disease related to alcohol abuse and suicide.

What is more, the team notes that there has been an increase in mental health issues in recent years, which may have also played a role in suicide and drug and alcohol abuse.

Based on their findings, Case and Deaton highlight a need for better financial security and equality to protect the health of future generations, as well as firmer restrictions on prescription painkillers.

“The Federal Drug Administration recently approved Oxycontin for kids,” notes Deaton. “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.”

The researchers add:

A serious concern is that those currently in midlife will age into Medicare in worse health than the currently elderly. This is not automatic; if the epidemic is brought under control, its survivors may have a healthy old age.

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.”

Medical News Today recently reported on a study published in JAMA that found the number of deaths caused by the five leading causes in the US – heart disease, cancer, stroke, unintentional injuries and diabetesdeclined between 1969-2013.