Americans are living longer and better than ever so why have white middle-aged Americans seen overall mortality rates increase over the past 15 years? For any other demographic it would mean protests and outrage and calls for action, instead this 'epidemic', which has killed more people than AIDS, has been overlooked.

The paper in the Proceedings of the National Academy of Sciences used data from a variety of surveys and reports and reports a sharp increase in the death rate for middle-aged whites after 1998. This turnaround in mortality reverses decades of progress, and is not seen among African-Americans or Latin-Americans in the United States. 

The death rates are related to drugs and alcohol and suicides, all opt-in behavior just like AIDS or other lifestyle diseases, and 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. The high death rates also coincide with self-reported declines in health, mental health and the ability to cope with daily living among middle-aged whites over this same period, the researchers report. More middle-aged whites in 2013 reported chronic pain and displayed poorer liver function than those of the same age in 1999. The fraction in the same age group who reported being unable to work doubled over this period. 

In the paper, the authors write that "a serious concern is that those currently in midlife will age into Medicare in worse health than the elderly of today," but that "this is not automatic; if the epidemic is brought under control, its survivors may have a healthy old age. Yet 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."