A new study reports that the decline in U.S. life expectancy seen since 2014 is driven by an increase in “deaths of despair” among working-age Americans, particularly in the Rust Belt states and Appalachia.

The study represents one of the most comprehensive analyses of U.S. mortality rates among the 50 states. According to the findings, working-age adults are now more likely to die before age 65 from drug overdoses, alcohol abuse, and suicides (“deaths of despair”) and a range of organ system diseases. All in all, mortality rates related to 35 different causes of death have risen between 1959-2017.

A turn for the worse

“Working-age Americans are more likely to die in the prime of their lives,” said lead author Steven Woolf, M.D., director emeritus of the Virginia Commonwealth University (VCU) Center on Society and Health.

“For employers, this means that their workforce is dying prematurely, impacting the U.S. economy. More importantly, this trend means that children are losing their parents and our children are destined to live shorter lives than us.”

Drugs, obesity, an inability to access health care, stress, and poor economic outlooks are at the root of this phenomenon, according to the paper. The trend poses a far-reaching threat to the U.S.’s future, Woolf explains, and the paper highlights the need for a better understanding of its driving forces.

The paper used data from the U.S. Mortality Database and Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research to analyze changes in death rates among different areas of the U.S. since 1959. U.S. life expectancy lost pace with other wealthy countries in the 1980s, the team found, stopped increasing in 2011, and has been falling steadily ever since 2014.

Since 2010, women and adults without a high school diploma have seen the largest increases in working-age mortality, according to the study. The largest overall increases in mortality have been recorded in areas that bore the brunt of the economic disruptions since the 1980s (e.g. job losses in the manufacturing sector).

The Midwest and other areas that traditionally focused on this economic sector, such as northern New England and the Ohio Valley, are particularly heavily-affected. Indiana, Kentucky, Ohio, and Pennsylvania account for one-third of all excess deaths for ages 25 to 64 — the number of deaths over the average mortality rate — since 2010. Eight of the 10 states with the largest number of excess deaths were in the Rust Belt or Appalachia, Woolf adds, with the 13 Appalachian states accounting for half of excess deaths recorded by the team.

“The notion that U.S. death rates are increasing for working-age adults is particularly disturbing because it is not happening like this in other countries,” Woolf said. “This is a distinctly American phenomenon.”

The team believes socioeconomic pressures and unstable employment are possible explanations for the increases in working-age mortality. The findings tie into the team’s previous work which showed that this increase in working-age mortality was affecting all racial groups.

The paper “Life Expectancy and Mortality Rates in the United States, 1959-2017” has been published in the journal JAMA.