Are middle-aged whites dying at alarming rates?

A new study published Nov. 2 in Proceedings of the National Academy of Sciences (PNAS) claims a decades-long decline in the death rate of middle-aged white Americans has changed course. The study’s authors, Nobel laureate Angus Deaton and his wife Anne Case, both Princeton economists, noted only whites in the United States are dying at an increased rate.

“Pretty quickly we started falling off our chairs because of what we found,” Deaton said.

Their research showed the mortality rate for whites between the ages of 45 and 54 with a high school education or less rose half a percent a year between 1999 and 2013, after falling by 2 percent a year between 1978 and 1998. A reversal of this kind is almost unknown for any large demographic group in an advanced nation.

Although African Americans in this age group still have a higher mortality rate than whites, their mortality numbers, along with Hispanics, continue to fall.

Previous studies looked at mortality of those over 50 and under 50 separately, and did not reveal the increased death rate trend. Deaton and Case took a different approach.

“We were interested in what was happening to suicide rates in the U.S. and to see whether or not regions where people were more likely to kill themselves were also regions where people were reporting themselves to be less happy,” Case said. “We decided it would be interesting to look at both of those two things together.”

They concluded that taken together—suicides, a surge in overdoses from opioid medication and heroin, as well as liver disease and other problems that stem from alcohol abuse—explained the overall increase in deaths.

“Half a million people are dead who should not be dead,” Deaton told his colleagues.

But the reason only middle-aged whites had a rise in their mortality rates, combined with dangerous trends marked along educational and racial lines, remains unclear.

Researchers noted those between 45 and 54 years old reported significant health concerns. Case’s studies revealed middle-aged people reported more pain in recent years than in the past. Those with the least education reported the most pain and the worst general health. Chronic pain led many in this population to the doctor for prescription painkillers and often to the less expensive, more readily available alternative: heroin. Among people who tried heroin in the last decade, 90 percent were white, according to The New York Times.

The researchers noted economic hardships as a possible explanation for why this population has turned to drugs and alcohol. Average hourly wages were $19.18 in 1964 and $20.67 in 2014, when adjusted for inflation, according to Bureau of Labor Statistics data cited by the Pew Research Center. Median real household incomes for whites with a high-school education have fallen since the late 1990s, Case said.

But critics of the study say there is more than one way to look at the numbers. For example, the study does not account for the increase in average age during the study period. Adjusting for that difference, they argue there is no increase in mortality among whites in this category.

“Instead, the curve is flat,” writes Andrew Gelman, a professor of statistics and political science and director of the Applied Statistics Center at Columbia University. “I think it’s misleading to imply that there were all these extra deaths.”

But Gelman concedes it remains significant that deaths in this category haven’t sharply declined as they have in other countries.

Ronald D. Lee, director of the Center on Economics and Demography of Aging at the University of California, Berkeley, agreed.

“Seldom have I felt as affected by a paper,” he said. “It seems so sad.”