The opioid epidemic that has ravaged life expectancy among economically stressed white Americans is taking a rising toll among blacks, Hispanics and Native Americans, driving up the overall rate of premature death among Americans in the prime of their lives.
Since the beginning of this decade, death rates have risen among people between the ages of 25 and 44 in virtually every racial and ethnic group and almost all states, according to a Washington Post analysis. The death rate among African Americans is up 4 percent, Hispanics 7 percent, whites 12 percent and Native Americans 18 percent. The rate for Asian Americans also has increased, but at a level that is not statistically significant.
After a century of decreases, the overall death rate for Americans in these prime years rose 8 percent between 2010 and 2015.
The jump in death rates has been driven in large measure by drug overdoses and alcohol abuse, according to the Post's analysis of mortality data from the U.S. Centers for Disease Control and Prevention.
"What it reflects is an out-of-control epidemic right now," said Josh Sharfstein, director of the Bloomberg American Health Initiative at Johns Hopkins. "It's affecting the economy. It's affecting the entire community. This is an absolute call to action for public health."
Ashish Jha, a health policy professor at the Harvard School of Public Health, added, "These are people who are in the most productive years of their lives — the years where they're supposed to be raising kids and becoming leaders of the next generation."
The Post confirmed the contours of the rise in death rates with CDC officials. The rate is adjusted for the nation's changing age profile, and every five-year age group (for example, 35 to 39, or 40 to 44) showed an increase in mortality.
Preliminary data from the first half of 2016 suggests that the trend is continuing, said Robert Anderson, chief of mortality statistics for the CDC.
"I think we're in for another steep increase in the drug overdose deaths overall," Anderson said.
The rash of deaths is a statistical echo of the 1980s and early 1990s, when the combination of the crack cocaine and HIV epidemics took a heavy toll on young Americans.
Many factors are likely contributing to the current spike, but opioids stand out. The widespread abuse of prescription drugs has become a national crisis, with addicts overdosing on prescription opioids; their illegal cousin, heroin; and, increasingly, synthetic drugs such as fentanyl and carfentanil, which are far more powerful and deadly.
Alcohol-related deaths also have increased among whites, blacks and Hispanics, the data show. Meanwhile, homicide, the leading cause of death among young blacks, also has risen since the beginning of this decade.
The new mortality spike is seen in almost every state. The breadth of the nation's deteriorating health has not been widely appreciated. Academic researchers and the news media in recent years have focused on the most intensely affected regions, such as Appalachia and rural New England, and on premature deaths among white Americans, a trend that began around 1999 and continues unabated.
For more than a century, Americans lived much longer lives because of improvements in medicine, sanitation, control of contagious diseases, nutrition and individual health care. But American mortality appears to have reached an inflection point around 2010, in the immediate aftermath of the Great Recession. Generally positive mortality trends among blacks and Hispanics flattened out, then gradually worsened.
For blacks and Hispanics, the biggest increase in deaths came in 2015, data for which was released earlier this year.
The geography of the epidemic also expanded dramatically. From 1999 to 2010, only seven states showed an increase of more than 10 percent in the death rates of people ages 25 to 44: West Virginia, Kentucky, New Hampshire, Oklahoma, North Dakota, Wyoming and Montana. All have predominantly white populations and few if any big cities.
The data from 2010 to 2015 tell a different story. During that period, 33 states showed death rates rising by at least 10 percent in the 25-44 age bracket, including all of New England and the Midwest Rust Belt. The death rate in Illinois is up 31 percent. Only in Hawaii and the District of Columbia has the death rate continued to decline since 2010.
Moreover, a phenomenon most pronounced among whites in small cities and rural areas appears to be spreading to the nation's suburbs and biggest cities. Before 2010, death rates had been declining for whites, blacks and Hispanics in metropolitan areas of at least 1 million people. Since 2010, the rates are up everywhere.
"The data is very concerning," said Leandris Liburd, director of the CDC's Office of Minority Health and Health Equity. "We do not want to see death rates going up for any age, or any ethnic or racial group. The rise in mortality is likely due to multiple factors, and opioids are certainly a part of the problem."
One clear distinction remains: education level. The only 25-to-44 group whose death rate is not climbing is people with four-year college degrees.
"People with four-year degrees overall are doing fine in this economy, and everybody else overall is doing pretty poorly," said Joan C. Williams, a University of California law professor, author and scholar on work and class. "This whole large segment of society is seeing their grip on the American Dream slipping away."
Deaths from drug overdoses among whites are still more than double the rate for blacks, and are rising rapidly. But the data suggest that this is a contagion that will not recognize boundaries of race or ethnicity.
In Cuyahoga County, which encompasses Cleveland, coroner Thomas Gilson testified in the Senate last month that he has seen deaths double in one year among African Americans from fentanyl, a deadly synthetic opioid, often taken in combination with cocaine.
"With seemingly purposeful intent, cocaine is now being mixed with fentanyl and its analogues in an effort to introduce these drugs into the African American population," Gilson testified.
"Fentanyl is playing a major driving force in increasing overdose deaths," said Michael Botticelli, director of the Grayken Center for Addiction Medicine at Boston Medical Center and the former head, under President Obama, of the White House Office of National Drug Control Policy. "Fentanyl is much more powerful than heroin or morphine. Often drug users don't know it's in their supply. It's increasingly fast acting. We know that the window of our opportunity to respond and resuscitate people is dramatically shortened."
Botticelli said dealers make a risk calculation when selling fentanyl or fentanyl-laced drugs: Addicts want the strongest drugs available, even if they are potentially fatal. He said a dealer arrested in Massachusetts had sent a text message to a colleague: "We don't want to kill them, we just want to bring them to that point."
The country is beginning to recognize the scale of the crisis, said Sharfstein, and turning to the question of how to fix it. But, he said, a criminal, judgmental or moral approach will block effective solutions.
"A really important barrier is to set aside ideology and say, 'This is killing our children. What can we do to make a real difference?'," he said. "In many parts of the country, there is not access to treatment that is effective for people, and in fact there is opposition to treatment that is effective for people. They say people should be put in jail."
A report in March, the 2017 County Health Rankings, produced by the University of Wisconsin and the Robert Wood Johnson Foundation, also highlighted a rise between 2014 and 2015 in premature deaths among people ages 15 to 44 and the broad geographic and demographic spread of those deaths.
In modern times, increases in mortality have been rare. One of the most dramatic occurred during and after the disintegration of the Soviet Union, when the economy went into free-fall and anti-alcohol campaigns were abandoned. Life expectancy for men dropped precipitously.
National attention to rising death rates in the United States flared following a November 2015 study by Princeton economists Anne Case and Angus Deaton, who noted that whites in their midlife years (45 to 54) have been dying at surprisingly high rates since the end of the 20th century. Case and Deaton earlier this year said the "deaths of despair" from drug overdoses, alcohol abuse and suicide appear to be associated with the deteriorating labor market since the 1970s among people without a college degree.
Deaton, a Nobel laureate, said the bigger picture for America is "catastrophic." Death rates are supposed to go down, not up, he said. "A society where this is going the wrong way, there's something very, very seriously wrong with it."