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Declining life expectancies in high income countries worldwide are coinciding with rising rates of young- and mid-adult mortality and declining health in the United States, according to two studies, one from the University of Southern California and Princeton University published in the BMJ, and the other from Virginia Commonwealth University in Richmond.

In the first study, researchers looked at life expectancy trends in 18 high income countries and found that in 2015, for the first time in decades, most of these countries showed significant simultaneous declines in life expectancy for both men and women. Most of the declines affected older adults and could be attributed to a severe influenza (flu) season. Other causes behind the declines included pneumonia and other respiratory diseases, heart disease, and Alzheimer’s. But in the U.S., the life expectancy decline was concentrated in younger adults, largely due to the ongoing opioid epidemic. In the United Kingdom and the United States (unlike in the other countries studied), these trends continued in 2016, according to the researchers.

The second study suggests the problem in the U.S. is bigger than the opioid epidemic, showing death rates from dozens of causes in people of all racial and ethnic groups. For this study, the Virginia researchers compared midlife death patterns from 1999 to 2016 using national data. They found that drug overdoses, suicides, and alcoholism were the leading causes of increasing death rates, but mortality rates from heart, lung, and other diseases also increased. This study also showed that overall death rates during the study period were higher in men, and that the increase in fatal drug overdoses and suicides was greater in women.