Mortality rates in the United States fell through the last three quarters of the twentieth century. But then, in the late 1990s, the progress slowed—and soon went into reverse.

A major reason for the decline in life expectancy is increasing mortality in midlife, between the ages of 25 and 64, when the most rapidly rising causes of death are accidental poisoning (nearly always from a drug overdose), alcoholic liver disease, and suicide. Overdoses are the most prevalent of the three types of deaths of despair, killing 70,000 Americans in 2017 and more than 700,000 since 2000. The 2017 total is more than the annual deaths from AIDS at its peak in 1995 and more than the total number of U.S. deaths in the Vietnam War; the total since 2000 outstrips the number of U.S. deaths in both world wars. The U.S. suicide rate has risen by a third since 1999; there are now more suicides than deaths on the roads each year, and there are two and a half times as many suicides as murders. In 2017 alone, there were 158,000 deaths of despair, the equivalent of three fully loaded Boeing 737 MAX jets falling out of the sky every day for a year.