While death rates have generally been decreasing in the United States and other industrialized countries, death rates in California have stopped declining among young and middle-aged whites (ages 25–34 years and 40–64 years, respectively) since 2000. a The impact of this trend is startling: between 1995 and 2014, increases in death rates in these two age groups from specific causes claimed an estimated 21,350 lives. This trend is consistent with findings from national studies, which also report rising death rates among certain groups of whites, especially those who are middle-aged, have less education, and women. 1–3 The decrease in life expectancy has been attributed to the opioid epidemic. 4

To better understand where and why this is happening in California, we undertook a detailed examination of state vital statistics from 1995 to 2014 and compared results across the state’s 58 counties. b The study was funded by the California Endowment and involved a partnership between the Center on Society and Health at Virginia Commonwealth University and the Graduate School of Public Health at the University of Pittsburgh.