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The New York Times reports that life expectancy, especially for Americans between the ages of 25 to 64, is declining despite the highest per capita spending in the world on health care, according to a study newly published in the Journal of the American Medical Association.

According to the new study, the death rate from 2010 to 2017 for all causes among people ages 25 to 64 increased from 328.5 deaths per 100,000 people to 348.2 deaths per 100,000. It was clear statistically by 2014 that it was not just whites who were affected, but all racial and ethnic groups and that the main causes were drug overdoses, alcohol and suicides.

Death rates are actually dropping for Americans over 65 and for children due to more reliable medical care, especially for those eligible for Medicare and Medicaid.

“The whole country is at a health disadvantage compared to other wealthy nations,” the study’s lead author, Dr. Steven Woolf of Virginia Commonwealth University, said. “We are losing people in the most productive period of their lives. Children are losing parents. Employers have a sicker work force.

States with the largest increase in mortality of young and middle age adults were: New Hampshire, Maine, Vermont, West Virginia and Ohio.

But one third of the total increase in deaths was due to just four states: Ohio, Pennsylvania, Kentucky, and Indiana, states that correspond to the declining economies of the coal fields and rust belt.

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Howard Koh of the Harvard T.H. Chan School of Public Health, who was not involved in the study, described the findings as “the most exhaustive and detailed analysis of this topic to date.”

In addition to weeding out the causes of death, Koh told Live Science that one solution to America's declining life expectancy may be “embracing the leading causes of life” — that is, paying more attention to how social connections and strong community networks impact wellbeing. “Other countries spend relatively more in terms of social services,” Koh said. “Health is much more than what happens in a doctor's office. It starts where people live, learn, labor and pray.”