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The death rate for middle-aged white Americans is rising even as it shrinks for other U.S. ethnic groups and around the globe.

The discovery was made by two Princeton economists named Angus Deaton and Anne Case, The New York Times reports. Deaton recently won the 2015 Nobel Prize for Economics for his work on understanding consumption and wealth.

After evaluating data from the Centers for Disease Control and other organizations, the two economists found that it was not major diseases like diabetes or heart disease that were to blame for the rise, but suicides and complications from substance abuse like liver disease and drug overdoses.

The deaths are concentrated among poorer, less-educated whites, but the rate of increase has been so dramatic that it has erased gains made by more affluent whites. The death rate for college-educated, middle-aged whites has actually decreased.

The death rate for middle-aged whites aged 45 to 54 with only a high school education or less increased by 22 percent, or 134 deaths per 100,000 people between 1999 and 2014.

The only parallel Deaton, the Nobel prize winner, could find to the sharp increase in mortality was at the height of the HIV/AIDS epidemic.

The economists were unable to determine why exactly middle-aged whites saw their death rates increase as the rates for blacks and Latinos fell. They speculated one possibility is the frequency with which whites are prescribed and abuse prescription painkillers.

They also thought that economic pessimism could also be a factor in both the drug use and increase in suicides. The inflation-adjusted income for a worker with a high school degree fell 19 percent during the time that was considered in the study.