That means “half a million people are dead who should not be dead,” Angus Deaton, the 2015 Nobel laureate in economics and co-author of the paper, told the Washington Post. “About 40 times the Ebola stats. You’re getting up there with HIV-AIDS.”

The reasons for the increased death rate are not the usual things that kill Americans, like diabetes and heart disease. Rather, it’s suicide, alcohol and drug poisonings, and alcohol-related liver disease.

The least-educated are worst off: All-cause mortality among middle-aged Americans with a high-school degree or less increased by 134 deaths per 100,000 people between 1999 and 2013, but there was little change in mortality for people with some college. The death rate for the college-educated fell slightly.