America’s health-care system includes the world’s most advanced medical technology, yet it produces some of the worst overall public-health outcomes reported in industrialized nations. Economic class, education levels, and an epidemic of opioid addiction could be playing greater roles than medical science in determining who lives and dies in America.

The nation’s opioid epidemic, which has hit northwest Ohio hard, is starting to skew general health statistics, two Princeton University economists recently suggested. In particular, overdoses related to opioid and heroin addiction are, here and around the country, helping to push death rates for middle-aged Americans with less education to startling levels.

Analyzing health and mortality data from the U.S. Centers for Disease Control and Prevention and other sources, economists Anne Case and Nobel Prize winner Angus Deaton found that the mortality rate for white Americans from ages 45 to 54 years old with a high school education or less rose by 22 percent from 1999 to 2014, while falling for those with a college education.

Mortality rates for less-educated whites in that age group increased by 134 deaths per 100,000 people. Mr. Deaton compared the impact to that of HIV/​AIDS. Not surprisingly, people with the least education reported the most pain, the worst general health, and the most financial distress.

By contrast, the death rate for middle-aged African and Hispanic-Americans continued to drop during the same period. So did death rates for younger and older people of all races. Middle-aged blacks still have higher mortality rates than whites, but the gap is closing. The mortality rate among middle-aged Hispanics is far lower than for middle-aged whites.

The years covered by the study parallel the nation’s opioid epidemic, which started with the explosion of prescription painkillers in the late 1990s and may have plateaued just this year. Other reasons for the rise in deaths among middle-aged whites included alcohol abuse and unprecedented rates of suicide.

Opioid addiction has become a national public-health emergency and ought to be treated as such by politicians and policy makers. Treatment and prevention efforts must do a far better job of targeting people with less education, including on-site outreach programs at factories and other work sites.

Last year in the Toledo area, 145 people died from heroin-related overdoses: Nearly 80 percent of those were men and more than 84 percent were white, according to figures provided by Dr. Robert Forney, Lucas County’s chief toxicologist. Dr. Forney said people in their late 30s or early 40s accounted for most of these deaths.

Dr. Forney’s office does not track the education or income levels of overdose victims. “It’s everywhere,” he told The Blade’s editorial page. In recent days, he added, “we’ve had three white males who were [found] sitting on a toilet with a syringe nearby.”

Health programs that account for the culture of targeted populations tend to work best. Besides race, cultural behaviors and tendencies derive from economic class, education levels, age, geography, and many other variables. State, local, and federal drug treatment and prevention programs need to find better ways to reach people with less formal education.

Improving outcomes for overall health in the United States will be hard if mortality rates for middle-aged white people with less education continue to rise. “This is a vivid indication that something is awry in these American households,” said Samuel Preston, a sociologist at the University of Pennsylvania. Finding out what’s wrong is the first step toward making it right.

First Published December 1, 2015, 5:00 a.m.