According to data from the National Center for Health Statistics (NCHS), a branch of the Centers for Disease Control and Prevention, the life expectancy for a baby born in 2016 fell to 78.6 years, which is a small but statistically significant decline of 0.1 percent. The report noted that this drop is due in large part to the growing opioid epidemic in the U.S.—mortality from drug overdoses rose by 21 percent in 2016.

The decline seen in 2015 was the first in more than two decades. The last time time there was a one-year drop was in 1993, at the height of the AIDS epidemic. With American life expectancy dropping again in 2016, this is the first multi-year drop recorded since 1962 and 1963, when influenza caused a spike in deaths.

While chief of the mortality statistics branch Bob Anderson said he wouldn’t go so far as to call this year’s decline a “trend,” he did note that it’s “concerning to see this two years in a row.” What’s more, the provisional data for 2017 indicates that drug-related deaths have continued to increase, which, “if we’re not careful” could lead to a declining life expectancy for a third year in a row, something that hasn’t been seen since the Spanish flu 100 years ago.

With these numbers, the U.S. is one of few developed countries where the life expectancy is declining and mortality increasing. According to the World Health Organization, newborns in 29 countries, including Canada, Spain, Italy, and Japan, had life expectancies over 80 years in 2015.

Despite growing concern about the opioid epidemic, the top ten leading causes of death have remained the same since 2015. They include: heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza and pneumonia, kidney disease, and suicide. And while overall life expectancy has decreased, the numbers are slightly less grim for women: female life expectancy remained the same at 81.1 years, while it dropped to 76.1 years for men.