Mortality Updates for 2022: Bad News Lurks in Non-COVID Causes of Death
Get a preview of my talk to Iowa Actuaries... and to you when I record for YouTube
I am presenting to an Iowa Actuaries meeting next week, and if you’re going to that already, you’re seeing a few of the graphs early…. given the slide deck is currently 70 slides long and there is no way I’m addressing all of them in the time slot I’m given, perhaps I won’t be talking about these next week anyway.
However, I will talk about them when I record a video for YouTube.
I did something like this last year, when I gave a talk to the Hartford (and Springfield) Actuaries:
Well, I’ve rethought some of the graphs now that I have 2022 data, and I’m seeing some other trends now as well, now that 2021 data are finalized.
Here is just a quick taste of a few items.
High-Level: 2022 is Better than 2021, But Still Worse than 2019
We knew from my earlier post, that excess mortality continued into 2022:
In the following, I will generally be using Age-Adjusted Rates for overall population and crude death rates for 5-year age groups. (Look here for an explanation for age-adjusted rates vs crude rates).
That said, the excess mortality was front-loaded for the year:
You can see most of the deaths occurred in January 2022, which fell rapidly in the spring and was flat through spring and summer, and then rose in the fall.
Major Causes of Death: COVID Kind of Flat at the End of 2022
Note that I am not saying COVID is gone.
Just that we’re not really seeing those “waves” of COVID deaths anymore.
You may notice that natural causes of death have a “wave” pattern. Part of that is flu/pneumonia deaths are more likely in the winter, but all sorts of things are more likely to kill old people in the winter.
I will point out: the peaks you see for the “natural” cause in January 2018 — there was a bad seasonal flu mix then. Notice it was muted in 2019, we’ve got major weirdness in 2020, 2021 shows a more normal pattern, and 2022 is a more normal pattern as if it’s really bad flu seasons at both ends.
That’s just what it looks like
By the way, the “External or Investigation” is because the “External” category — Homicide, Suicide, and Accidents — those death records get censored/delayed in coding into the database for 6 months. I have nothing for those past the first week of September 2022. They are in the total deaths count but with a code that they’re under investigation.
However, even if I combine the External category with “Under Investigation”:
No, I don’t think the External category truly dropped off like that at the end of the year (COVID and Natural do not do that, by the way — even with lag in reporting, the numbers look close to complete).
So I will not talk about those causes for the rest of this post, though they have some nasty changes since 2020.
Age Structure of COVID Death Rates
The graph of COVID death rates by 5-year age groups is actually pretty similar to the graph of death rates by all causes — that is, the shape takes on a curve that is exponential with age.
I hate looking at the graphs like this, because I can’t tell distinctions when the rates are low… (well, even when the rates are high).
This sort of curve I’ve talked about before — the Gompertz-Makeham form. It’s a frailty curve, and one way you can tell is by graphing it with a logarithmic scale on the vertical axis:
So, let’s ignore childhood rates, which we generally have to do because there are too few deaths to be meaningful.
For 2021, the curve is somewhat convex, which doesn’t quite work — that indicates higher-than-expected deaths for middle-aged people and lower-than-expected deaths for older people. Now, there are potential explanations for that, such as: vaccines were made available to the oldest people first, so younger adults were more vulnerable; the oldest people most at risk to COVID had already died in 2020 so didn’t die in 2021… and I could spin out more (because geographic patterns shifted).
But we can see some severity shifting: 2020 does look close to the Gompertz-Makeham concept of a line, severity was worse in 2021, and then 2022 looks better than 2020 and 2021. Nice.
Other Causes of Death: A Mixed Bag
I am not going to cover all the causes of death, even all the major ones.
As I said - there are 70 slides in this presentation. You’re just getting a taste right now.
Here is a longer-term trend for three top causes of death since 1999, plus COVID:
“Accidents” belongs to the “External” category, and when the finalized stats come in for 2022, I wouldn’t be surprised if the age-adjusted death rate for accidental causes of death is higher than COVID.
That’s because “Accidents”, as a category, includes accidental drug overdose deaths.
That has been an increasing cause of death before the pandemic, then it jumped up greatly in 2020, and I doubt it fell a great amount in 2022.
I will note that heart disease had a rapidly decreasing age-adjusted death rate until about 2011, then flattened out, slightly rose in 2015, and then increased in 2020 and 2021.
Cancer, on the other hand, has had a steady improvement from 1999 to 2020, and the graph of its age-adjusted death rate is almost a straight line. But something has gone wonky in 2021 and 2022.
Let’s see what that might be.
Cancer: Pandemic Stall Out?
For the natural causes of death, I plot the curves both pre-pandemic and during the pandemic, and I use a logarithmic vertical scale.
It is very difficult to see that there are any differences between the years. So let us graph percentage changes against 2019 for the pandemic years:
For changes in death rates, negative is good and positive is bad. There is a real mixed bag going on here.
It looks like from age 45 to 74, throughout the pandemic, the cancer death rates continued to decrease. That’s good!
But for other ages, the numbers are a mix — it does look like cancer death rates make have increase for the oldest age group (age 85+) in 2021 and 2022. Also, something may be going on with ages 30-34.
That said, you need to keep some skepticism here with this analysis, especially for the young ages: very few people age 30-34 die to begin with, and a change of less than 5% is really not very much.
The cancer death rate changes may not even be that significant, but just noise — and may be too dependent on our estimates of population sizes at those age (think about that one for a moment.)
Heart Disease: What Is Going On?
Heart disease death rates:
Notice there are relatively high heart disease death rates for infants. That is likely due to congenital problems.
But check this one out:
Isn’t that interesting — both 2020 and 2021 have much higher heart disease death rates for younger adults compared to 2019 than does 2022.
But 2022 is showing higher heart disease death rates for older adults.
Remember that older adults are the most numerous of those dying.
Again, the rates for 2022 are likely to be way off due to population estimates needing to change, but order of magnitude for the oldest adults are probably in the right range. Heart disease is the top cause of death at the oldest ages.
Kidney Disease: Often Overlooked
The last cause of death I want to show in this post is kidney disease, as I had picked up various stories on people having problems getting to dialysis throughout the pandemic.
I think I will talk about my experience with the Kidney Foundation in my next podcast.
That’s the most linear-looking graph so far.
So. That pretty much speaks for itself.
Each year is worse than the last for each age group, across the board.
Parting Graph
Here is one last graph, which I’m not going to explain right now:
Okay, I can give a hint.
