Mortality with Meep: Top Causes of Death in the United States in 2020

Plus: the mysterious drop in suicides

Before I begin, let me remind you of my post from October 2020:

Even if all the COVID deaths stop now (they won’t), it looks like COVID will be #3 on the cause of death list for the U.S. in 2020, after cancer and heart disease.

Yes, cancer and heart disease will still outstrip COVID deaths in number.

And let’s take a look as to how that shook out:

Okay, COVID was #3, and behind heart disease and cancer. But how far behind?

COVID-19 was at 50% of the number of deaths from heart disease, which has been the top killer for years. But note: heart disease deaths were up 5% compared to 2019, while cancer deaths were flat between 2019 and 2020. I find that very interesting.

Indeed, three causes of death in those top ten had increases of 10% or higher:

• Diabetes (15% increase)

• Unintentional injuries (11% increase)

• Alzheimer disease (10% increase)

Of the top ten, two showed decreases:

• Suicide (6% decrease)

• Chronic lower respiratory disease (3% decrease)

I will address a few of these changes below.

Video review of top causes of death, 2020 and other mortality news

Here’s my video (which I did last week and also posted in my prior post):

Also, I’m trying out doing video round-ups of stories accumulated on Actuarial News. This week I did mortality:

Mortality category at Actuarial News.

It won’t necessarily be the same theme each week.

The mysterious drop in suicides

Fox News: US suicides dropped amid coronavirus, defying pandemic expectations

The number of U.S. suicides fell nearly 6% last year amid the coronavirus pandemic — the largest annual decline in at least four decades, according to preliminary government data.

Death certificates are still coming in and the count could rise. But officials expect a substantial decline will endure, despite worries that COVID-19 could lead to more suicides.

It is hard to say exactly why suicide deaths dropped so much, but one factor may be a phenomenon seen in the early stages of wars and national disasters, some experts suggested.

“There’s a heroism phase in every disaster period, where we’re banding together and expressing lots of messages of support that we’re in this together,” said Dr. Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention. “You saw that, at least in the early months of the pandemic.”

So, I have some bad news. Because this:

The CDC has not yet reported national suicide rates for 2020, nor has it provided a breakdown of suicides by state, age or race and ethnicity.

Moutier is anxious to see more data. For example, while overall suicides decreased last year, it’s possible that suicides by youths and young adults did not, she said.

I think it will help to look at recent statistics to see how suicides for one group may grow, for another could decrease, and overall it would decrease.

Using the Underlying cause of death database, I’m going to do an age and sex breakout on deaths by suicide.

Here are the absolute counts in 2019:

You’ll see that among adults, the age range with the most suicides are people age 50-55. That’s due to two things: the number of people in that age range (early Gen X, so tailing off from Boomers) and the rate. For each age group far more males die by suicide than do females.

You can see that deaths by suicide in number drop off in old age…. but that’s because the population is dropping off in size (as mortality rates accelerate at high ages).

If we look at the death rate, we can see the dynamic, which differs by sex:

You can see that deaths by suicide, in rate, is fairly level (and relatively high) for men for most adulthood and increases greatly in old age. Women’s rates peak in late middle age, and then drop off.

At all ages, men’s suicide rate is higher than that of women, and past age 50, the disparities in rates are amazingly high. For age 80-84 years, men have a rate over 10 times that of women… that’s a huge disparity.

Here is one potential explanation for drop in number of suicides: other things were killing off old people more.

You can have the number of deaths by suicide increase for younger people, but if you have just old men dying from COVID more (and they are), then that may explain why suicides in total number decreased.

Increase in drug overdoses

The other issue, though, is that deaths by drug overdoses increased a lot in 2020. They are included in unintentional injuries, which includes all sorts of accidents, such as car crashes.

Two items on this out of Actuarial News:

• The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward

• Opioid deaths in America reached new highs in the pandemic

We have the data through the end of August, and it looks really bad.

Synthetic opioid (think fentanyl) overdose deaths were up through the end of August 2020, an increase of 52% for the 12 months ending 8/2020 compared with the 12-month period ending 8/2019. We don’t have detail at that level for the full 2020 yet.

I have a feeling not all of those overdoses were accidental. Coroners may not have been all that interested, in the middle of a pandemic, in investigating whether a drug overdose was accidental or on purpose.

Let’s do a comparison, stacking together the “accidental causes” (including drug overdoses) and suicides.

So yes, we can see “unintentional injuries” jumped up quite a bit in 2020, but it had been increasing as a cause for some time.

Maybe suicides were down in 2020 in reality, but the age and sex breakout, once we have them, should give us a good idea of how real the change was. If the decrease was among old men (because COVID killed them), we may have our answer. If the decrease was among younger adults, but the drug overdose deaths in that group shot up incredibly…. well, we have a different answer.

Of course, it could be a mixture of those two trends, or something else entirely.

Dead is dead

Yes, I’ve been beating the excess mortality drum for a while now (and yes, there are multiple ways to define ‘excess mortality’). Maybe I should simply say “total mortality”.

It’s not merely because some COVID deaths were missed in the first wave of deaths in March/April 2020, though some surely were missed.

It’s that the fact that people are dead is far more important than the specific cause of death.

I mentioned my ‘dead is dead’ perspective on a prior post, but this is an important enough point I will keep making it.

Yes, I particularly want to know the demographic breakdown of those who died, especially their age. A lot of people, even those over age 85, died years before they normally would have. Those age 85 have a life expectancy of over 5 years, both male and female, in “normal” years. Excess mortality, whether directly from COVID or effects from lockdowns or other secondary measures, cut that much shorter for many elderly people.

Much younger people also died years before their time, and whether other policies could have reduced the spike in drug overdose deaths in 2020, for instance… I don’t know. Maybe some areas of the U.S. had a better experience on that score than others, but I do not have the detail breakout on that yet.

We will be arguing the issues for years, and it is best to keep in mind not to focus solely on COVID deaths, because obviously many causes of death were affected in 2020.

Underlying spreadsheets:

Top Causes of Death 1999-2020 U.S.

Suicide statistics U.S. 1999-2019