Young Adult Mortality Trends, 1999-2021 (provisional), Ages 18-39 -- The Recent Millennial Massacre (Part 1)
Age 35-39 hardest hit in this group, and COVID is only a small part
After my recent review of childhood mortality trends, I’m going to be looking at adult mortality trends in 20-year (approximately) chunks.
The recent 20-year chunk will approximately line up with particular generational groups. Of course, as those groupings were mostly invented for marketing purposes (though based on a few real demographic trends), I don’t really care that they don’t match exactly.
The groups will be:
Young Adults — Age 18-39: approximately the Millennials in 2020-2021
Middle Agers — Age 40-59: approximately Gen X
Young Seniors — Age 60-79: approximately Boomers
Old Seniors — Age 80+: mainly Silent Generation (as older generations are mostly dead at this point)
You can look up various definitions of generations to see how well these match up. Obviously, in 1999, over 20 years ago, these are going to be the older generations in those categories. I’m following specific age groups, not specific cohorts (that is, people born around the same time).
But a quick check — a common definition for the Boomers is that they were born from 1946-1964. In 2021, they ranged in age from 57-75 years old. No, that doesn’t match up to age 60-79 exactly, but it’s close enough
There is a lot to go through, so I will be doing a quick pass through each of these groups for a high-level trend and looking at some top causes of death. I am not doing a very deep dive on the cause of death right now, as I’m waiting for data updates from the CDC (and that may take longer than I had expected, but I’m not addressing that in this post.) However, I can point out some major trends during the pandemic and also preceding the pandemic.
With respect to young adults, there are some very significant mortality trends that many people may have missed.
High-level trend for young adults
There are two things I want you to notice in the overall trend for death rate by age group in the young adult group:
Let’s address the pandemic death rate increase first, because it’s very large and because I will be digging into it more fully below.
Here it is in the text:
Ages 35-39: 45% increase in death rate from 2019-2021
Age 30-34: 43% increase
Age 25-29: 32% increase
Age 18-24: 29% increase
I hope I don’t have to tell you, but these are very large increases, whether that would have been over a long period or over two years. We’re used to the concept that for a given age group, with improved medical care, mortality trends should decrease.
And yes, age 35-39 has the worst increases, and we’ll try to figure out why below.
Separately, I want you to notice that death rates were getting worse for years before the pandemic. The amount it increased was less drastic than the two-year increase, but it still was noticeable.
In fact, here is a year-over-year snapshot (and yes, here are my notes from when I was originally looking at stuff). Since 2013, mortality rates have gotten worse for these age groups, and we will be seeing why below. For children, in general, mortality had been improving. When we look at old people, we will see their mortality has really been improving (pre-pandemic).
But this? This is not good.
Top causes of death for young adults: age 18-24
In the prior post on childhood causes of death, I focused solely on teens, as younger ages did not have much going on, trend-wise. I will have the spreadsheet for all graphs at the bottom of the post, but let me just pick the two extreme age groups for cause of death, given continuity in trend.
Let’s start on the young end, from age 18-24, using rankable causes of death for this graph, with a catch-all “other causes” category:
Even with a catch-all category, we can clearly see the “accidents” category is larger than all the others.
(The red “investigation” bar is an uncategorized “external” cause of death that will likely resolve to be accidental, suicide, or homicide. These are censored for 6 months after they occur, so these all come from December 2021 in my data set.)
With a stacked column graph, it can be difficult to see year-over-year changes, but the main point is to see the relative sizes of the portions. Let’s look at a line graph now.
With this line graph, we can see that accidental deaths sharply increased in 2020, but that there had also been a bump up in 2016-2017 before falling back down. We will return to this below.
Note that the sharp increase in accidental deaths is about twice the magnitude of COVID deaths in 2021.
Age group 25 – 29
Let us go up one age group and see how things change.
Accidental deaths are still the largest category. But now other categories are growing. And it is looking, just eyeballing it, that the mortality trend looks bad before the pandemic.
Remember that little blip of accidental death rates for 2016-2017 for age 18-24 before? Well, the accidental death trend is far steeper now pre-pandemic. This is not looking good.
In addition, we can see that there has been a slight increasing trend to suicide rates for this age group over the period, and homicide death rates have been increasing since 2014.
The COVID death rate in 2021 is now closer to the increase in accidental death rates from 2019 to 2021.
One comment before I get to the older ages, and it starts to become really dire: there is quite a difference between seeing how these causes of death stack up on a line graph like this, and a ranking table as they’re often listed.
Indeed, “Other causes” is not a “rankable cause of death”, and I used that as a placeholder. Initially, I included causes such as diabetes and liver disease, but removed them (they did notably increase during the pandemic, btw, but we will investigate these in more detailed posts later.) If I removed “other causes”, you would see that huge gap from accidents to suicide.
Age group 30-34
Now we see the natural causes of death start taking a harder bite…. but those “accidental causes of death” are also higher.
Yes, there are even more accidental deaths for this age group than for younger groups. But now, in relative sizes, cancer and heart disease are growing. As people age, these natural causes of death grow in an exponential manner in their effect.
Let’s switch to the lines:
Sorry, I know the labels are overlapping each other and it’s tough to tell these apart. Suicide and COVID are essentially sitting on top of each other. When the data updates, both these numbers will go up, so I don’t see the need to distinguish which one officially outranks the other in my spreadsheet right now. Essentially, they’re the same.
What you can really see is that I don’t know that the pandemic has made for a different trend during the pandemic versus before the pandemic for accidental deaths.
From 2013 to 2017, the rate increased at a 12% compound annual growth rate and from 2019 to 2021, there was a 16% CAGR. There is some difference, but that’s spitting range, as far as I’m concerned.
(Both of these are bad, in case you were wondering)
The suicide trend has been steadily increasing since before the pandemic. Yes, it looks like it went down in 2021, but once final 2021 numbers come in, it may be level or even continue increasing.
Age 35-39 — the worst of the bunch
And finally, we get to the worst-hit of this first of the adult ages I’m looking at — age 35-39.
That is a steep increase in the pandemic, and spoiler: no, it’s not just accidental deaths, and yes, COVID is actually large enough to make a noticeable difference.
Because of the choices I made in this post (which is long enough already), I’m not digging into detail on cause of death. But yes, there are natural causes of death, such as diabetes and liver disease, that are embedded in that “other cause” increase. Again, note that those “other causes” start increasing before the pandemic as a slighter slope before taking off in 2020.
Heart disease did go up, by the way.
When we get to the Gen X group, the next age group up, we will get a witches’ brew. The issue is that you have increasing accidental death rates up to a certain age (and then it falls off or at least levels off), and then natural causes like cancer, heart disease, and COVID have increasing death rates with increasing age.
So age 35-39 gets the worst of all worlds – no, they don’t get “wiser” with increasing age. You’ll see the composition of their accidental deaths below.
Drug overdoses are a large driver for these age groups
I’ve written about this before: drug overdoses are really the large driver.
Yes, it says “accidents” because that’s how they carve out “rankable causes of death” and I’m just following their categories for that. I’m not breaking out “cancer” into breast cancer and skin cancer, or “heart disease” into congestive heart failure vs ischemic heart attack, for example.
But I do have the data, so as a preview.
Here are the accidental drug OD trends for these ages:
And if you were wondering what percentage of the “accidents” category were drug ODs, here you go:
People want to yak about COVID vaccines for young adults, when it’s more to the point for many of them to prevent drug ODs. COVID, as we’ll see when I get to those age groups, is far more salient for Baby Boomers. Who are old.
For the young, the mortality risks are very different.
We should adjust our policies and advise accordingly.
UPDATE: spreadsheet available now [attached on 7 July 2022, but data grabbed pre-data update]
