The data serve as a reminder that social science-driven health policies even in the most advanced societies remain vulnerable unless constant monitoring and improvement are optimized. JL
Jon Kamp and colleagues report in the Wall Street Journal:
The U.S.’s age-adjusted mortality rate shot up 16% in 2020 from the year before, the highest point since 2003. This also broke a 90-year streak in which the yearly death rate was always lower than 10 years earlier. A communicable disease became the third-leading cause of death in 2020, trailing heart disease and cancer. It is the highest level deaths from infections have ranked in 83 years. Since 1900 improved hygiene and sanitation, antibiotics, vaccines and falling smoking habits (meant) Americans began living longer. (But) in 2020, U.S. life expectancy declined by a year. "We will see an enduring, measurable impact from Covid on age-adjusted mortality and life expectancy for a while."Deaths from the Covid-19 pandemic are causing an extraordinary jolt in the U.S., inflating the nation’s death rate to the highest level seen in nearly two decades.
Whether the U.S. will quickly snap back to pre-pandemic levels following a mass-vaccination effort remains to be seen. Daily Covid-19 deaths are on their way back down, but the disease is unlikely to disappear, and health experts say there could also be long-running effects from issues like missed cancer screenings, a surging rate of drug overdoses and health inequities exacerbated by the pandemic.
“I imagine there will be lingering effects after 2021 just because this has taken such a toll on people’s health, both directly and indirectly,” said Noreen Goldman, professor of demography and public affairs at the Princeton School of Public and International Affairs.
The U.S.’s age-adjusted mortality rate shot up by about 16% in 2020 from the year before, according to provisional data from the Centers for Disease Control and Prevention, marking the highest point since 2003. This also broke a 90-year streak in which the yearly death rate was always lower than it was 10 years earlier.
U.S. deaths per 100,000 people
1980
1,039
2000
869
Highest rate
in 17 years
2020
829 deaths
2019
715
Note: Figures are age adjusted and 2020 is provisional.
Source: Centers for Disease Control and Prevention
The age-adjusted mortality rate measures deaths in the U.S. per 100,000 people while taking into account the age distribution of the population. On a yearly basis, 2020’s death-rate surge was the biggest since the 1920s, when disease outbreaks often caused fluctuations, and the devastating 1918 flu pandemic before then.
Suddenly, a communicable disease became the third-leading cause of death in 2020, trailing only heart disease and cancer. It is the highest level that deaths from infections have ranked in 83 years, marking abrupt changes to patterns of how long people live and how they die.
Covid-19 vaccines are already tamping down U.S. infections and promise to restore some normalcy. Some researchers think the death rate will return closer to pre-pandemic levels, perhaps as soon as next year, because it takes significant changes to shift trends in a nation of 330 million people. Yet health experts say Covid-19 may also cast a long shadow.
“There’s no guarantee we get back to our baseline rates,” said Derek Chapman, interim director at the Virginia Commonwealth University Center on Society and Health.
As more people died during the pandemic, life expectancy fell, provisional CDC data show. In the first half of 2020, the agency estimated that U.S. life expectancy at birth had declined by about a year since 2019, to 77.8 years. The agency hasn’t released full-year data, but the impact is expected to worsen.
“I expect it’s likely two years or more once we add the rest of the data,” said Robert Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. The decrease will largely depend on the age patterns of deaths in the second half of last year, he said.
U.S. life expectancy at birth
2019
78.8
First half of 2020
77.8 years
Lowest level
in 15 years
2000
76.8
1980
73.7
Note: Figure for 2020 is estimate based on provisional data from January through June 2020.
Source: Centers for Disease Control and Prevention
CDC records going back to 1900 show influenza, pneumonia and tuberculosis often ranking among the top causes of death early in the century. Improved hygiene and sanitation, treatments such as antibiotics and the widespread use of vaccines eventually drove down infections and deaths, and Americans began living longer. The focus started to shift to more chronic conditions such as heart disease and cancer.
Falling smoking rates, other prevention and new treatments helped improve Americans’ health, and big swings in the mortality rate became more rare as deaths from infections generally became less common. The HIV epidemic disrupted this trend when it emerged as a high-ranking cause of death in the 1980s and 1990s.
The rate has historically trended lower over time, though it had stagnated in recent pre-pandemic years due to stalled progress against heart disease and surging drug-overdose deaths, among other factors. Uneven access to care in the U.S. also impedes progress, researchers say.
Then came Covid-19, which the CDC has linked to about 384,000 deaths in the U.S. last year, and which exacted an even steeper toll when accounting for excess deaths, or deaths that exceeded averages from recent years.
A combination of deaths that weren’t properly attributed to Covid-19, plus collateral damage from issues like people avoiding hospital trips for other health problems, are part of the pandemic’s true toll, researchers say. As with known Covid-19 deaths, the surge in excess deaths has hit communities of color particularly hard.
According to CDC data, about one in three deaths among Hispanic people in 2020 were excess deaths, or those exceeding recent averages. About one in four deaths among Black people were excess, and about one in eight among white people were excess.
Marc Gourevitch, who chairs the Department of Population Health at NYU Langone Health in New York City, says the nation could continue to struggle with widened health inequities that Covid-19 inflamed beyond the pandemic.
“I think it’s quite possible we will see an enduring, measurable impact from Covid on age-adjusted mortality and life expectancy for a while,” Dr. Gourevitch said.
While the CDC has thus far measured a decline of a year across the population, Black men lost three years, pulling their life expectancy at birth down to 68 years, the CDC said. For white women, the loss was 0.7 years, pulling their life expectancy to less than 81 years.
U.S. life expectancy at birth, by race, ethnicity and gender
Total U.S. population
Male
Female
Black*
Lost 3 years
Hispanic
Lost 2.4 years
White*
Lost 0.8 years
Black*
Lost 2.3 years
Hispanic
Lost 1.1 years
White*
Lost 0.7 years
Lost 1 year
2019
’20
84.4
83.3
81.3
80.6
Total U.S.
population
78.8
years
79
78.1
77.8
76.6
76.3
75.8
Life-expectancy gap
75.5
71.3
68.3
*Non-Hispanic
Note: Figures for 2019 race and ethnicity are not final. Figures for 2020 are estimates for the first half of the year based on provisional data from January through June 2020.Source: Centers for Disease Control and Prevention
The pandemic’s enduring effects could include health implications for those who lost their jobs, or complications for people who weren’t able to care for their chronic medical problems during the pandemic and are now more exposed to potentially serious complications, health experts say.
New survey data from the American Diabetes Association show nearly a quarter of adults with diabetes reported challenges managing their blood glucose during the pandemic, and 17% reported developing new complications such as high blood pressure and heart problems. Poorer disease management can lead to serious health consequences, including kidney problems, nerve damage and amputation, said Robert Gabbay, the association’s chief science and medical officer.
Another concern is that Covid-19 could compromise the health of some survivors of infections enough to ultimately shorten their lives, and many people have experienced pervasive and sometimes debilitating symptoms months after their initial infections. Epidemiologists also expect the virus to continue to circulate in the U.S. and cause some degree of cases and deaths, even after the immediate crisis.
Meantime, screenings for breast, colorectal and prostate cancers were also pushed back as Covid-19 took hold, particularly in the earliest pandemic months, raising another longer-term risk for some patients. One recent study in JAMA Oncology estimated that there were 9.4 million missed screenings for those cancers in 2020 across the U.S.
“Even if you completely stop screening for six months, people who might have presented with an early stage cancer are presenting with a cancer that is a little bit more advanced,” said Deborah Schrag, chief of the division of population sciences at Dana-Farber Cancer Institute.
Dr. Schrag and some other population health researchers say that they still expect the national death rate to return to more normal-looking levels as Covid-19 deaths recede. But that doesn’t mean the pandemic’s impact will disappear.
“What the challenge will be is being able to quantify those lingering effects,” said Heidi Brown, an associate professor in the epidemiology and biostatistics department at the University of Arizona. “They won’t be as dramatic, but that doesn’t make them any less real.”
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