Excess Deaths Beyond the Pandemic
This week I want to touch base on a very sensitive topic, which is excess death in the US, or some researchers call this, missing Americans.
When you hear excess death, you may think about excess deaths associated with COVID in the last two years. You are not wrong. You may have also seen some news articles relating excess COVID death to political views. Let me make my stand clear here; I am here to discuss medical facts only.
It is not a myth that COVID has caused many excess deaths in the US. In fact, excess deaths of Americans have been trending up even before the pandemic.
A pre-print study from a researcher from the California Center for Population Research at UCLA looked at the excess mortality in the US relative to its European peers between 2017 and 2021.
The author used publicly available data from the Human Mortality Database, Short-term Fluctuation Series, to calculate the annual estimates of excess mortality.
(https://www.mortality.org/Data/STMF)
The annual number of excess deaths has doubled between 2017 and 2021, with most of the increase occurring during the pandemic.
(https://www.medrxiv.org/content/10.1101/2022.03.21.22272722v3.full.pdf)
We tend to think COVID is more deadly to older people and people with comorbidities. That’s true from the COVID disease standpoint.
But the pandemic is not the primary reason for excess deaths. More than half of the excess death in 2021 were people between 15 to 64. This is an age group with a far lower COVID fatality regardless of vaccination status.
One pre-print article is never enough to be evidence.
Another pre-print from a renowned epidemiologist, Jacob Bor, from Boston University School of Public Health, and his colleague performed a much more in-depth analysis. They looked at excess deaths in the US from 1933 to 2021 using data from the Human Mortality Data Base and CDC.
(https://www.medrxiv.org/content/10.1101/2022.06.29.22277065v2.full.pdf)
They reported an increase in excess death since the beginning of the 21st century, with a sharp increase since the beginning of the pandemic. Similar to the previous study, they also saw that the US has a much worse excess death than other industrial countries. They estimated 626,000 excess American deaths by 2019, and COVID has bought the number to over 1 million.
The most alarming signal is also the excess death in working-age adults. 1 in 2 of the excess death in 2021 was under age 65. This is in agreement with the previous study as well.
These two studies tell us that the US is doing a better job in preventing excess death in people over 65 but a lousier job in preventing excess death in the younger population.
Certainly, there is public health policies related reason for such tragedy. While we could do something to change by voting, most of these changes would be too slow to make individual differences. Again, we are not here to debate government policies.
So, what could be the reason for so many excess deaths in people under 65?
According to two articles published in JAMA in late 2020 and mid-2021. Opioid drug overdose was the leading cause during the early phase of the pandemic.
(https://jamanetwork.com/journals/jama/fullarticle/2774445)
(https://jamanetwork.com/journals/jama/fullarticle/2780436)
Another article published just a few days ago, on November 1st, suggested that between 2015 and 2019, 1 in 8 deaths among adults aged 20 to 64 and 20% aged 20 to 49 were due to excessive alcohol consumption.
(https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798004)
The number of deaths involving alcohol continued to increase between 2019 and 2020, up from 2.8% of all deaths in 2019 to 3% in 2020.
(https://jamanetwork.com/journals/jama/fullarticle/2790491)
We have all experienced the lockdown, and many people lost their job as a result. Could that be related? That’s certainly something worthy of more investigation.
The National Academies of Sciences, Engineering, and Medicine also published a book-length report on high and rising mortality rates among working-age American adults with data collected before the pandemic. This book is free to download; I have the link in the description box.
US life expectancy began to fall in 2014 and continued through 2017. The main reason was the increase in mortality among middle-aged and younger adults aged 25 to 64.
Substance use was one of the reasons.
The report also focuses on rising deaths from cardiometabolic diseases, such as diabetes, high blood pressure, and heart disease, which are health consequences of the obesity epidemic.
Adults aged 24 to 44 have been especially affected because most were born after 1980, when the obesity epidemic began.
To quickly sum up, I don’t mean that COVID is not contributing to the excess death we see in the country, but there is a bigger picture that seems to have been mostly negated in the past two years. When we talk about losing a year or two in life expectancy, it may not look like a big deal, but it means a lot more younger people were dying prematurely to decrease the average life span in the population. That is a serious problem.
While there is little, we can do to change health policies. Our health is in our hands. We can make healthy choices. I am not saying we need to buy everything organic. But we can be conscious in choosing daily sugar and fat intake and balance our diet with adequate physical activities.
