STUMP » Articles » Mortality with Meep: Cause of Death Trend -- Heart Disease -- 1999-2020 » 26 July 2021, 18:12

Yes, I haven’t posted in a bit. This may explain. I cannot promise any particular publication schedule, alas. I never know when the pain will hit.

As mentioned in this post, U.S. Life Expectancy Fell 2.4% in 2020, and Death Rates Increased 16.1%, I want to address what happened with some of the major causes of death in 2020.

The causes of death in the following are in the order of magnitude (excluding COVID, of course, which came in as number three, after heart disease and cancer).

Heart disease has been the primary cause of death in the U.S. for decades. Another time, we can look at when heart disease surpassed infectious disease as the top cause of death in our past. Also, we can think through cancer being the top cause of death in the future, as heart disease deaths have been dropping more rapidly than cancer deaths.

Video: looking at the heart disease death trend

Here is my video on the mortality trend for death by heart disease, with a particular focus on 2020:

Here are my sources — the Society of Actuaries study (which used CDC data): Society of Actuaries study: U.S. Population Mortality Observations, Preview of 2020 Experience – June 2021 Update

CDC’s dashboard: Excess Deaths Associated with COVID-19

SOA study: trends by year, quarter, and age group

Let me pull out specific tables/exhibits from the Society of Actuaries study as linked above.

First, the top-level age-adjusted death rates by cause of death, year-over-year changes for 2019 to 2020:

As you can see, heart disease is the top age-adjusted cause of death at 167 per 100,000 people, for 2020. That is a 3.4% increase over 2019.

Next, let’s look at how this changed quarter-over-quarter:

In the upper left-hand corner, we see that for 2020Q1, age-adjusted death rate by heart disease saw a slight decrease. Given that this is comparing full-year 2019 against 2019Q2 through 2020Q1, that means there is an overlap of 2019Q2 through 2019Q4. We’re really comparing 2020Q1 against 2019Q1.

The long-term trend has been one of decrease, so yay. But we see that for 2020Q2, 2020Q3, and 2020Q4, we get increases each quarter for the entire United States.

Changes in heart disease deaths by age range

Let’s drill into what we can see by age range:

The long-term trend has been improvement for this cause of death, with it most obvious for the oldest age groups. This trend has been driven by improvement in medical treatment for the condition, but also due to the decrease in smoking rates… decades ago. Some causes of death have behavior that precede the death by decades, which can get tricky to track for our top two causes of death: heart disease and cancer. Even so, smoking cigarettes has been a huge driver for both these causes, and made a large differentiator by sex and smoking status for a long time.

Here is a more detailed graph and table for 2020, quarter-by-quarter:

As I pointed out in the video, the greatest increases were seen in the youngest adult age groups with appreciable deaths by heart disease, that is, those age 45-54 years old.

CDC dashboard on circulatory diseases

Here is the CDC dashboard (right now, not when I made the video) showing the circulatory disease death trend for 2020 and 2021:

Notice that spike in deaths due to ischemic heart disease (aka heart attacks), centered in April 2020. I am willing to bet that many of those were due to blood clots directly caused by COVID.

To a certain extent, heart attacks may increase due to lack of health care, but these are acute incidents, as opposed to slower ways of dying, like cancer. Maybe some people were too scared to go to hospitals for fear of catching COVID… and died of their heart attack instead.

That said, the magnitude of change in the first spike makes me think of undiagnosed COVID — heart attacks can be caused due to a blood clot lodged in a cardiac artery… just like strokes could spike (aka cerebrovascular diseases) due to a blood clot traveling into a key artery into the brain.

As noted in the video, I want you to see that not all circulatory diseases were elevated in 2020 (or 2021) — congestive heart failure was flat. That’s a slower way of dying, and more women suffer this condition than men.

It is good to note the differences in official causes of death (and note – these dashboards are based on “underlying causes of death” – as with The Highlander, there can be only one for each death.)

Coverage to come

I will be looking at other causes of death, trying to do a similar analysis as I did for heart disease.

As noted in the video, here are key items I want to cover:

• Cancer: no effect from COVID (as far as I can tell)
• Diabetes: increased deaths… was it due to COVID directly, or lack of medical care?
• Alzheimer disease: increased — again, was it really COVID or due to nursing home policies
• “External causes” — breaks out into accidents (which further breaks out into: falls, transport accidents, drug overdoses), homicides, and suicide — very complicated changes in these, almost all due to policy and not directly due to COVID

In all of this, I am trying to just capture what happened, and maybe a little bit of why it happened.

But this is not (yet) an argument over the balancing of priorities that comes in setting public policy. I have my own opinion on preferred public policy, but unless we can really see what the trade-offs were, it is difficult to think through what we should do now.

I do not (necessarily) blame people for making flawed decisions under limited knowledge.

But as we get more knowledge, the trade-offs should become more clear.