STUMP » Articles » Silent Generation Has Odd 2021: COVID Over 100% of 2021 Mortality Increase Compared to 2019 in the U.S. for those over age 85 » 21 August 2022, 19:35

Yes, you read that correctly.

For the “Silent Generation”, the group age 80 and over, mortality actually was better in 2021 than 2020, unlike all the other adult groups.

To be sure, 2021 was still worse than 2019 for those 80 and over, but all the other adult age groups in the U.S. saw a noticeably worse 2021, mortality-wise, than 2020. Not for the oldest of seniors. It actually got a little better in 2021.

Also, when you look at the COVID deaths in 2021, subtract that mortality off, and then compare that against 2019…. it’s well below 2019 levels for those aged 85 and over. Huh.

There are only two age groups at this level where the CDC will give rates: 80-84 years and 85+. Above age 85, the population estimates get a little iffy… it thins out rapidly.

If you look at that vertical scale for the graph above, you see that the age 85+ line is around 15,000 in 2020 — that’s a 15% mortality rate. That’s a fairly high probability of death. Above age 85, mortality climbs rapidly.

Age 80-84

Long-term trend 1999-2021

Here you see Alzheimer’s disease as a fairly prominent cause of death, though smaller than heart disease and cancer. It’s about the same magnitude as stroke.

COVID is substantial as a cause of death, and is smaller only than heart disease and cancer.

I do want to note the good mortality improvement from 1999-2019, a 23% decrease over the 20 years.

Attribution of increase in mortality, 2020-2021:

Unlike with the younger age groups, where the causes of death with negative contributions were unsubstantial, there were quite substantial negative contributions for cancer and chronic lower respiratory diseases, so I wanted to make sure those were shown. Some smaller negative contributions also came from motor vehicle accidents and Alzheimer’s disease (only in 2021).

On the positive side, obviously, most of the contribution is from COVID. That’s difficult to miss. Alzheimer’s had some contribution in 2020, heart disease with the same contribution both years, other causes threw in quite a bit (though I couldn’t find anything named that stood out as a single cause, just a bunch of little things that add up).

Basically, COVID. Boom. It’s the same story as Baby Boomers, though an eye on Alzheimer’s may indicate some neglected nursing home patients. That will become important in a moment.

Age 85+

Long-term trend 1999-2021

Interestingly, the mortality improvement in this age group is less than in the 80-84 group, but this makes some sense. The crude rate improved only 15% from 1999-2019.

The reason it makes sense is that, well, the oldest catch-all age group is going to include the age at which all people die… whatever age that happens to be. That will bias the statistic. The crude rate could stay constant while the average age at death increased, indicating mortality improvement — one would need to do an age-adjusted statistic for an appropriate comparison. When I look at the crude rate for 5-year age groups, they don’t get distorted enough for it to make a difference.

This may be difficult to see on the graph, but the Alzheimer’s rate is increasing, while stroke is decreasing, and they crossed over in 2011. Cancer has also been decreasing while Alzheimer’s is increasing. Again, some of this is distorted by the aging of the age 85+ bin. Alzheimer’s increases in incidence with increasing age.

I want you to look at the COVID bars — the COVID bar for 2020 was much bigger than the 2021 bar. Isn’t that interesting?

Also, note that total mortality is lower in 2021 than 2020… and if you removed the COVID bar in 2021, the level would be lower than in 2019.

Attribution of increase in mortality, 2020-2021:

You can see all that in this graph.

The 2020 graph has only one thing kind of interesting: the Alzheimer’s contribution is bigger than what we saw for the age 80-84 group, too. That might explain some things in 2021.

The 2021 graph is very interesting, because we really need to think about what’s going on.

We have so many negative contributions, and they’re quite large. An Alzheimer’s contribution, but negative, about as large in magnitude as the 2020 one. Heart disease, cancer, chronic lower respiratory disease, even other causes! All negative.

There are a few possibilities here, given the delta/omicron wave of 2021. First, we have the “they would have died of something anyway” explanation — that explains why someone who would have died of heart disease died of COVID instead in 2021. Remember, total mortality for the age 85+ group was still higher in 2021 than 2019. It’s just that a bunch of causes of death were also lower than usual, unlike what we saw with other adult age groups.

But let’s think of that increase in Alzheimer’s deaths in 2020 — could be the nursing home deaths of 2020, could be due to neglect during lockdowns and other causes. This could be a “they died earlier, so they couldn’t die later” explanation.

So those are a couple of explanations.

Summary tables of contribution to excess mortality

For 2020

In the first column, I’m indicating how much mortality increased compared to 2019. So for the age 80-84 years group, their mortality increased 16% from 2019 to 2020, and of that increase, 87% is explained by COVID.

I will point out that the two age groups are substantially similar in the relative increases as well as the attribution of causes. There is a small difference in that Alzheimers provides a slightly higher contribution to the increase in mortality for the age 85+ group.

You should note the mortality level roughly doubles between the 80-84 age group and the age 85+ group.

Cancer and chronic lower respiratory disease both provided negative contributions, having gone down a little.

For 2021

And again, now that we see it in table form, we see that chronic lower respiratory disease, heart disease, and Alzheimer’s disease had fairly large negative contributions to the change in mortality for age 85+, to counteract the over 100% contribution of COVID. If it’s the case of medically fragile people died of COVID instead of causes that would have killed them that year or the next, the question can be if this will have effects in short-term mortality trends (see below).

Links to all the mortality posts

These will get updated as I fill in the posts

Young Adults — Age 18-39: approximately the Millennials in 2020-2021 Part 1 and Part 2, plus the podcast
Middle Agers — Age 40-59: approximately Gen X – Middle-aged Massacre (too!): Increase in Mortality for Ages 40-59 in the U.S. for 2020-2021 Mainly Driven By COVID
Young Seniors — Age 60-79: approximately Boomers – Baby Boomer Mortality Experience: Welcome to Old Age! 2020-2021 U.S. Mortality Increase for Ages 60-79 was Mostly COVID
Old Seniors — Age 80+: mainly Silent Generation (as older generations are mostly dead at this point) – this post

What does 2022 and the future hold?

Some people took a stab in this Society of Actuaries survey. A group of actuaries and other mortality experts were surveyed for their forecasts on where U.S. mortality would go in the short-term, both in terms of COVID and non-COVID trends. People came from a variety of areas – life insurance, annuity, pension, and general population mortality experience (these are not necessarily the same thing).

What’s interesting is that people were surveyed between March 11 and March 31, 2022, so this was after we knew about the Delta/Omicron wave at the end of 2021, and many of the people surveyed probably already knew the results for their own companies even if not for the whole insurance industry or pension plans.

In the survey, people were given what the 2020 actuals had been, but not what it was for 2021.

This is what the survey said:

I may come back to this, to compare against what actually happened for 2022 once we find out next year.

I will only note that age 45 had higher excess mortality in 2021 than age 25, due to the combination of drug overdoses and COVID.

But it will be interesting to see what happens with the elderly mortality trend if the “dry tinder” trend happens to have been the situation, that the most vulnerable seniors died in 2020 and 2021, such that mortality may be lower in 2022 for those groups. The 2021 result for age 85+ wasn’t exactly what we were expecting.

Methodology

Data for deaths in 1999-2020 had been taken from the CDC WONDER Online Database for Underlying Cause of Death, finalized data. Citation: Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Mortality 1999-2020 on CDC WONDER Online Database, released in 2021. Data are from the Multiple Cause of Death Files, 1999-2020, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/ucd-icd10.html on August 21, 2022.

Data for deaths in 2021 had been taken from the CDC WONDER Online Database for provisional mortality data. Citation: Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System, Provisional Mortality on CDC WONDER Online Database. Data are from the final Multiple Cause of Death Files, 2018-2020, and from provisional data for years 2021-2022, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at http://wonder.cdc.gov/mcd-icd10-provisional.html on August 21, 2022.

For cause of death, the ICD-10 113 Cause List had been used, and specific causes of death were used for their significance for these specific age groups. If this is on substack, you can download the accompanying spreadsheet to see the specific cause of death codes from the list of 113, and that they were non-overlapping. There was a catch-all “other causes” category used.

To measure the increase in mortality, a comparison against the year 2019 was used.

In all cases, crude death rates (based on population estimates provided in CDC WONDER) are used as provided by the CDC, using the standard rate per 100,000 people per year.

It is to be noted that some of the causes of death showed a decrease in rate in 2020 and 2021 compared to 2019 (most notably, cancer), and in some cases, these were substantial decreases.