STUMP » Articles » Mortality with Meep: Cause of Death Trend -- Cancer -- 1999-2020 » 5 August 2021, 20:05

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Mortality with Meep: Cause of Death Trend -- Cancer -- 1999-2020  

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5 August 2021, 20:05

Ultimately, I will have a list of causes-of-death posts, so let me start a list now. Later, I will go back and update all the posts with links to the entire series:

I plan on covering accidental causes (falls, overdoses, car crashes), homicides, suicide, diabetes, and Alzheimer’s. I may cover additional causes, but those are the main ones I want to dig into.

For cancer, here is the tl;dr version: the pandemic had no effect on cancer death rates.

Isn’t that interesting?

The changes I show in the graph above are for changes in the number of deaths from 2019 to 2020. When we dig into the age-related rate changes, we’ll see that yeah, there basically were no changes.

Video: looking at the cancer death trend

Here ya go:

What is below are the items I looked at in the SOA (Society of Actuaries) report on death trends in the U.S. as well as the CDC dashboard on preliminary death statistics for 2020-2021.

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

I’m using the June 2021 update on U.S. 2020 mortality data from the SOA study. Here is table 3, which gives us the age-adjusted death rate:

You can see that while the number of deaths was a wash (as I noted above), the age-adjusted death rate due to cancer decreased 1.7% in 2020.

That’s pretty good. It also shaved off from the excess mortality in 2020, which is also good.

So yay! Cancer deaths (on an age-adjusted basis) were down in 2020!

To be sure, cancer deaths could have been down because other things were killing off cancer patients, but that’s true of any of the causes of death.

As I wrote in my latest update on Stu’s cancer status, when you’ve got incurable cancer, you hope you live long enough that something else kills you. To be sure, some of the treatments of cancer as a chronic condition will kill you (such as giving you a heart attack), but the oncologists don’t like that, either. I don’t want to go down that rabbit hole, especially since I don’t know how they write down “the treatment for your cancer killed you” — is it counted as a cancer death?

That’s all irrelevant, though — the question is whether cancer patients were killed off by COVID instead, which would explain why cancer deaths were down… but I don’t think that’s true. I’ll come back to that.

Here is table 4 from the report, which gives quarterly trends:

Improvements every quarter for cancer. Sounds great to me. If you look at other causes, there may have been reductions in Q1, before COVID fully hit, but many of the other causes saw increases 2020Q2 – 2020Q4.

Changes in cancer deaths by age range

Let’s drill down by age group.

I may have mentioned this before, but while cancer is only the #2 cause of death in the U.S. by count, after heart disease, it’s usually the top cause for middle-aged people (like, my age. And Stu’s age.)

There’s less of an age differential in cancer death rates than there is for heart disease.

Anyway, let’s check out the SOA’s graphs. Here’s the long-term trend of cancer deaths by age group:

As with heart disease, we see improvement at all ages, but the percentage improvement is not as high with cancer as it was with heart disease.

One of the biggest things, though, is how death rates go up by age group. I will use 2020Q1 cause of death rates to make comparisons, as these are in the SOA report, and the COVID impact didn’t come fully until 2020Q2.

Heart disease death rate for those aged 85+ was 3766 per 100K, and those aged 75-84 was 986. That’s a ratio of 3.8.

Cancer deaths for those aged 85+ was 1562 per 100K, and those aged 75-84 was 1004. That’s a ratio of 1.6.

Two things to note:

  • Cancer death rate for those age 75-84 was higher than the heart disease death rate for the same group
  • Heart disease death rates climb much more rapidly than cancer death rates by age

That held before the pandemic.

Let’s look at cancer deaths quarter-to-quarter:

I don’t want to read too much into this, but given that cancer is the #2 cause of death overall, looking at quarterly fluctuations does have meaning. Cancer deaths decreased in the second quarter of 2020, were flat over most of the ages in the third quarter, and decreased again in 2020Q4.

Now, the big peaks of COVID deaths were in Q2 (centered around NYC) and Q4 (over the entire U.S., and peaking in 2021Q1). It killed old folks, mainly, and we’re seeing the largest decreases for cancer deaths among the old folks.

Maybe cancer deaths went down when COVID was peaking, as COVID killed off cancer patients, instead of the cancer.

CDC dashboard on cancer

Here is the CDC dashboard (right now, not when I made the video) showing the cancer death trend for 2020 and 2021 compared to recent years:

squint

I don’t really see anything. It’s completely flat.

Yes, there are some small differences over the quarters in 2020, but we didn’t look at the kinds of quarterly fluctuations that may occur in improvement in prior years. Frankly, it looks like COVID had no effect on cancer deaths, at least in the short term.

One piece of good news

As we can see from the above, it looks like cancer deaths weren’t affected by COVID at all, in terms of responses to the pandemic.

In my own personal experience, Stu’s cancer care was not interrupted at all by COVID (it was interrupted by a change in insurance coverage, but that may have been a switch for the good, as he had to change care providers, and they were more willing to listen to him about changing certain aspects of his treatment regimen.)

Stu did talk with the nurses and doctors about what was going on with the cancer patients, and yes, there were telehealth appointments that they did, and the locations of certain treatments were moved from the hospital to private doctors’ offices (which may have been cheaper anyway.) Stu was one of the few people showing up at the hospital in the early months, but it didn’t sound like anybody was missing treatment.

I do know that lots of cancer screenings were missed last year, as health care usage outside of COVID dropped precipitously, but for certain types of cancer, it’s iffy that screening necessarily is efficacious in reducing cancer death rates absent risk factors or symptoms. Lots of false positives out there, which have their own costs. Cancer screening recommendations are contentious for that reason — a true risk analysis has to include the costs of false positives, and at certain ages (or lack of symptoms or risk factors) the probability of false positive is much higher than the probability of a true positive.

In any case, it is good to see that at least one major cause of death was unaffected.


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