The COVID pandemic and worsening health of American young adults

The CDC has just published provisional mortality data for 2021. Here are the key takeaways:

(1) Despite the general availability of a free vaccine that radically reduced the risk of dying from COVID-19, approximately 76,000 more Americans died from the disease in 2021 (460,513) than in 2020 (384,536). The age-adjusted mortality rate from COVID increased by 19.5% between 2020 and 2021.

(2) Because of this, age-adjusted mortality in the population as a whole rose from 835.4 to 841.6 per 100,000, rising to approximately the same level last seen in 2003. (It was 715.3 in 2019).

(3) These general statistics obscure some striking age-related demographic differences in regard to what happened with COVID in 2021 compared to 2020.

Note that the majority of deaths in the population occur among people 75 and older. Yet overall, mortality rates declined quite a bit in this demographic. Among people 85 and older, mortality rates declined by 9%, with 72,000 fewer Americans in this age cohort dying in 2021 as compared to 2020. They also declined slightly among 75-84 year olds, by 2.3%. (These stats reflect the very high vaccination rates among the elderly).

If the majority of deaths are among the elderly, and mortality rates declined markedly in this cohort, how is it that mortality rates for the population as a whole rose? The answer of is that, in percentage terms, mortality rates rose moderately among the middle aged, and quite sharply among young adults (Mortality rates among infants and children have remained essentially unchanged over the past three years, as neither COVID nor its secondary effects have had any discernible mortality effect in these cohorts).

Mortality rates in 2019, 2020, and 2021 by age group. Figures are per 100,000:

85+: 13,229/15,211/13,826

75-84: 4308/4997/4883

65-74: 1765/2072/2148

55-64: 883/1039/1132

45-54: 392/474/539

35-44: 199/248/292

25-34: 129/160/179

To get a sense of what these figures mean in longitudinal/historical terms, here is the last year in which the mortality rate in a particular age group was approximately the same as it was in 2021.

85+: 2010

75-84: 2009

65-74: 2004

55-64: 1994

45-54: 1984

35-44: 1973

25-34: 1950

Yes that last figure is correct: the last time the mortality rate for 25 to 34 year olds in the US was as high as it was last year was in the middle of Harry Truman’s presidency.

COVID mortality rates skyrocketed among young and middle-aged adults in 2021, doubling among 45-54 year olds, increasing by two and half times among 35-44 year olds, and tripling among 25-34 year olds. Nevertheless, COVID deaths, or at least official COVID deaths, played a fairly small role in the massive jump in mortality rates among young adults. For example, between 2019 and 2021 mortality rates among 25-34 year olds increased by nearly 40%, but COVID deaths accounted for only about 30% of this increase (I haven’t crunched the numbers but I suspect increases in drug and alcohol-related deaths accounted for a greater share of the increase).

As for ethnic factors, COVID continues to hit Hispanic and Black Americans much harder than non-Hispanic whites (COVID mortality rates for the three groups in 2021 were 158, 147, and 101 per 100,000 respectively.)

Nevertheless, overall age-adjusted mortality rates for both Hispanics and Blacks declined modestly in 2021 (from 724 to 700 and 1119 to 1081 respectively), while increasing among non-Hispanic whites, from 835 to 852. (All per 100,000). In all three cases, the declines and increases are accounted for by declining (among Hispanics and Blacks) and increasing (among non-Hispanic whites) COVID mortality rates.

Currently the CDC estimates the US has seen 1.14 million excess deaths since February of 2020. This is a pretty conservative estimate, as it uses average mortality rates over the five years prior to the pandemic as the baseline for measuring excess deaths, instead of using the declining trend in age adjusted mortality prior to the pandemic (age-adjusted mortality declined by 2.5% over this period). Using the latter baseline suggests that we’ve seen about 1.2 to 1.25 million excess deaths over the last 25 months.

It’s becoming increasingly clear that a significant portion of those excess deaths — and especially the excess deaths among the young adults — have not been caused directly by COVID, but rather by its indirect effects, as well as by other societal factors that have led to what should be considered a shocking increase in the death risk faced by young adults in this country.