Howe: US Death Rate Rose by 15% in 2020

03/16/21 08:28AM EDT

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Howe: US Death Rate Rose by 15% in 2020 - 3 16 2021 8 25 21 AM

Covid-19 triggered a 15% estimated spike in the mortality rate for 2020, according to the CDC. This jump would mark the largest single-year increase since 1918. (Politico)

NH: Politico is among several news sources delivering a pre-publication "scoop" on a report by the CDC's Morbidity and Mortality Weekly Report (MMWR) that will be officially released later this week. 

The CDC is expected to say that U.S. age-adjusted deaths per 100,000 persons rose by +15%, from 715 in 2019 to about 822 in 2020.

Some news outlets are leading with headlines screaming that 2020 was "Deadliest Year in U.S. History." Well yes, that's true but also without significance--because the total number of deaths rises almost every year. The growing size of the population now adds about +0.5% each year to the raw death count, and the aging of the population adds another +1.5%.

The declining trend in the age-adjusted death rate, due for example to improvements in lifestyle or health-care technology, is seldom enough to overcome this margin. And over the last decade, in fact, such improvements have ground almost to a halt. (See "Death Becomes Us... Mortality Increases.")

So let's run some numbers. In 2019, there were 2.854 million total deaths. Growing that by trend to 2020 and assuming no change in age-adjusted mortality, we get to 2.911 million deaths. So using that number as a baseline, we can calculate the impact of a 15% rise in age-adjusted mortality: That would take us to 3.348 million deaths in 2020. Which is about 437K more than we would have otherwise expected.

Sounds very plausible to me. The CDC calculation of "excess deaths" in 2020 over the 2017-2019 average is +528K. That would work out to +440K once we adjusted for the expected population-and-aging effect, implying a +15.1% rise in the mortality rate. So we could have accurately estimated the results of the new MMWR report on the basis of data that have been available for weeks!

Of the total (+15%) increase in the mortality rate in 2020, 13% of it (or +378K) is accounted for by excess deaths "related to" Covid-19. That leaves another 2% (+59K) unexplained.

How can we explain these unexplained deaths? One easy hypothesis (which I have explored in my Covid Report) is that these are Covid-related deaths that simply weren't diagnosed or verifiable for the coroner's reports. This would imply that actual Covid-19 deaths have been running about 15% higher than official Covid-19 deaths--which is at the low end of a range of undercount margins that we have seen in many other high-income countries with comparable health-care systems.

But there are other explanations. Mortality from other causes probably shifted in 2020. Mortality from drug overdoses almost certainly rose significantly. On the other hand, mortality from motor-vehicle accidents and other respiratory diseases (like influenza) almost certainly declined.

Time will tell how the CDC will parse the statistics. It could well be that the Covid-19 undercount was higher than 15% and that the death rate from other causes actually declined.

As I wrote earlier with respect to the 2020 decline in life expectancy ("In First Half of 2020, U.S. Life Expectancy Fell by One Year"), the final life expectancy figure for all of 2020 is likely to take America back to where it was 2002, 18 years ago. Similarly, the final age-adjusted mortality figure for 2020 is likely to take us back to where we were in 2003, 17 years ago.

Howe: US Death Rate Rose by 15% in 2020 - March15

Now let's return to a question I raised earlier. In what sense is the 2020 mortality hike a historical record other than the absolute number of deaths? 

If you want to count the absolute number of pandemic-related U.S. deaths, 2020 was about the same at 1918: about 500K. Since the U.S. population was less than one-third of what it is today, of course, the Spanish Influenza represented a one-year mortality hike over 3X as large. But since the total mortality rate in 1917 was roughly 3X larger than it was in 2017, it could be argued--especially if we start from the already-elevated rate in 1917--that the percentage increase in the rate for that year was a bit less than it was in 2020.

Such are the games you can play with numbers.

IMO, percentage changes in percentages have questionable meaning. The Spanish Flu was clearly much worse than Covid-19 by any relevant per-capita measure.

That deadly scourge, which came mostly in the fall and winter of 1918, was made even grimmer by the youth of its victims--the median age of death was in the mid-30s, not (as with Covid-19) in the late-70s. And we're not even counting the horrors of World War I that spring and summer, which killed another 50K+ American doughboys on the battlefield.

The toll of Covid-19 in 2020 was bad enough. We don't need to make it worse than it was.

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Neil Howe is a renowned authority on generations and social change in America. An acclaimed bestselling author and speaker, he is the nation's leading thinker on today's generations—who they are, what motivates them, and how they will shape America's future.

A historian, economist, and demographer, Howe is also a recognized authority on global aging, long-term fiscal policy, and migration. He is a senior associate to the Center for Strategic and International Studies (CSIS) in Washington, D.C., where he helps direct the CSIS Global Aging Initiative.

Howe has written over a dozen books on generations, demographic change, and fiscal policy, many of them with William Strauss. Howe and Strauss' first book, Generations is a history of America told as a sequence of generational biographies. Vice President Al Gore called it "the most stimulating book on American history that I have ever read" and sent a copy to every member of Congress. Newt Gingrich called it "an intellectual tour de force." Of their book, The Fourth Turning, The Boston Globe wrote, "If Howe and Strauss are right, they will take their place among the great American prophets."

Howe and Strauss originally coined the term "Millennial Generation" in 1991, and wrote the pioneering book on this generation, Millennials Rising. His work has been featured frequently in the media, including USA Today, CNN, the New York Times, and CBS' 60 Minutes.

Previously, with Peter G. Peterson, Howe co-authored On Borrowed Time, a pioneering call for budgetary reform and The Graying of the Great Powers with Richard Jackson.

Howe received his B.A. at U.C. Berkeley and later earned graduate degrees in economics and history from Yale University.

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