Tag: excess mortality

The future of excess mortality after COVID-19

Mary Pat Campbell

Link: https://www.swissre.com/institute/research/topics-and-risk-dialogues/health-and-longevity/covid-19-pandemic-synonymous-excess-mortality.html?utm_campaign=CPN-2181_mortality-2024_Group_GLOBAL_2024&utm_medium=Other_Organic&utm_source=LinkedIn&utm_content=Health_N/A_Publication_EN&utm_term=excessmortality

Graphic:

Excerpt:

Four years on from the outbreak of the pandemic in 2020, many countries worldwide still report elevated deaths in their populations. This impact appears generally independent of healthcare systems and population health. This trend is evident even after accounting for shifting population sizes, and the range of reporting mechanisms and death classifications that make inter-country comparisons complex. There is also likely a degree of excess mortality under-reporting.

Quantifying excess mortality has been an acute challenge since 2020 due to the exceptional mortality rates of the pandemic. Excess mortality refers to the number of deaths over and above an assumed “expected” number of deaths. The different methods of estimating expected mortality can generate very different excess mortality rates.

This represents a potential challenge for Life and Health (L&H) insurance, with potentially several years of elevated mortality claims ahead, depending on how general population trends translate into the insured population. Ongoing excess mortality can have implications for L&H insurance claims and reserves. Excess mortality that continues to exceed current expectations may affect the long-term performance of in-force life portfolios as well as the pricing of new life policies.

Author(s): By Daniel Meier, Life & Health R&D Manager, CUO L&H Reinsurance & Prachi Patkee, Life & Health R&D Analyst, CUO L&H Reinsurance & Adam Strange, Life & Health R&D Manager, CUO L&H Reinsurance

Publication Date: 16 Sept 2024

Publication Site: Swiss Re Institute

U.S. Deaths Still 7% Over Pre-COVID Norm in Q2

Mary Pat Campbell

Link:https://www.thinkadvisor.com/2024/08/12/u-s-deaths-still-7-over-pre-covid-norm-in-q2/

Excerpt:

What You Need to Know

  • General-population mortality trends may differ from trends for people with life insurance and annuities.
  • The total number of first-half deaths was about 110,000 higher than the first six months of 2019.
  • One group would like to see life insurers use voluntary screening tests to learn more about mortality trends.

Author(s): Allison Bell

Publication Date: 12 Aug 2024

Publication Site: Think Advisor

Mortality in the United States — Provisional Data, 2023

Mary Pat Campbell

Link: https://www.cdc.gov/mmwr/volumes/73/wr/mm7331a1.htm?s_cid=mm7331a1_w

Graphic:

FIGURE 1. Provisional* number of COVID-19–associated deaths† and other deaths and percentage of deaths associated with COVID-19, by week of death — National Vital Statistics System, United States, 2023

* National Vital Statistics System provisional data for 2023 are incomplete. Data from December 2023 are less complete because of reporting lags. These data exclude deaths that occurred in the United States among residents of U.S. territories and foreign countries.

† Deaths with confirmed or presumed COVID-19 as an underlying or contributing cause of death, with International Classification of Diseases, Tenth Revision code U07.1.

Excerpt:

Abstract

Final annual mortality data from the National Vital Statistics System for a given year are typically released 11 months after the end of the calendar year. Provisional data, which are based on preliminary death certificate data, provide an early estimate of deaths before the release of final data. In 2023, a provisional total of 3,090,582 deaths occurred in the United States. The age-adjusted death rate per 100,000 population was 884.2 among males and 632.8 among females; the overall rate, 750.4, was 6.1% lower than in 2022 (798.8). The overall rate decreased for all age groups. Overall age-adjusted death rates in 2023 were lowest among non-Hispanic multiracial (352.1) and highest among non-Hispanic Black or African American persons (924.3). The leading causes of death were heart disease, cancer, and unintentional injury. The number of deaths from COVID-19 (76,446) was 68.9% lower than in 2022 (245,614). Provisional death estimates provide an early signal about shifts in mortality trends. Timely and actionable data can guide public health policies and interventions for populations experiencing higher mortality.

Author(s): Farida B. Ahmad, MPH1; Jodi A. Cisewski, MPH1; Robert N. Anderson, PhD

Publication Date: 8 Aug 2024

Publication Site: CDC, MMWR Morbidity/Mortality Weekly Report

Suggested citation for this article: Ahmad FB, Cisewski JA, Anderson RN. Mortality in the United States — Provisional Data, 2023. MMWR Morb Mortal Wkly Rep 2024;73:677–681. DOI: http://dx.doi.org/10.15585/mmwr.mm7331a1

Mortality Stays Slightly Elevated: Globe Life Exec

Mary Pat Campbell

Link:https://www.thinkadvisor.com/2024/07/30/mortality-stays-slightly-elevated-globe-life-exec/

Excerpt:

Since the COVID-19 pandemic began, in early 2020, Globe Life has been one of the life insurers that’s been quickest to give analysts candid assessments of U.S. mortality.

Mortality is much lower than it was when pandemic-related mortality was peaking, and mortality trends are now helping, not, hurting, Globe Life’s earnings, Kalmbach said.

“Mortality has been fairly consistent over the last few quarters, which has been good,” he said.

He sees the mortality rate from accidents and other nonmedical causes improving.

….

“Heart disease and cancer, although improved, are still a little bit higher,” he said. “Another one that remains elevated as a cause of death is neurological disorders, which would be stroke and Alzheimer’s. We’re keeping an eye on that.”

Author(s): Allison Bell

Publication Date: 30 July 2024

Publication Site: think Advisor

How COVID-19 has Affected Mortality in 2020 to 2023 [Australia]

Mary Pat Campbell

Link: https://www.actuaries.asn.au/public-policy-and-media/our-thought-leadership/reports/how-covid-19-has-affected-mortality-in-2020-to-2023?utm_medium=email&utm_campaign=240722-PPP-How%20COVID-19%20has%20Affected%20Mortality%20in%202020%20to%202023-Members&utm_content=240722-PPP-How%20COVID-19%20has%20Affected%20Mortality%20in%202020%20to%202023-Members+CID_aedad499bf553276132939b99d7a0215&utm_source=Campaign%20Monitor&utm_term=How%20COVID-19%20Affected%20Mortality%20in%20Australia%20from%202020%20to%202023

Graphic:

Excerpt:

There were 8,400 more deaths in Australia in 2023 than predicted had the pandemic not occurred – less than half of the almost 20,000 excess deaths estimated for 2022.

The new Research Paper from the Mortality Working Group explores how COVID-19 affected mortality in Australia from 2020 to 2023 and how Australia’s experience compares with the rest of the world.  

In brief: 

  • The steep decline in excess deaths in 2023 was primarily due to the number of people dying from COVID-19 falling to 4,600 in 2023 from 10,300 in 2022.  
  • While Australia’s excess mortality rate had dropped substantially, it remains significantly higher than the 1-2% excess observed in years of high flu deaths prior to the pandemic.  
  • When analysing the excess mortality of 40 countries from 2020 to 2023, Australia’s excess mortality over the four-year period (5%) was low by global standards (11%).  

Author(s): Mortality Working Group. Members Karen Cutter, Ronald Lai, Jennifer Lang, Han Li, Richard
Lyon, Matt Ralph, Amitoze Singh, Michael Seymour, Zhan Wang.

Publication Date: July 2024

Publication Site: Actuaries Institute

The Hartford Sees High Mortality for the Next Few Years

Mary Pat Campbell

Link:https://www.thinkadvisor.com/2024/04/26/hartford-sees-high-mortality-for-next-few-years/

Excerpt:

Chris Swift, the chief executive officer of Hartford Financial, on Friday confirmed what government statistics seem to be showing: The U.S. death rate continues to be noticeably higher than it was before early 2020, when the COVID-19 pandemic came to light.

Swift talked about the effects of the higher U.S. mortality rate on the company’s group life insurance business Friday during a conference call with securities analysts.

He noted that mortality was much lower in the first quarter than in the first quarter of 2023, but that it was still somewhat higher than the pre-pandemic average.

“The trends are downward,” Swift said. “But we believe that we’re still operating in an endemic state of mortality, which means it’s going to be higher than normal, and we think that will continue for at least the next the next couple of years. We’ve been pricing our product with that view.”

Author(s): Allison Bell

Publication Date: 26 April 2024

Publication Site: Think Advisor

An Iowa farm county seeks answers amid cancer rates 50% higher than national average

Mary Pat Campbell

Link: https://www.thenewlede.org/2024/05/an-iowa-farm-county-seeks-answers-amid-cancer-rates-50-higher-than-national-average/

Graphic:

Excerpt:

Palo Alto’s [County, Iowa] 2022 tally of 842 farms generates nearly $800 million in annual market value. But nearly 400 small farms have been absorbed into bigger operations or otherwise stopped operating over recent decades, and Palo Alto’s population has dropped by 4,200 people since 1970.

Today’s Iowa farms are largely focused on raising hogs and growing corn, both of which are linked to numerous environmental problems. Farmers growing corn, for example, often rely heavily on applications of toxic pesticides and fertilizers, while livestock operations generate millions of tons of manure annually. The chemicals and manure pollute food and water consumed by people even far from farm fields.

When nitrogen from fertilizer and manure combine with oxygen they create nitrates, which routinely drain from farm fields into groundwater, streams, and rivers, contaminating water sources. Babies can suffer severe health problems when consuming nitrates in drinking water, and a growing body of literature indicates potential associations that include an increased risk of cancer. Exposure to elevated levels of nitrates in drinking water has been linked by researchers to cancers of the blood, brain, breast, bladder and ovaries.

As well, there are years of research showing that many herbicides and other pesticides applied to farm fields are linked to cancers and other diseases. The National Cancer Institute and the National Institute of Environmental Health Sciences have been funding research to investigate the links between disease and farming for more than 30 years, focusing their work on people in Iowa and North Carolina. Among the findings are links between pesticides and malignant brain tumors, multiple myeloma, pancreatic cancer and certain breast cancers.

Concerns about connections between the farm pollutants and cancer have been mounting, particularly in Palo Alto County, which had the highest incidence of cancer of any county in the state and the second-highest incidence of cancer among all US counties, with 83 new cases of cancer on average each year, in a population of 8,996, according to a 2023 report by US News.

Author(s): Keith Schneider

Publication Date: 7 May 2024

Publication Site: The New Lede

Excess mortality in England post Covid-19 pandemic: implications for secondary prevention

Mary Pat Campbell

Link: https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00221-1/fulltext#secsectitle0010

DOI:https://doi.org/10.1016/j.lanepe.2023.100802

Graphic:

Excerpt:

Many countries, including the UK, have continued to experience an apparent excess of deaths long after the peaks associated with the COVID-19 pandemic in 2020 and 2021. Numbers of excess deaths estimated in this period are considerable. The UK Office for National Statistics (ONS) has calculated that there were 7.2% or 44,255 more deaths registered in the UK in 2022 based on comparison with the five-year average (excluding 2020). This persisted into 2023 with 8.6% or 28,024 more deaths registered in the first six months of the year than expected. The Continuous Mortality Investigation (CMI) found a similar excess (28,500 deaths) for the same period using different methods. Several methods can be used to estimate excess deaths, each with limitations which should be considered in interpretation, however the overall trends tend to be consistent across the various methods.

The causes of these excess deaths are likely to be multiple and could include the direct effects of Covid-19 infection, acute pressures on NHS acute services resulting in poorer outcomes from episodes of acute illness, and disruption to chronic disease detection and management. Further analysis by cause and by age- and sex-group may help quantify the relative contributions of these causes.

Since July 2020, the Office for Health Improvement and Disparities (OHID) has published estimates of excess mortality based on a Poisson regression model for England week by week, overall and decomposed by age, ethnicity, region and cause. This model finds that in the period from week ending 3rd June 2022 to 30th June 2023, excess deaths for all causes were relatively greatest for 50–64 year olds (15% higher than expected), compared with 11% higher for 25–49 and < 25 year olds, and about 9% higher for over 65 year old groups. While the median age of these groups has changed since 2020, age-standardised mortality analysis breaking down death rates by sex find clearer age differences still. The age-standardised CMI found similar patterns with the largest relative excess deaths for 2022 observed in young (20–44 years) and middle-aged (45–64 years) adults. These findings should be interpreted carefully because of greater than usual delay in registration of deaths in the latter part of 2022.

Several causes, including cardiovascular diseases, show a relative excess greater than that seen in deaths from all-causes (9%) over the same period (week ending 3rd June 2022–30th June 2023), namely: all cardiovascular diseases (12%), heart failure (20%), ischaemic heart diseases (15%), liver diseases (19%), acute respiratory infections (14%), and diabetes (13%).

For middle-aged adults (50–64) in this 13-month period, the relative excess for almost all causes of death examined was higher than that seen for all ages. Deaths involving cardiovascular diseases were 33% higher than expected, while for specific cardiovascular diseases, deaths involving ischaemic heart diseases were 44% higher, cerebrovascular diseases 40% higher and heart failure 39% higher. Deaths involving acute respiratory infections were 43% higher than expected and for diabetes, deaths were 35% higher. Deaths involving liver diseases were 19% higher than expected for those aged 50–64, the same as for deaths at all ages.

Looking at place of death, from 3rd June 2022 to 30th June 2023 there were 22% more deaths in private homes than expected compared with 10% more in hospitals, but there was no excess in deaths in care homes and 12% fewer deaths than expected in hospices. For deaths involving cardiovascular diseases the relative excess in private homes was higher than all causes at 27%. Deaths in hospital were 8% higher and deaths in care homes only 3% higher.

The greatest numbers of excess deaths in the acute phase of the pandemic were in older adults. The pattern now is one of persisting excess deaths which are most prominent in relative terms in middle-aged and younger adults, with deaths from CVD causes and deaths in private homes being most affected. Timely and granular analyses are needed to describe such trends and so to inform prevention and disease management efforts. Leveraging such granular insights has the potential to mitigate what seems to be a continued and unequal impact on mortality, and likely corresponding impacts on morbidity, across the population.

Author(s):
Jonathan Pearson-Stuttard
Sarah Caul
Stuart McDonald
Emily Whamond
John N. Newton

Publication Date: 1 Dec 2023

Publication Site: The Lancet Regional Health Europe

Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2807617

Graphic:

Excerpt:

Key Points

Question  Was political party affiliation a risk factor associated with excess mortality during the COVID-19 pandemic in Florida and Ohio?

Findings  In this cohort study evaluating 538 159 deaths in individuals aged 25 years and older in Florida and Ohio between March 2020 and December 2021, excess mortality was significantly higher for Republican voters than Democratic voters after COVID-19 vaccines were available to all adults, but not before. These differences were concentrated in counties with lower vaccination rates, and primarily noted in voters residing in Ohio.

Meaning  The differences in excess mortality by political party affiliation after COVID-19 vaccines were available to all adults suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been a factor in the severity and trajectory of the pandemic in the US.

Abstract

Importance  There is evidence that Republican-leaning counties have had higher COVID-19 death rates than Democratic-leaning counties and similar evidence of an association between political party affiliation and attitudes regarding COVID-19 vaccination; further data on these rates may be useful.

Objective  To assess political party affiliation and mortality rates for individuals during the initial 22 months of the COVID-19 pandemic.

Design, Setting, and Participants  A cross-sectional comparison of excess mortality between registered Republican and Democratic voters between March 2020 and December 2021 adjusted for age and state of voter registration was conducted. Voter and mortality data from Florida and Ohio in 2017 linked to mortality records for January 1, 2018, to December 31, 2021, were used in data analysis.

Exposures  Political party affiliation.

Main Outcomes and Measures  Excess weekly deaths during the COVID-19 pandemic adjusted for age, county, party affiliation, and seasonality.

Results  Between January 1, 2018, and December 31, 2021, there were 538 159 individuals in Ohio and Florida who died at age 25 years or older in the study sample. The median age at death was 78 years (IQR, 71-89 years). Overall, the excess death rate for Republican voters was 2.8 percentage points, or 15%, higher than the excess death rate for Democratic voters (95% prediction interval [PI], 1.6-3.7 percentage points). After May 1, 2021, when vaccines were available to all adults, the excess death rate gap between Republican and Democratic voters widened from −0.9 percentage point (95% PI, −2.5 to 0.3 percentage points) to 7.7 percentage points (95% PI, 6.0-9.3 percentage points) in the adjusted analysis; the excess death rate among Republican voters was 43% higher than the excess death rate among Democratic voters. The gap in excess death rates between Republican and Democratic voters was larger in counties with lower vaccination rates and was primarily noted in voters residing in Ohio.

Conclusions and Relevance  In this cross-sectional study, an association was observed between political party affiliation and excess deaths in Ohio and Florida after COVID-19 vaccines were available to all adults. These findings suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been factors in the severity and trajectory of the pandemic in the US.

Author(s): Jacob Wallace, PhD1; Paul Goldsmith-Pinkham, PhD2; Jason L. Schwartz, PhD1

Publication Date: 24 July 2023

Publication Site: JAMA Internal Medicine

Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020

Mary Pat Campbell

Link:https://jamanetwork.com/journals/jama/article-abstract/2804822/

JAMA. 2023;329(19):1662-1670. doi:10.1001/jama.2023.7022

Excerpt:

Key Points

Question  How many excess deaths and years of potential life lost for the Black population, compared with the White population, occurred in the United States from 1999 through 2020?

Findings  Based on Centers for Disease Control and Prevention data, excess deaths and years of potential life lost persisted throughout the period, with initial progress followed by stagnation of improvement and substantial worsening in 2020. The Black population had 1.63 million excess deaths, representing more than 80 million years of potential life lost over the study period.

Meaning  After initial progress, excess mortality and years of potential life lost among the US Black population stagnated and then worsened, indicating a need for new approaches.

Author(s): César Caraballo, MD1,2; Daisy S. Massey, BA3; Chima D. Ndumele, PhD4; et al

Publication Date: 16 May 2023

Publication Site: JAMA Network

One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database

Mary Pat Campbell

Link: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2802095

JAMA Health Forum. 2023;4(3):e230010. doi:10.1001/jamahealthforum.2023.0010

Graphic:

Excerpt:

Key Points

Question  Do postacute sequelae of SARS-CoV-2 increase risks of 1-year adverse outcomes?

Findings  In this case-control study of 13 435 US adults with post–COVID-19 condition (PCC) and 26 870 matched adults without COVID-19, the adults with PCC experienced increased risks for a number of cardiovascular outcomes, such as ischemic stroke. During the 12-month follow-up period, 2.8% of the individuals with PCC vs 1.2% of the individuals without COVID-19 died, implying an excess death rate of 16.4 per 1000 individuals.

Meaning  Individuals with PCC may be at increased risk for adverse outcomes in the year following initial infection.

Author(s): Andrea DeVries, PhD1; Sonali Shambhu, BDS, MPH1; Sue Sloop, PhD1; et al

Publication Date:

Publication Site: JAMA Health Forum