We analyzed all deaths from 1999 to 2023 in which the International Statistical Classification of Diseases and Related Health Problems, 10th Revision code was P81 (environmental hyperthermia of newborn), T67 (effects of heat and light), or X30 (exposure to excessive natural heat) as either the underlying cause or as a contributing cause of death, as recorded in the Multiple Cause of Death file. Data were accessed through the Centers for Disease Control and Prevention’s WONDER platform,5 which combines death counts with population estimates produced by the US Census Bureau to calculate mortality rates. For each year, we extracted age-adjusted mortality rates (AAMRs) per 100 000 person-years for heat-related deaths. The AAMR accounts for differences due to age structures, allowing direct comparisons across time. The approach of analyzing cause-specific mortality rates rather than excess mortality is warranted because the excess mortality methodology is subject to confounding from the COVID-19 pandemic from 2020 to 2023. This study used publicly available, deidentified aggregate data; thus, it was not considered human subjects research.
Joinpoint version 5.2.0 (National Cancer Institute) regression6 was used to analyze AAMRs to assess trends and determine elbow points where the trend began to shift to a new trajectory. Results of joinpoint analyses are reported as average annual percentage change (AAPC) in rates with 95% CIs. Statistical significance was defined as 2-sided P < .05. Data were visualized with R version 4.2.2 (R Foundation for Statistical Computing).
Results
From 1999 to 2023, 21 518 deaths were recorded as heat-related underlying or contributing cause of death, with an AAMR of 0.26 per 100 000 person-years (95% CI, 0.24-0.27) (Table). The number of heat-related deaths increased from 1069 (AAMR = 0.38; 95% CI, 0.36-0.40) in 1999 to 2325 (AAMR = 0.62; 95% CI, 0.60-0.65) in 2023, a 117% increase in the number of heat-related deaths and a 63% increase in the AAMR. The lowest number of heat-related deaths in the study period was 311 in 2004, whereas the highest, 2325, was in 2023.
Results of the joinpoint trend analysis showed that during the entire period, the AAMR increased by 3.6% per year (AAPC = 3.6%; 95% CI, 0.1%-7.2%; P = .04) from 1999 to 2023 (Figure). The number of heat-related deaths and AAMR showed year-to-year variability, with spikes in 2006 and 2011, before showing steady increases after 2016. Joinpoint results showed a nonsignificant decrease of 1.4% per year from 1999 to 2016 (AAPC = −1.4%; 95% CI, −4.7% to 2.1%; P = .42), followed by a significant increase of 16.8% per year in the AAMR from 2016 to 2023 (AAPC = 16.8%; 95% CI, 6.4%-28.2%; P = .002).
Author(s): Jeffrey T. Howard, PhD1; Nicole Androne, MS1; Karl C. Alcover, PhD2; et al
Publication Date: Published online August 26, 2024 ` Publication Site: JAMA Network
More Americans died from heat in 2023 than any year in over two decades of records, according to the findings published Monday. Last year was also the globe’s hottest year on record, the latest grim milestone in a warming trend fueled by climate change.
The study, published in the American Medical Association journal JAMA, found that 2,325 people died from heat in 2023. Researchers admit that number is likely an undercount. The research adjusted for a growing and aging U.S. population, and found the death toll was still staggering.
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Howard – along with researchers from the Uniformed Services University of the Health Sciences, in Maryland, and Pennsylvania State University – examined death certificate data between 1999 and 2023. Deaths were counted if heat was listed as an underlying or contributing cause of death.
Reported deaths remained relatively flat until around 2016, when the number of people dying began increasing, in what Howard, who studies health effects from extreme weather, calls a “hockey stick.” The hockey stick analogy has been used to describe warming global temperatures caused by climate change, where temperatures have swooped upward at alarming rates in recent years.
Howard’s study suggests the human toll follows the same outline. An important indicator is age-adjusted deaths per 100,000 people. That heat-related death rate has increased dramatically compared to the early 2000s, regardless of age or population size.
The upward trajectory appears to be sharpening recently. In 2022, 1,722 people died at an adjusted rate of 0.47. But 2023 saw 603 more deaths than the previous year, with an adjusted rate of 0.63, the highest on record.
Deaths weren’t evenly spread nationally. In an interview, Howard said deaths were overwhelmingly concentrated in traditionally hot regions: Arizona, California, Nevada and Texas.
The study is limited in how local governments classify heat-related deaths, which could mean the actual number of deaths is an undercount. It’s also potentially skewed as more people become aware of the fatal risks of heat. The study didn’t break down vulnerable groups. For example, people without air conditioning, those who live or work outdoors, and people with underlying health conditions, are all at greater risk of serious illness or death from heat.
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
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
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.”
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.
Are we all really living longer? Let’s first point out that Princeton economists Anne Case and Angus Deaton, noted for their research in health and economics, recently showed that many Americans are not, in fact, enjoying extended lives. As they stated in their own New York Times op-ed, those without college degrees are “scarred by death and a staggeringly shorter life span.” According to their investigation, the expected lifespan for this group has been falling since 2010. By 2021, people without college degrees were expected to live to about 75, nearly 8.5 years shorter than their college-educated counterparts.
Overall life expectancy in America dropped in 2020 and 2021, with increases in mortality across the leading causes of death and among all ages, not just due to COVID-19. In August 2022, data confirmed that Americans are dying younger across all demographics. Again, the U.S. is an outlier. It was one of two developed countries where life expectancy did not bounce back in the second year of the pandemic.
So the argument that everyone is living longer greatly stretches the truth—unless, of course, you happen to be rich: A Harvard study revealed that the wealthiest Americans enjoy a life expectancy over a decade longer than their poorest counterparts.
Could the idea that working into our seventies and beyond boosts our health and well-being hold true? Obviously, for those in physically demanding roles, such as construction or mining, prolonged work is likely to lead to a higher risk of injury, accidents, and wearing down health-wise. But what about everybody else? What if you have a desk job? Wouldn’t it be great to get out there, do something meaningful, and interact with people, too?
Perhaps it’s easy for people like Steuerle and Kramon to imagine older people working in secure, dignified positions that might offer health benefits into old age – after all, those are the types of positions they know best.
But the reality is different. Economist Teresa Ghilarducci, a professor at the New School for Social Research, focuses on the economic security of older workers and flaws in U.S. retirement systems in her new book, Work, Retire, Repeat: The Uncertainty of Retirement in the New Economy. She calls those praising the health perks of working longer “oddballs” – those fortunate folks in cushy positions who have a lot of autonomy and purpose. Like lawmakers or tenured professors, for example.
Author(s): Lynn Parramore
Publication Date: 8 May 2024
Publication Site: Institute for New Economic Thinking
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.”
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.
Importance Many medical journals, including JAMA, restrict the use of causal language to the reporting of randomized clinical trials. Although well-conducted randomized clinical trials remain the preferred approach for answering causal questions, methods for observational studies have advanced such that causal interpretations of the results of well-conducted observational studies may be possible when strong assumptions hold. Furthermore, observational studies may be the only practical source of information for answering some questions about the causal effects of medical or policy interventions, can support the study of interventions in populations and settings that reflect practice, and can help identify interventions for further experimental investigation. Identifying opportunities for the appropriate use of causal language when describing observational studies is important for communication in medical journals.
Observations A structured approach to whether and how causal language may be used when describing observational studies would enhance the communication of research goals, support the assessment of assumptions and design and analytic choices, and allow for more clear and accurate interpretation of results. Building on the extensive literature on causal inference across diverse disciplines, we suggest a framework for observational studies that aim to provide evidence about the causal effects of interventions based on 6 core questions: what is the causal question; what quantity would, if known, answer the causal question; what is the study design; what causal assumptions are being made; how can the observed data be used to answer the causal question in principle and in practice; and is a causal interpretation of the analyses tenable?
Conclusions and Relevance Adoption of the proposed framework to identify when causal interpretation is appropriate in observational studies promises to facilitate better communication between authors, reviewers, editors, and readers. Practical implementation will require cooperation between editors, authors, and reviewers to operationalize the framework and evaluate its effect on the reporting of empirical research.
The analysis of national mortality trends is critically dependent on the quality of the population, exposures and deaths data that underpin death rates. We develop a framework that allows us to assess data reliability and to identify anomalies, illustrated, by way of example, using England and Wales population data. First, we propose a set of graphical diagnostics that help to pinpoint anomalies. Second, we develop a simple Bayesian model that allows us to quantify objectively the size of any anomalies. Two-dimensional graphical diagnostics and modelling techniques are shown to improve significantly our ability to identify and quantify anomalies. An important conclusion is that significant anomalies in population data can often be linked to uneven patterns of births of people in cohorts born in the distant past. In the case of England and Wales, errors of more than 9% in the estimated size of some birth cohorts can be attributed to an uneven pattern of births. We propose methods that can use births data to improve estimates of the underlying population exposures. Finally, we consider the effect of anomalies on mortality forecasts and annuity values, and we find significant effects for some cohorts. Our methodology has general applicability to other sources of population data, such as the Human Mortality Database.
Keywords: Baby boom;Cohort–births–deaths exposures methodology; Convexity adjustment ratio; Deaths; Graphical diagnostics; Population data
Author(s): Andrew J.G.Cairns, Heriot-Watt University, Edinburgh, UK David Blake, Cass Business School, London, UK Kevin Dowd Durham University Business School, UK and Amy R. Kessler Prudential Retirement, Newark, USA
Publication Date: 2016
Publication Site: Journal of the Royal Statistical Society
J. R. Statist. Soc. A (2016) 179, Part 4, pp. 975–1005
Objective—This report describes deaths from drug overdoses in 2020 in U.S. residents in 46 states and New York City by usual occupation and industry. August 22, 2023
Conclusions—Variation in drug overdose death rates and PMRs by usual occupation and industry in 2020 demonstrates the disproportionate burden of the ongoing drug overdose crisis on certain sectors of the U.S. workforce.
Methods—Frequencies, death rates, and proportionate mortality ratios (PMRs) are presented using the 2020 National Vital Statistics System mortality data file. Data were restricted to decedents aged 16–64 for rates and 15–64 for PMRs with usual occupations and industries in the paid civilian workforce. Age-standardized drug overdose death rates were estimated for usual occupation and industry groups overall, and age-adjusted drug overdose PMRs were estimated for each usual occupation and industry group overall and by sex, race and Hispanic-origin group, type of drug, and drug overdose intent. Age-adjusted drug overdose PMRs were also estimated for individual occupations and industries.
Results—Drug overdose mortality varied by usual occupation and industry. Workers in the construction and extraction occupation group (162.6 deaths per 100,000 workers, 95% confidence interval: 155.8–169.4) and construction industry group (130.9, 126.0–135.8) had the highest drug overdose death rates. The highest group-level drug overdose PMRs were observed in decedents in the construction and extraction occupation group and the construction industry group (145.4, 143.6–147.1 and 144.9, 143.2–146.5, respectively). Differences in drug overdose PMRs by usual occupation and industry group were observed within each sex, within each race and Hispanicorigin group, by drug type, and by drug overdose intent. Among individual occupations and industries, the highest drug overdose PMRs were observed in decedents who worked as fishers and related fishing occupations and in fishing, hunting, and trapping industries (193.1, 166.8–222.4 and 186.5, 161.7–214.1, respectively).
Author(s): Billock RM, Steege AL, Miniño A.
Publication Date: August 22, 2023
Publication Site: CDC, National Vital Statistics System
