#20: Many great things you missed this year

Link: https://www.scientificdiscovery.dev/p/20-so-many-great-things-you-missed



You can see that, in childhood, in the US, the most common causes of death are ‘external causes’. This is a broad category that includes accidents, falls, violence, and overdoses, and is shown in red. But there’s also a notable contribution from birth disorders (in muted green), childhood cancers (in blue), and respiratory diseases (in cyan).

The share of deaths in childhood from cancers stood out to me. We’ve seen lots of progress against many childhood cancers over the last 50 years — notably in treating leukemia, brain cancers, kidney cancers, lymphomas, and retinoblastoma — but this is a reminder that there’s still further to go.

From adolescence until middle-age, ‘external causes’ are now the overwhelming cause of death. Around 80% of deaths at the age of 20 in the US are due to external causes. These result from causes such as accidents, violence, and overdoses.

At older ages, diseases rise in importance. Causes of death also become more varied, although cardiovascular diseases and cancers are the most common.

You might also be wondering about the brown category at the bottom, called ‘special ICD codes’. That’s a placeholder category in the system for deaths caused by new diseases — predominantly Covid-19, since the data spans 2018 to 2021.3


Publication Date: 16 Mar 2022

Publication Site: Scientific Discovery on substack

Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19)

Link: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf



Certifying deaths due to post-acute sequelae of
In the acute phase, clinical manifestations and complications
of COVID-19 of varying degrees have been documented,
including death. However, patients who recover from the acute
phase of the infection can still suffer long-term effects (8).
Post-acute sequelae of COVID-19 (PASC), commonly referred
to as “long COVID,” refers to the long-term symptoms, signs,
and complications experienced by some patients who have
recovered from the acute phase of COVID-19 (8–10). Emerging
evidence suggests that severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19,
can have lasting effects on nearly every organ and organ system
of the body weeks, months, and potentially years after infection
(11,12). Documented serious post-COVID-19 conditions include
cardiovascular, pulmonary, neurological, renal, endocrine,
hematological, and gastrointestinal complications (8), as well as
death (13).

Consequently, when completing the death certificate, certifiers
should carefully review and consider the decedent’s medical
history and records, laboratory test results, and autopsy report,
if one is available. For decedents who had a previous SARSCoV-2 infection and were diagnosed with a post-COVID-19
condition, the certifier may consider the possibility that the death
was due to long-term complications of COVID-19, even if the
original infection occurred months or years before death. If it is
determined that PASC was the UCOD, it should be reported on
the lowest line used in Part I with the condition(s) it led to on the
line(s) above in a logical sequence in terms of time and etiology.
If it is determined that PASC was not the UCOD but was still a
significant condition that contributed to death, then it should be
reported in Part II. Certifiers should use standard terminology,
that is, “Post-acute sequelae of COVID-19.” See Scenario IV in
the Appendix for an example certification. In accordance with
all death certification guidance, if the certifier determines that
PASC did not cause or contribute to death, then they should not
report it anywhere on the death certificate.

Author(s): National Vital Statistics System, National Center for Health Statistics

Publication Date: updated 27 Feb 2023

Publication Site: CDC

Two Key Takeaways From The New CDC Life Expectancy Data

Link: https://www.forbes.com/sites/ebauer/2022/09/02/two-key-takeaways-from-the-new-cdc-life-expectancy-data/?sh=6ce149f31cfc


To what extent, are these drops of life expectancy due to Covid-19, rather than other causes?

From 2019 to 2020, the CDC reports that 90% of the drop in Hispanic life expectancy was attributable to Covid; the corresponding rates were 68% for whites and 59% for blacks. (No breakdown was provided for the AIAN or Asian categories.) However, the CDC data splits its breakdowns into “contributions to decreases” and “contributions to increases” rather than overall net effect. Those readers who are used to looking at data and charts will expect a “waterfall” style chart; the CDC version is not this, and is not particularly helpful.

In any event, relative to the 2020 baseline, the further decreases in life expectancy during 2021 had multiple causes. Only among the White demographic group was Covid the cause of over half of the decline; unintentional injury (including overdoses) was the second-largest contributing factor and for the AIAN demographic group, worsening rates of death due to chronic liver disease and cirrhosis played almost as substantial a role.

And, finally, it is important to understand that the CDC data shows a continued improvement in life expectancy due to reductions in death due to such causes as influenza/pneumonia, COPD/emphysema, Alzheimer disease, diabetes, and perinatal conditions (infant deaths). In fact, strikingly, in 2021, heart disease was a contributor to increased life expectancy in the Black, Hispanic, and Asian demographic groups, but a contributor to decreased life expectancy for the White and AIAN groups.

Again, though, the way the CDC provides its information means that, when it comes down to it, there is much that is simply missing; we do not know the magnitude of the improvements in life expectancy due to these causes, just that it exists. It even seems likely, or at least possible, that some of the apparent improvement in mortality due to these factors was actually because deaths were actually recorded as Covid deaths instead (whether due to multiple causes of death or other reasons).

Author(s): Elizabeth Bauer

Publication Date: 2 Sept 2022

Publication Site: Forbes

Excess mortality in England

Link: https://app.powerbi.com/view?r=eyJrIjoiYmUwNmFhMjYtNGZhYS00NDk2LWFlMTAtOTg0OGNhNmFiNGM0IiwidCI6ImVlNGUxNDk5LTRhMzUtNGIyZS1hZDQ3LTVmM2NmOWRlODY2NiIsImMiOjh9

Data download:



The numbers of expected deaths are estimated using statistical models and based on previous 5 years’ (2015 to 2019) mortality rates. Weekly monitoring of excess mortality from all causes throughout the COVID-19 pandemic provides an objective and comparable measure of the scale of the pandemic [reference 1]. Measuring excess mortality from all causes, instead of focusing solely on mortality from COVID-19, overcomes the issues of variation in testing and differential coding of cause of death between individuals and over time [reference 1].

In the weekly reports, estimates of excess deaths are presented by week of registration at national and subnational level, for subgroups of the population (age groups, sex, deprivation groups, ethnic groups) and by cause of death and place of death.

Author(s): Office for Health Improvement and Disparities

Publication Date: accessed 10 Aug 2022

Publication Site: Public PowerBI dashboard

Mortality Monday: DEATH TO GEESE

Link: https://stump.marypat.org/article/766/mortality-monday-death-to-geese




Going back to the mortality database from the U.S. in 2014, I needed to figure out what the relevant ICD-10 codes were.


That’s a total of 384 deaths, and it looks like the primary cause is being attacked by some non-dog mammal. I would assume the second cause is primarily people being thrown from or falling off horses. Alas, most of the vehicular accident codes do not distinguish between hitting a person and hitting an animal.

Author(s): Mary Pat Campbell

Publication Date: 3 July 2017

Publication Site: STUMP

Mortality Nuggets: Videos on Suicide Rate Trends, Society of Actuaries Report, and Fixing Their Graph





  • I highlighted a few of the cause-of-death trends. In particular, COVID (which, obviously, is biased more towards the old), and external causes of death: homicide, suicide, and accidents (which includes drug overdoses and motor vehicle accidents).
  • There are basically too many things going on in this graph, so there aren’t a lot of good choices for either me or the SOA. What I did was to pick four of the data series to highlight with data labels, as noted above (and I also slapped one data label on dementia for the oldest age group, just because). I am in the middle of a series going through how that external causes of death changed in 2020 — in particular, accidents and homicides went up, and really affected mortality for adults under age 45, plus male teens.
  • Yeah, check out heart disease and cancer (bottom of the graph). Ain’t old age great?

Author(s): Mary Pat Campbell

Publication Date: 6 Feb 2022

Publication Site: STUMP at substack

U.S. Population Mortality Observations – Updated with 2020 Experience


pdf: https://www.soa.org/globalassets/assets/files/resources/research-report/2022/population-mortality-observation.pdf



The overall age-adjusted mortality rate (both sexes) from all causes of death recorded the historically highest increase of published records dating back to 1900 of 16.8% in 2020, following a 1.2% decrease in 2019. The increase eclipsed the size of recent years’ annual volatility and exceeded the 11.7% increase in
1918 that occurred during the Spanish influenza pandemic. When COVID deaths are removed, all other
CODs’ (Cause of Death) combined mortality increased by 4.9%, which was last exceeded by a 5.6% increase in 1936.

All other CODs featured in this report had increased 2020 mortality. In many instances, the single year
mortality increases were the largest for the span of this report. Heart disease and Alzheimer’s/Dementia
had 4.7% and 7.8% increases, respectively. Other physiological CODs with lower death rates had double-digit increases. Diabetes, liver and hypertension had increases of 14.9%, 16.0% and 13.3%, respectively.
The external CODs of assaults and opioid overdoses had extreme increases at ages 15-24 of 35.9% and
61.2%, respectively.


Jerome Holman, FSA, MAAA, RJH Integrated Solutions, LLC
Cynthia S. MacDonald, FSA, MAAA, Society of Actuaries Research Institute

Publication Date: Jan 2022

Publication Site: SOA

2021 U.S. January-June Cause-of-Death Ranking Table




I don’t recommend simply doubling the numbers from the ranking table and comparing them to the 2020 table, especially for the COVID numbers. I know that won’t work, because of the overall 2021 mortality trend we saw:


However, I have been making estimates and projections, and I see some really worrying numbers for the ages 15-44 grouping, especially for external causes of death: suicide, homicide, and accidents. The worrying trend is that these may extend past the time COVID mortality wanes. It looks worse for 2021 than for 2020.

I will be doing posts looking at these three large categories, starting with suicide, in upcoming posts, by more detailed demographics than just age. Some of these trends have geographic components to consider as well.

Author(s): Mary Pat Campbell

Publication Date: 27 Jan 2022

Publication Site: STUMP at substack

Top Causes of Death by Age Group, 2020: Raw Numbers

Link: https://marypatcampbell.substack.com/p/top-causes-of-death-by-age-group



The numbers below each cause are the total number of finalized deaths in CDC Wonder as of 11 January 2022 for the completed calendar year 2020.

COVID deaths for under age 15 weren’t in the top 10 causes for those age groups, which is why they aren’t seen in the table. But you may be interested in those numbers:
at #12 for ages 5-14, with 49 deaths
at #12 for ages 1-4, with 19 deaths
at #13 for infant mortality (<1 year), at 35 deaths

In general, other than the new cause of COVID, most of the causes of death were in the same rank order as in 2019, with a few switches for causes that tend to be close in numbers.

Author(s): Mary Pat Campbell

Publication Date: 12 Jan 2022

Publication Site: STUMP at substack

As U.S. Nears 800,000 Virus Deaths, 1 of Every 100 Older Americans Has Perished

Link: https://www.nytimes.com/2021/12/13/us/covid-deaths-elderly-americans.html



As the coronavirus pandemic approaches the end of a second year, the United States stands on the cusp of surpassing 800,000 deaths from the virus, and no group has suffered more than older Americans. All along, older people have been known to be more vulnerable, but the scale of loss is only now coming into full view.

Seventy-five percent of people who have died of the virus in the United States — or about 600,000 of the nearly 800,000 who have perished so far — have been 65 or older. One in 100 older Americans has died from the virus. For people younger than 65, that ratio is closer to 1 in 1,400.


After the first known coronavirus death in the United States in February 2020, the virus’s death toll in this country reached 100,000 people in only three months. The pace of deaths slowed throughout summer 2020, then quickened throughout the fall and winter, and then slowed again this spring and summer.

Throughout the summer, most people dying from the virus were concentrated in the South. But the most recent 100,000 deaths — beginning in early October — have spread out across the nation, in a broad belt across the middle of the country from Pennsylvania to Texas, the Mountain West and Michigan.

These most recent 100,000 deaths, too, have all occurred in less than 11 weeks, a sign that the pace of deaths is moving more quickly once again — faster than at any time other than last winter’s surge.

By now, Covid-19 has become the third leading cause of death among Americans 65 and older, after heart disease and cancer. It is responsible for about 13 percent of all deaths in that age group since the beginning of 2020, more than diabetes, accidents, Alzheimer’s disease or dementia.

Author(s): Julie Bosman, Amy Harmon and Albert Sun

Publication Date: 13 Dec 2021

Publication Site: New York Times

Thousands more people than usual are dying … but it’s not from Covid




While focus remains firmly fixed on Covid-19, a second health crisis is quietly emerging in Britain. Since the beginning of July, there have been thousands of excess deaths that were not caused by coronavirus.

According to health experts, this is highly unusual for the summer. Although excess deaths are expected during the winter months, when cold weather and seasonal infections combine to place pressure on the NHS, summer generally sees a lull.


Data from Public Health England (PHE) shows that during that period there were 2,103 extra death registrations with ischemic heart disease, 1,552 with heart failure, as well as an extra 760 deaths with cerebrovascular diseases such as stroke and aneurysm and 3,915 with other circulatory diseases.

Acute and chronic respiratory infections were also up with 3,416 more mentions on death certificates than expected since the start of July, while there have been 1,234 extra urinary system disease deaths, 324 with cirrhosis and liver disease and 1,905 with diabetes.

Alarmingly, many of these conditions saw the biggest drops in diagnosis in 2020, as the NHS struggled to cope with the pandemic.

Author(s): Sarah Knapton

Publication Date: 24 Sept 2021

Publication Site: Yahoo News

Mortality with Meep: Cause of Death Trend — Heart Disease — 1999-2020

Link: https://marypatcampbell.substack.com/p/mortality-with-meep-cause-of-death




The long-term trend has been improvement for this cause of death, with it most obvious for the oldest age groups. This trend has been driven by improvement in medical treatment for the condition, but also due to the decrease in smoking rates… decades ago. Some causes of death have behavior that precedes the death by decades, which can get tricky to track for our top two causes of death: heart disease and cancer. Even so, smoking cigarettes has been a huge driver for both these causes, and made a large differentiator by sex and smoking status for a long time.

Author(s): Mary Pat Campbell

Publication Date: 26 July 2021

Publication Site: STUMP at substack