The Hartford Sees High Mortality for the Next Few Years

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

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

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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

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

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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

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

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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

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

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

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

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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

Total 2022 U.S. Deaths Up About 15% Over Pre-Pandemic Level

Link: https://www.thinkadvisor.com/2023/01/24/total-2022-u-s-deaths-up-about-15-over-pre-pandemic-level/

Excerpt:

U.S. public health agencies recorded a total of about 3.2 million deaths in 2022, according to full-year mortality figures from the U.S. Centers for Disease Control and Prevention.

The total number of deaths was down 7% from the preliminary total for 2021 that the CDC reported a year earlier, but it was 15% higher than the preliminary, full-year average — about 2.8 million per year — for the period from 2015 through 2019, before the COVID-19 pandemic began.

Author(s): Allison Bell

Publication Date: 24 Jan 2023

Publication Site: ThinkAdvisor

Catch up on the Actuaries Institute’s COVID-19 Mortality Working Group’s latest analysis of excess deaths.

Link: https://www.actuaries.digital/2022/11/03/covid-19-mortality-working-group-another-month-of-high-excess-mortality-in-july-2022/

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In summary:

  • Total excess mortality for the month of July 2022 is estimated at 16% (+2,600 deaths), relative to expected mortality at pre-pandemic levels.
  • Total excess mortality for the first seven months of 2022 is 14% (+13,700 deaths).
  • Around half of the excess mortality for the first seven months of 2022 is due to COVID-19 (+7,100 deaths) with remaining excess of +6,600 due to the remaining causes.
  • October 2022 has the lowest COVID-19 surveillance deaths of any month in 2022.
  • We estimate that COVID-19 deaths will result in excess mortality of around 6% (+2,800) for August to October 2022, with overall excess mortality likely to be higher than this.
  • We continue to expect that COVID-19 will be the third leading cause of death in Australia in 2022.

Author(s): COVID-19 MORTALITY WORKING GROUP

Publication Date: 3 Nov 2022

Publication Site: Actuaries Digital

Will Survivors of the First Year of the COVID-19 Pandemic Have Lower Mortality?

Link: https://crr.bc.edu/working-papers/will-survivors-of-the-first-year-of-the-covid-19-pandemic-have-lower-mortality/

Report: https://crr.bc.edu/wp-content/uploads/2022/08/wp_2022-10.pdf

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Abstract:

The mortality burden of the COVID-19 pandemic was particularly heavy among older adults, racial and ethnic minorities, and those with underlying health conditions.  These groups are known to have higher mortality rates than others even in the absence of COVID.  Using data from the 2019 American Community Survey, the 2018 Health and Retirement Study, and the 2020 National Vital Statistics System, this paper estimates how much lower the overall mortality rate will be for those who lived through the acute phase of the early pandemic after accounting for this selection effect of those who died from COVID.  Such selection may have implications for life insurance and annuity premiums, as well as assessments of the financial standing of Social Security – if the selection is large enough to substantially alter projected survivor mortality.

The paper found that:

  • 10-year mortality rates, absent direct COVID deaths and long COVID, will likely be lower in 2021 than anticipated in 2019.
  • However, these differences are small, ranging from a decline of 0.4 percentage points for people in their 60s to 1 percentage point for those in their 90s.
  • The small difference is in spite of the fact that COVID mortality was, indeed, very selective, with mortality declines exceeding half the maximum possible declines, holding total COVID deaths constant, for every age group.

 
The policy implications of the findings are:

  • That declines in mortality due to COVID selection likely will not impact overall population mortality substantially enough to affect Social Security cost projections.
  • Any impact of selection effects on Social Security costs will likely be swamped by ongoing mortality increases directly attributable to acute and long COVID.

Author(s): Gal Wettstein, Nilufer Gok, Anqi Chen, Alicia H. Munnell

Publication Date: August 2022

Publication Site: Center for Retirement Research at Boston College

2020-2021 Excess Deaths in the U.S. General Population by Age and Sex

Link: https://www.soa.org/resources/research-reports/2022/excess-death-us/

Full report: https://www.soa.org/4a55a7/globalassets/assets/files/resources/research-report/2022/excess-death-us.pdf

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The data used for this analysis was provided by the CDC as of August 17, 2022 and includes incurred deaths
by week, beginning on December 29, 2019 and going through July 2, 2022. For 2020, the CDC defines Week
1 as ranging from December 29, 2019 through January 4, 2020 and Week 52 as ranging from December 19,
2020 through December 26, 2020, so when reporting on 2020 results, this convention is used. The year
2021 begins on December 27, 2020 and runs through January 2, 2022. For the purposes of this analysis, the
start of the COVID-19 active period is March 22, 2020.
Due to the delay in reporting, the actual deaths have been completed based on factors that vary by age
and sex. These are shown below along with the expectations that are based on the five-year trend after
adjusting for seasonality.

These data are as of August 17, 2022 and exclude deaths that occurred after July 2, 2022. Figure 1 shows
that, for most months, the total A/E ratio is much greater than 100%, while the A/E ratio excluding COVID19 deaths is also greater than 100% by a few percent.

Author(s): Rick Leavitt, ASA, MAAA

Publication Date: August 2022

Publication Site: Society of Actuaries Research Institute

5 Worst States for Working-Age Death Increases in July

Link: https://www.thinkadvisor.com/2022/09/12/5-worst-states-for-working-age-death-increases-in-july/

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Early government mortality numbers show that the number of U.S. deaths has stayed very high this summer, both for members of the general population and for working-age people.

For all U.S. residents, for the period from July 3 through Aug. 27, the number of deaths recorded in the U.S. Centers for Disease Control and Prevention’s FluView reports was 426,881, according to the report released Friday, which included data sent to the CDC by Sept. 3.

The “all cause” total for the general population was down just 0.8% from the total for the comparable period in 2021, and it was 22% higher than the total for the comparable period in 2019, before the COVID-19 pandemic began.

For U.S. residents ages 25 through 64, the all-cause death total during that same period was 113,665, according to early, weighted data in the CDC’s Weekly Counts of Deaths by Jurisdiction and Age reports, as of Sept. 8.

Author(s): Allison Bell

Publication Date: 12 Sept 2022

Publication Site: Think Advisor