The COVID-19 pandemic has been deadly for older Americans. The Centers for Disease Control and Prevention (CDC) report weekly deaths from all causes and deaths attributed to COVID-19 according to death certificate data coded by the National Center for Health Statistics. Based on these mortality data, the CDC reported that between March 2020 and February 2021 one in 128 Americans 65 years and older died from COVID-19 compared to one in 9,570 Americans between the ages of 15 and 44. Because Americans age 15 to 44 account for almost 40% of the US population but only about 2.5% (13,662 of 537,916) of COVID-19 deaths over this period, the mortality data give the mistaken impression that the pandemic has not contributed to the deaths of many young adults. However, the mortality data does not capture the extent to which physical and mental health may have been impacted by the pandemic. The indirect mortality effects of the pandemic that result from joblessness, lockdown, social distancing, stress, inability to access routine healthcare, and isolation can only be assessed by examining excess deaths, the difference between deaths during the pandemic and expected deaths (based on recent years trends’ in mortality rates).
In this blog post I focus on the 15-month period from March 2020 to May 2021 and show that young adults suffered many more excess deaths during the pandemic than deaths directly attributed (through mortality data) to COVID-19. There were 63,011 excess deaths for the 15 to 44 age group over this period, almost four times the number of deaths attributed to COVID-19 by the CDC. Excess deaths during the pandemic not attributed to COVID-19 can be due to many different causes including drug overdose, suicide, homicide, and the inability to access healthcare due to an overwhelmed health system. These indirect excess deaths for the 15 to 44 age group are a major public health concern. Over the 15 months from March 2020 to May 2021 excess deaths for this age group are higher than all US military fatal casualties in the Vietnam War.
Figure 1 displays the number of deaths for all causes for the age groups 15-24, 25-34 and 35-44 during 2018, 2019, and the pandemic year from March 2020 through February 2021. Deaths for these age groups during the first year of the pandemic were about 30% higher, on average, than during 2018 and 2019. Note that the increase in deaths during the first year of the pandemic was substantially more than the deaths directly attributed to COVID-19 by the CDC.
Figure 2 presents mortality rates for all causes for these age groups for 2018-2019, the year from March 2020 to February 2021, and the three-month period from March to May 2021. The mortality rate was about 29% higher during the pandemic than in 2018-2019. Moreover, for this age group the mortality rate is about the same from March to May 2021 as during the first year of the pandemic. This contrasts with the decline in mortality rates for older Americans during the spring of 2021 following the COVID-19 vaccines and improvement in health care for treating COVID-19. The mortality rate for Americans in the 65 and older age group declined by about 1/6 from March to May 2021 relative to the first year of the pandemic. The decline in mortality rates for older Americans in the spring of 2021, likely due to vaccinations and improved treatments for those infected with the coronavirus, was not shared by those in the 15 to 44 age group. While the vaccine and improved COVID-19 treatments eased the death toll of older Americans ages 65 and older, the source of excess morbidity and mortality for many younger Americans ages 15-44 was not alleviated. Social isolation, lockdowns, and many of the other factors that contributed to the morbidity and mortality of this age group remain.
Figure 3 presents all deaths for the age groups 15-24, 25-34 and 35-44 from March 2020 through May 2021. Deaths are divided into three categories: (i) expected deaths if the mortality rate was the same as in 2018-2019, (ii) deaths attributable to COVID-19, and (iii) excess deaths attributable to causes other than COVID-19.
The totals in Figure 3 indicate that 278,156 Americans in these age groups died over this 15-month period, about 63,011 more than expected if the mortality rate was equal to the 2018-2019 rate. The 16,164 deaths attributed to COVID-19 means that there were 46,847 excess deaths over this 15-month period attributable to causes other than COVID-19 that were not expected based on 2018-2019 mortality rates.
According to the CDC, fatalities with COVID-19 as a cause of death are concentrated among older Americans. The 65 and above age group accounts for 16.9% of the population and 79.5% of the deaths attributed to COVID-19. Nonetheless, Americans in the 15 to 44 age group experienced about 30% more deaths than expected during the first 15 months of the pandemic and almost three-fourths of the excess deaths were due to causes other than COVID-19. Public health officials often face the challenge of protecting the public safety, while considering the social repercussions from public health laws and policies. Throughout the COVID-19 pandemic many public health officials strongly recommended legally enforced lockdowns, social distancing, mask wearing, and social isolation to minimize the spread of the virus. However, the data presented here suggest that public health researchers should investigate the causes and reasons for the substantial increase in the excess deaths of young adults during the pandemic to ascertain how many of these deaths may have been the unintended consequence of lockdowns, social distancing and other public health policies.