The US Midlife Mortality Crisis Continues: Excess Cause-Specific Mortality During 2020

Area of Science:

• Public Health
• Epidemiology
• Mortality Statistics

Background:

• The COVID-19 pandemic impacted mortality patterns globally in 2020.
• Understanding excess mortality beyond confirmed COVID-19 cases is crucial for public health.
• Previous analyses focused on overall excess deaths, necessitating age- and cause-specific investigations.

Purpose of the Study:

• To investigate variations in monthly excess mortality by age and cause of death in the United States during 2020.
• To differentiate between COVID-19 and non-COVID-19 excess deaths across demographic groups.
• To identify specific causes contributing to excess mortality, particularly among working-age populations.

Main Methods:

• Utilized national death counts and population estimates from 1999-2020.
• Employed sex-specific negative binomial regression models to estimate monthly cause-specific excess mortality.
• Analyzed excess deaths by age group (including working ages 25-64) during 2020.

Main Results:

• Non-COVID excess deaths disproportionately affected working-age men (71%) compared to women (36%).
• Leading causes of non-COVID excess deaths included external causes (especially for men), heart disease, diabetes, Alzheimer disease, and cerebrovascular disease.
• External causes, potentially driven by drug-related deaths, significantly contributed to working-age male excess mortality, independent of COVID-19 misclassification.

Conclusions:

• While older adults experienced the highest COVID-19 mortality, substantial non-COVID excess deaths occurred in working-age Americans, particularly men.
• External causes and heart disease were major drivers of excess non-COVID mortality in working-age men.
• The findings highlight the need for targeted public health interventions addressing diverse mortality causes beyond the pandemic itself.