Young American Adults Are Dying — and Not Just From Covid

(Bloomberg Opinion) -- Nearly 19% more Americans died in 2020 than in 2019, according to data that the Centers for Disease Control and Prevention updates each week as more reports from state and local medical examiners trickle in (meaning that the 2020 numbers will keep rising although likely not by much).

This is the biggest such increase since 1918, when deaths rose 30%. Deadly pandemics will do that. In a chart of overall U.S. mortality rates since 1900, both years stand out as anomalies amid a trajectory of — if you adjust for the aging of the U.S. population — sustained decline.

The age-adjustment is needed because in 1900 just 1.7% of Americans were 65 or older and at present almost 17% are. By holding the population share of different age groups steady, one gets a better picture of the changing mortality risk over time.

This metric also obscures some things, though. Examine the age-group mortality rates separately, and it becomes apparent that there are three different U.S. mortality stories. Older Americans and kids have seen sustained mortality declines, albeit at different paces. Younger adults and teen-agers have faced a different, less-encouraging trajectory.

For Americans 65 and older, the 1918 pandemic wasn’t a big deal and mortality rates have been in steady decline for almost a century, a decline that was interrupted in awful fashion by Covid-19 but could well accelerate at least temporarily after the pandemic. For those 45 through 64, the declines have been less steady — the 55-to-64 age group actually saw a slight increase in mortality in the decade before the pandemic — but the general picture has been similar.

The vertical axes on this and the following two charts are in base-10 logarithmic scale. That means the distance from 10 to 100 is the same as the distance from 100 to 1,000, and so on, which is the only practical way to compare all the age groups in one chart. It’s arguably also the best way — although certainly not the only valid one — to observe changes in mortality over the long haul, because on a log scale, percentage moves look the same no matter how big or small the underlying numbers are.

For infants and children, the mortality declines since 1900 have been spectacular and 2020 wasn’t a bad year at all. Infants have gone from being the age group with the second-highest mortality rate (after those 85 and older) to middle of the pack. Small children have gone from middle of the pack to second-lowest. Kids ages 5 through 14 have always had the lowest mortality rate, and its decline has stalled over the past decade, while U.S. infant-mortality has not fallen as far in as in other rich countries. Overall, though, the picture is one of vast improvement.

For ages 15 through 44, it’s a different story. The 1918 flu was deadliest for young adults and Covid-19 has not been, so their 2020 mortality increases pale in comparison with those of 1918. But since about 1950, the mortality trajectories of this group have departed from the path of steady decline seen for other ages. Those aged 25 through 34 have seen the least improvement of all, dying at about the same rate in 2020 as they did in 1953.

In March, a National Academies of Sciences, Engineering, and Medicine committee summed up the current state of knowledge in a 475-page report on “High and Rising Mortality Rates Among Working-Age Adults.” Advances in overall life expectancy stalled in the U.S. after 2010 even while continuing in other wealthy countries, the committee summed up, attributing this mainly to (1) rising mortality due to external causes such as drugs, alcohol and suicide among those aged 25 through 64 and (2) a slowing in declines in deaths from internal causes, chiefly cardiovascular diseases.

There are lots of different ways to analyze this disturbing turn of events, and the fact that much attention so far has gone to the plight of the middle-aged makes sense in that middle-aged people are a lot likelier to die than younger adults. The 3.7% increase in mortality from 2010 through 2019 for those aged 55 through 64, for example, amounted to almost four times as many deaths as the 25.2% increase among those aged 25 through 34.

Still, a 25.2% mortality increase over nine years amounts to a staggering setback, far worse than any other age group experienced over that period. It was followed up in 2020 with an also staggering 24.5% one-year increase, which made for a 55.8% rise since 2010. What also stands out in the historical data is that this isn’t the first such big mortality setback for the 25-to-34 group and other Americans on the young side. Here’s another (non-logarithmic) way of looking at what’s happened to them since 1950.

Mortality rates have been more volatile for younger adults in part because younger adults are less likely to succumb to the afflictions that fell the rest of us. Heart diseases and cancer are far and away the leading killers in the U.S., together responsible for nearly half of all deaths from 1999 though 2019. But among those aged 25 through 34 they come in fourth (cancer) and fifth (heart diseases), behind accidents, suicides and homicides. For young adults, the medical and public-health advances that have helped bring overall mortality down over time can be overwhelmed by a crime wave, a drug-overdose epidemic or a pandemic that turns the world upside-down.

CDC data show that motor vehicle accidents and homicides were the chief drivers of increased mortality among young adults in the 1960s, and HIV/AIDS in the 1980s and early 1990s. Here’s the breakdown from 1999 through 2019:

Drug overdoses have been the main problem, with the CDC attributing most of the increase in overdose deaths since 2013 to fentanyl and related synthetic opioids, but suicide rates also rose from the mid-2000s to mid-2010s. It may be relevant that Americans under 40 saw their share of U.S. household wealth fall to a record low 4.3% in 2009, and that the current 5.9% is still lower than at any time before 2008. Young adults would appear to have been victimized by tough economic times on the one hand and toxic new drugs on the other.

The above chart doesn’t go to 2020 because full cause-of-death-by-age data for last year aren’t out yet. Covid deaths have been reported by age group, and the CDC has so far counted 2,615 last year among 25-to-34-year-olds — 3.5% of the total deaths in the age group and 17.8% of the increase in deaths over 2019. The CDC has also reported deaths by cause among the population as a whole for the first 11 months of 2020, and drug overdoses and homicides, which tend to disproportionately victimize young adults, rose sharply. As of June 16, 20,131 additional deaths from overdoses had been reported, a 31.3% increase over the same period in 2019, and 5,018 from homicides, a 28.8% increase. Reported suicides fell by 1,362, or 3.1%, but that drop gets a little smaller each week as the numbers are updated. In a year that was stressful for all us, those stresses would appear to have have hit young adults the hardest.

Even before the pandemic, young adults in the U.S. faced much higher mortality rates than their peers in most other wealthy countries. (The source of the data in the following chart, the Human Mortality Database, reports mortality rates by five-year age groups, not 10-year, so I’ve gone with the 25-to-29-year olds.)

The takeoff of U.S. young adult mortality relative to other countries over the past two decades is, again, mainly about drug overdoses. Before then, U.S. deaths per 100,000 from accidental poisoning — the vital statistics category that includes overdoses — did not stand out from the rates in the rest of the developed world; by 2017 they were much higher. Lately, Canada has been catching up in overdose deaths, which explains its recent rise in young-adult mortality.

But the U.S. young adult death rate was on the high end even before 2000, due to persistently higher death rates from traffic accidents and homicides. This is probably because we (1) drive more and have laxer speeding enforcement and (2) have lots more guns, which are deadlier than the other weapons with which people assault each other. I’ve left suicide off the below chart because the U.S. rate doesn’t really stand out, but it did go from below average among wealthy countries in 2000 to above average in 2015.

If you want fewer young American adults to die, finding a way to stop the opioid epidemic would clearly save the most lives, but reducing gun violence and driving, and installing lots more speed cameras, would help too. I’m more optimistic about progress on opioids than the others — drug epidemics have a tendency to subside eventually. An end to the Covid-19 pandemic and improving job prospects for young adults also offer some hope of improvement. Past increases in young-adult mortality were subsequently reversed. Though that doesn’t make the current one any less tragic.

The crude overall mortality rate and the age-group mortality rates for 2020 are calculated using provisional deaths data released by the CDC on June 16 and population estimates released May 27 by the Census Bureau. As noted above, the provisional deaths numbers keep going up every week. But the population numbers for all or most age groups will also be revised upward when the full results of the 2020 Census are released, so I'm guessing the end result will be mortality rates are slightly lower than the ones reported here. For the age-adjusted mortality rate, I used on a CDC estimate from April. Mortality numbers prior to 1933 arefrom a sample of states, not all of them. The log charts were created by Bloomberg Opinion's Elaine He.

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Justin Fox is a Bloomberg Opinion columnist covering business. He was the editorial director of Harvard Business Review and wrote for Time, Fortune and American Banker. He is the author of “The Myth of the Rational Market.”

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