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U.S. death rate soared 17 percent in 2020, final CDC mortality report concludes

Covid, accidental drug overdoses and increases in heart disease, Alzheimer’s disease and diabetes drove the increase in deaths.
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Elizabeth Cooper looks out at the "In America: Remember" public art installation near the Washington Monument in Washington on Sept. 20. The installation commemorates all the Americans who have died of Covid-19. Getty Images file

Death rates for Americans ages 15 and older rose sharply in 2020, hitting Black and Hispanic Americans the hardest, according to a report released Wednesday by the Centers for Disease Control and Prevention.

The report — the agency’s finalized data on 2020 death rates — confirmed that life expectancy in the United States fell last year by nearly two years, the largest one-year drop since World War II

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“We normally don’t see declines of life expectancy of this magnitude,” said Bob Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics. “Usually when we see fluctuations in life expectancy, it’s only for a couple months of the year, so this is quite significant.”

Life expectancy overall fell from 78.8 years in 2019 to 77 years in 2020. For males, the average life expectancy fell  2.1 years, from 76.3 in 2019 to 74.2 in 2020. For women, the average decrease was 1.5 years, from 81.4 in 2019 to 79.9 in 2020. 

“One of the most jolting things in the report is the racial disparities,” said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. 

The average age-adjusted death rate increased by nearly 17 percent, from 715.2 deaths per 100,000 people in 2019, to 835.4 deaths per 100,000 people in 2020. But the increase for Black and Hispanic Americans was far greater. 

Death rates increased by almost 43 percent for Hispanic males and more than 32 percent for Hispanic females. Death rates in Black males rose by 28 percent and almost 25 percent for Black females, compared to roughly 13 percent for white males and 12 percent for white females. 

“That just shouldn’t be happening,” Woolf said. “There is this deeply embedded health consequence of systemic racism.” 

Nine of the 10 long-time leading causes of death in the U.S. stayed the same, with Covid appearing on the list for the first time. Deaths from heart disease remained the leading cause of death, with cancer second, followed by Covid-19, unintentional injuries — which includes drug overdoses — stroke, chronic lower respiratory disease, Alzheimer’s disease, influenza and pneumonia, and kidney disease. Deaths due to heart disease, unintentional injury and diabetes saw the biggest rises. 

The rise in deaths from these other causes show the impact the pandemic has had on all aspects of health in America, experts say.

“What these increases in non-Covid causes are telling us is that in addition to people dying of Covid directly, there was also an adverse effect on people’s health for conditions unrelated to the virus,” Woolf said. Decreased access to care and medication, as well as the stress of the pandemic itself, contributed to the rise in non-Covid deaths, he said.

Dr. Elizabeth Seaquist, director of the Division of Diabetes, Endocrinology and Metabolism at the University of Minnesota, agreed.  

“During the pandemic, many people have stepped away from routine care and choose to not come into clinics because of risk of infection,” she said. 

In the absence of routine screening, warning signs of illnesses like heart disease and cancer may be missed. 

For people with diabetes, which requires multiple aspects of management and treatment, it may be difficult to keep blood sugar levels under control, Seaquist said. “When your diabetes is not well controlled, you can die of acute problems,” she said.

Death from diabetes rose sixteenfold from 2019 to 2020, and surpassed 100,000 deaths  for the first time, the report found. 

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Access to insulin continued to be an issue for many Americans in 2020. On top of missed appointments during the pandemic that could cause a prescription to lapse, the drug has also become unaffordable to many patients in recent years, Seaquist said.

The average list price for insulin in the U.S. tripled from 2002 to 2013 and doubled from 2012 to 2016. In the past two years, states including Maine, Minnesota and Texas have passed laws limiting out-of-pocket insulin costs, though costs can still rise into the hundreds of dollars per month even with the caps. 

Despite the sobering increases in death rates overall, there were substantial decreases in one area: infant mortality. According to the report, the infant mortality rate decreased by nearly 3 percent in 2020, to a record low of 541.9 infant deaths per 100,000 live births. 

That decline, Anderson of the NCHS said, kept U.S. life expectancy from falling even further. 

“That is a bright spot in the report,” Woolf said. “This tells us that this trend continued in 2020 despite the pandemic, which is, of course, welcome news.”

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