News & Views: COVID-19 Death Rates — Reality and Conspiracies

One of the conspiracy theories of the COVID-19 pandemic was that healthcare providers were adjusting death certificates to make the pandemic look worse than it was. For those who work in healthcare, this idea was a non-starter:

• First, healthcare providers on the frontlines knew full well that they were busy treating many people who were very ill with this new infection.
• Second, healthcare providers also knew they were mandated to maintain accurate records.

Recordkeeping in healthcare systems relies on the global classification system, known as the International Classification of Diseases (ICD). The ICD system has been in place for more than 100 years and is a shared set of codes that indicate patient diagnoses, ensure accurate billing and compliance, and allow for comparison of disease and death rates across countries and regions.

The idea that healthcare providers around the world would effectively conspire by employing inaccurate ICD codes to create a sense of urgency that did not actually exist is ludicrous. Indeed, record keeping is not perfect; some regions are better equipped than others. Some providers are more attentive than others. But the idea of creating a false narrative by getting all of these individuals worldwide to “tell the same lie” is out of the realm of possibility.

Unfortunately, these types of false narratives, coupled with other pandemic-associated steps and missteps, have resulted in diminished societal confidence in important public health entities, such as the Centers for Disease Control and Prevention (CDC). Most members of the public do not realize the vast resources, infrastructure and expertise that the CDC contributes to the health of our country. Admittedly, like the strengths and weaknesses of every individual, institutions, such as the CDC, have strengths and weaknesses too. But, we don’t dismiss individuals because of their imperfections, and it would be unwise to stop believing everything from the CDC because of perceived weaknesses in their pandemic response. The recent hepatitis cases of unknown etiology in children provide an example of the need for a national infrastructure and expertise that is necessary for resolving unexpected situations and emergencies.

Another example of the importance of the CDC is their annual calculation of mortality. For more than 100 years, the CDC has been monitoring the number and causes of death overall and among subgroups of the U.S. population. Only by understanding what is causing the most deaths and in which age, gender and racial or ethnic groups can we effectively understand and address diseases or situations that are having an outsized effect on the nation’s health. Recently, the CDC published the provisional mortality data for 2021. The process of finalizing the array of data takes about 11 months, so provisional data are shared earlier in the year to provide an opportunity for intervention while the final numbers are compiled.

So, what did we learn in the recent data release?

COVID-19 remained the third most likely cause of death.
If you look at the mortality reports for the five years prior to 2020, the top 10 causes of death ranked very similarly. From 2015 to 2019, the top two causes of death were heart disease and cancer, respectively. These diseases each killed about 500,000 to 600,000 people annually during those years. The drop off between those and the remaining eight causes of disease was significant, with the third most common causing between 155,000 and 173,000 deaths annually. In 2015, the third most common cause of death was chronic lower respiratory disease. In 2016-2019, the third most common cause was unintentional injuries. In 2020, COVID-19 took the third spot, causing almost 385,000 deaths. COVID-19 remained the third most common cause of mortality in 2021, contributing almost 461,000 deaths.

In 2021, deaths caused by influenza and pneumonia were not in the top 10.
Deaths attributed to influenza and pneumonia typically number between 50,000 and 59,000, making this category eighth or ninth on the list of causes. However, in 2021, the number of deaths attributed to this cause was just under 42,000, making it fall out of the top 10. Chronic liver disease and cirrhosis replaced it in the top 10, capturing the ninth spot on the list with more than 56,000 deaths in 2021.

Death rates related to COVID-19 increased among almost all age groups in 2021.
Other than those 85 years of age and older, every other age group experienced greater rates of death per 100,000 individuals during 2021, compared with 2020. Increases varied by age group:

• Less than 1 year old: 1.4 deaths per 100,000 (dpht) in 2020 to 4.2 dpht in 2021
• 1- to 14-year-olds: 0.2 dpht (2020) to 0.4 dpht (2021)
• 15- to 24-year-olds: 1.4 dpht to 3.9 dpht
• 25- to 34-year-olds: 5.7 dpht to 15.2 dpht
• 35- to 44-year-olds: 16.0 dpht to 40.6 dpht
• 45- to 54-year-olds: 45.2 dpht to 97.9 dpht
• 55- to 64-year-olds: 107.0 dpht to 187.2 dpht
• 65- to 74-year-olds: 252.1 dpht to 329.9 dpht
• 75- to 84-year-olds: 644.4 dpht to 649.3 dpht

Among those 85 years and older, the rate of death per 100,000 people dropped from 1,842.9 in 2020 to 1,395.7 in 2021. It is important to note that while this rate decreased, likely due to widespread vaccination of this age group, the oldest among us are still at greatest risk of dying when infected with COVID-19.

• For more details, including data related to gender and race/ethnicity, check the complete report.

The data related to mortality are critical for helping us understand where to turn attention in keeping communities healthy. These data have been collected for more than a century, and as such, while some may have taken solace in thinking that the data were being altered to create a particular narrative, the framework was in place long before COVID-19 came along. Further, the data are applied to much more than any short-lived political narrative. As a society, we would do well to remember that systems in place to save lives outlive the 24-hour news cycle in terms of both their impact and importance.