Question: Trump said yesterday that the average age of death was 78, so I was trying to verify that number since we hear so much about younger people dying that I figured he was exaggerating data again, and I came across this chart from the CDC: https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm. Is this right? It looks like death rates for all age groups was really high in April, but has fallen substantially for all age levels to almost zero for all but the oldest age groups, and they are now in the less than 100 range. My two questions are: is this data right or is there some delay in reporting or something? Or have drs and hospitals figured out how to prevent death in the vast majority of patients?
Answer: So much to unpack here! The demographer in me loves this question! Let’s dig in (but not too deep since I’m trying to keep this relatively short). First, when it comes to average age of death, Trump was not exaggerating (though it’s more complex). Second, CDC’s NCHS data are always several weeks behind, so the data from the last several weeks is not representative of the true picture (ignore it). That said, there is a modest change in the proportion of deaths by age (Table 1) with people ages 45–64 more recently accounting for a larger proportion of deaths. Third, doctors and hospitals have improved their patient care thanks to experience and evidence, which seems to have improved patient outcomes though data are still limited.
Average Age of Death Varies by Race and Ethnicity
Based on this report published a couple of weeks ago in CDC’s Morbidity and Mortality Weekly Report (MMWR), the average age of death varies dramatically by race and ethnicity. Using data compiled as of 18 May, the authors find “median age was 71 years (IQR = 59–81 years) among Hispanic decedents, 72 years (IQR = 62–81 years) among all nonwhite, non-Hispanic decedents, and 81 years (IQR = 71–88 years) among white decedents. The percentages of Hispanic (34.9%) and nonwhite (29.5%) decedents who were aged <65 years were more than twice those of white decedents (13.2%)… Among the decedents during February 12–April 24, 2020, for whom supplementary information was provided, 9,997 (93.9%) resided in New York City, New Jersey, or the state of Washington, three areas with early widespread circulation of SARS-CoV-2; the median age among decedents in these three jurisdictions was 75 years, (IQR = 64–84 years). The median age among decedents residing in the other 13 jurisdictions was similar (78 years, [IQR = 68–85 years]).” [Note: IQR means inter-quartile range and it’s a measure of the spread of the data — for example, among Hispanic decedents, the middle 50% of all deaths were among people between the ages 62–81.]
CDC’s National Center for Health Statistics (NCHS) Data Are Always Several Weeks Behind
We talked about mortality reporting in our Q&A of 5/5 (#Coding Deaths), which also describes how death certificate data captured by CDC is always several weeks delayed. This means that the sharp decline in deaths over the last several weeks that you observed in NCHS’s “Provisional Death Counts” chart is due to data reporting lag rather than sharp decline in deaths. That said, deaths have fallen dramatically since their peaks in April. Unfortunately, deaths are back on the rise (Figure 1).
Patient Care has Improved
We know so much more every day and as a result, patient care is improving as are patient outcomes. We talked about some of this evidence in our Q&A of 5/31 (#Outcomes) The ongoing challenge (beyond the virus itself) is that in the context of sustained, widespread transmission, local health systems may become overloaded and in that case, patient care and patient outcomes will suffer.
One Other Note of Interest — Life Expectancy
1) This not yet peer-reviewed article by a world renowned demographer estimates that due to COVID, “In the US, life expectancy is projected to decline this year by more (−.68), [a reduction greater] than the worst year of the HIV epidemic, or the worst three years of the opioid crisis, and to reach its lowest level since 2008. Substantially larger reductions, exceeding two years, are projected for Ecuador, Chile, New York, New Jersey and Peru.”
Table 1. Proportion of Weekly Deaths by Age Group (data from NCHS)
Figure 1. Daily COVID Deaths in the USA (data from covidtracking.com)
