Mortality among Adults Ages 25-44 in the United States During the COVID-19 Pandemic

  1. Jeremy Samuel Faust
  2. Harlan M. Krumholz
  3. Katherine L. Dickerson
  4. Zhenqiu Lin
  5. Cleavon Gilman
  6. Rochelle P. Walensky

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Abstract

Introduction

Coronavirus disease-19 (COVID-19) has caused a marked increase in all-cause deaths in the United States, mostly among adults aged 65 and older. Because younger adults have far lower infection fatality rates, less attention has been focused on the mortality burden of COVID-19 in this demographic.

Methods

We performed an observational cohort study using public data from the National Center for Health Statistics at the United States Centers for Disease Control and Prevention, and CDC Wonder. We analyzed all-cause mortality among adults ages 25-44 during the COVID-19 pandemic in the United States. Further, we compared COVID-19-related deaths in this age group during the pandemic period to all drug overdose deaths and opioid-specific overdose deaths in each of the ten Health and Human Services (HHS) regions during the corresponding period of 2018, the most recent year for which data are available.

Results

As of September 6, 2020, 74,027 all-cause deaths occurred among persons ages 25-44 years during the period from March 1st to July 31st, 2020, 14,155 more than during the same period of 2019, a 23% relative increase (incident rate ratio 1.23; 95% CI 1.21–1.24), with a peak of 30% occurring in May (IRR 1.30; 95% CI 1.27-1.33). In HHS Region 2 (New York, New Jersey), HHS Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), and HHS Region 9 (Arizona, California, Hawaii, Nevada), COVID-19 deaths exceeded 2018 unintentional opioid overdose deaths during at least one month. Combined, 2,450 COVID-19 deaths were recorded in these three regions during the pandemic period, compared to 2,445 opioid deaths during the same period of 2018.

Meaning

We find that COVID-19 has likely become the leading cause of death—surpassing unintentional overdoses—among young adults aged 25-44 in some areas of the United States during substantial COVID-19 outbreaks.

Note

The data presented here have since been updated. As a result, an additional 1,902 all-cause deaths occurring among US adults ages 25-44 during the period of interest are not accounted for in this manuscript .

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  1. ScreenIT

    SciScore for 10.1101/2020.10.21.20217174: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    3,4 We calculated death incident rates per 100,000 person-month with 95% confidence intervals (SAS 9.4, SAS Institute, Carey, NC).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    This study has limitations. The provisional data used represents lower-bound estimates due to reporting lags. While the magnitude of our findings may increase as COVID-19 spreads among younger populations, emerging treatments might improve fatality rates. Together, these data indicate that the mortality of COVID-19 among adults ages 25-44 is sizeable and should not be discounted by individuals or policymakers.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. ScreenIT

    SciScore for 10.1101/2020.10.21.20217174: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We calculated death incident rates per 100,000 person-month with 95% confidence intervals (SAS 9.4, SAS Institute, Carey, NC).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    This study has limitations. The provisional data used represents lower-bound estimates due to reporting lags. While the magnitude of our findings may increase as COVID-19 spreads among younger populations, emerging treatments might improve fatality rates. Together, these data indicate that the mortality of COVID-19 among adults ages 25-44 is sizeable and should not be discounted by individuals or policymakers. Data Statement and Author Contributions: Dr. Faust had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Faust, Gilman, Krumholz, Walensky. Acquisition, analysis, or interpretation of data: Faust, Dickerson. Drafting of the manuscript: Faust, Walensky. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Faust, Lin, Krumholz, Walensky. Administrative, technical, or material support: Dickerson. Supervision: Faust, Krumholz, Walensky. Funding Statements: Faust: None. Krumholz: Harlan Krumholz works under contract with the Centers for Medicare & Medicaid Services to support quality measurement programs; was a recipient of a research grant, through Yale, from Medtronic and the U.S. Food and Drug Administration to develop methods for post-market surveillance of medical devices; was a recipient of a research grant from Johnson & Johnson, through Yale University, to support clinical trial data sharing; was a recipient...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.10.21.20217174v1 on medRxiv