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US - Trends in Death Rates from Neoplasms, All Ages and 75-84 Detailed Analysis

US Cause of Death Project

Update Date: April - 2024

Carlos Alegria, Yuri Nunes


Go to paper pre-print (Research Gate)   Paper Link


Navigation to related reports:

US - Death Trends from Neoplasms, Ages 15-44

UK - Death and Disability Trends from Malignant Neoplasms, Ages 15-44
UK - Death Trends from Malignant Neoplasms - Analysis of Individual Causes, Ages 15-44



Data:

Country: US

Period: Yearly data from 2010 to 2022.

Cause of Death Data
The data used in this analysis is comprised of the number of deaths recorded in the USA between 2010 and 2022, categorized by underlying cause code (ICD-10), sex, and 10-year age groups. These data were acquired through the CDC WONDER system, provided by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC). The mortality data is considered final up to 2021 but provisional from 2022 onwards. Additionally, to compare trends in multiple cause (MC) of death from neoplasms with those in underlying cause (UC) of death, we retrieved data from both the multiple cause of death databases and underlying cause of death databases.

Link to the underlying cause of death databases: CDC Wonder Underlying Cause of Death Data

Query parameters:
For underlying cause of death data, select variable grouped by:
1. Ten-year-age-groups, 2. Gender, 3. Year, 4. UCD – ICD Chapter

Link to the multiple cause of death databases: CDC Wonder Multiple Cause of Death Data

Query parameters:
For multiple cause of death data, select variable grouped by:
1. Ten-year-age-groups, 2. Gender, 3. Year, 4. MCD – ICD Chapter

Limitations on CDC Data Utilization:

In this research paper we abide by the CDC’s restrictions on data use which are:
In alignment to the guidelines set forth by the Centers for Disease Control and Prevention (CDC) regarding data utilization, this research paper complies with the following restrictions:
“The Public Health Service Act (42 U.S.C. 242m(d)) provides that the data collected by the National Center for Health Statistics (NCHS) may be used only for the purpose for which they were obtained; any effort to determine the identity of any reported cases, or to use the information for any purpose other than for health statistical reporting and analysis, is against the law. Therefore, users will:

  • Use these data for health statistical reporting and analysis only.
  • Do not present or publish death counts of 9 or fewer or death rates based on counts of nine or fewer (in figures, graphs, maps, tables, etc.).
  • Make no attempt to learn the identity of any person or establishment included in these data.
  • Make no disclosure or other use of the identity of any person or establishment discovered inadvertently and advise the NCHS Confidentiality Officer of any such discovery.”


Summary/Abstract


We investigate trends in death rates from neoplasms (ICD-10 codes C00-D48) for all age groups in the US using data from the CDC (Centers for Disease Control and Prevention). We also perform a detailed analysis for older individual aged 75 to 84. We investigate trends in neoplasms where these appear on multiple causes (MC) of death, or as the underlying cause (UC), as well as the trends in the ratio of multiple cause to underlying cause death rates.

For individuals aged 75 to 84 we show a rise in excess mortality from neoplasms reported as the underlying cause of death, which started in 2021 (+4.8%) and increased substantially in 2022 (+11.5%). The increase in excess mortality in both 2021 (Z-score of 10.5) and 2022 (Z-score of 25.1) are highly statistically significant (extreme events). When looking at neoplasm deaths reported as multiple cause of death, we observe a similar trend, but starting in 2020, with excess mortality of +3.4% in 2020, +9.2% in 2021, and +16.4% in 2022, which were also highly statistically significant.

The larger rise of excess death rates due to neoplasms in multiple causes compared to underlying cause indicates that some deaths from neoplasms are being brought forward by other causes. However, the rise in cancers as underlying cause indicates that there might also be an unexpected rise in the incidence of fatal cancers, an increase in rapid growth cancers and/or an acceleration of existing cancer cases leading to earlier death.

We also show that excess deaths from cancers occurred for most age groups, with the strongest effect in ages 15-24 and individuals 65 and older. The results indicate that from 2020 a novel phenomenon leading to increased neoplasm deaths appears to be present. An exception was observed for individuals aged 55-64. This cohort did not exhibit excess deaths from neoplasms in 2020, 2021 or 2022.



Trends in US Death Rates from Neoplasms for Ages 75-84

In this section we analyse the trend in yearly death rates for individuals aged 75 to 84 in the USA. In this analysis we use the 2010-2019 trend in deaths per 100,000 (death rates) as the baseline estimate for excess death rates. Excess death rates for the 2010-2019 period are in-sample while the rates for 2020, 2021, and 2022 are out of sample computations.


Trends in Death Rates from Neoplasms as Underlying Cause (UC) of Death

The Figure (left) below shows the death rate per 100,000 individuals for neoplasm deaths (ICD-10 codes C00 to D48) as underlying cause in the US, for the 75-84 age group of both sexes. The Figure on the right shows the absolute number of deaths.

plot_USneoplasms_7584_Fig1_1
plot_USneoplasms_7584_Fig1_2

Summary:

  • The left figure shows the death rate per 100,000 individuals for neoplasm deaths in the US from 2010 to 2022. We can observe that deaths per year from neoplasms in the 75-84 age group have been trending lower from 2010 to 2019, with a significant downward slope. In 2010 the death rate was 1238 per 100,000 and in 2019 it was 1035 per 100,000, a 16.4% drop.
  • The death rate dropped in 2020 to about 1021 per 100,000 in line with the 2010-2019 trend, and then rose to 1049 per 100,000 in 2021. In 2022 the death rate increased again to 1091 per 100,000, a level that is similar to that observed in 2017.
  • In terms of the absolute number of deaths for diseases from neoplasms, shown in the figure (right), we can observe that in 2020 there were 167,957 deaths, while in 2021 there were 169,929 deaths, and 176,784 in 2022.






Analysis of Excess Death Rates from Neoplasms for Ages 75-84, Both Sexes.

In this section we investigate the trends in excess death rates from neoplasms as underlying cause in the US, for the 75 to 84 age group from 2010 to 2022. We also show the excess all-cause deaths for comparison. The figure on the left refers to relative deviations from the 2010-2019 trend, while the figure on the right shows the Z-score (signal strength) for the deviations from trend.


Excess UC Death Rates from Neoplasms, 75-84

In the figure (left) we can observe that the excess death rates from neoplasms as the underlying cause were slightly negative in 2020 at -0.1%, then rose to +4.8% in 2021, and +11.5% in 2022. By comparison, the excess mortality for all-cause deaths was +16.6% in 2020, +20.9% in 2021, and +21.7% in 2022. Noteworthy is that while excess mortality for all-cause deaths increased only slightly from 2021 to 2022, excess deaths from neoplasms as the underlying cause rose substantially.

When translating these values into absolute number of excess deaths, the UC excess death rates from neoplasms correspond to -208 excess deaths in 2020, 7815 in 2021 and 18213 in 2022. For comparison, for all-cause death rates, the corresponding number of excess deaths were 117235 in 2020, 143592 in 2021 and 147040 in 2022.

In terms of statistical significance of the excess deaths, we observe from Figure 4 (right) that the Z-scores for neoplasm death rate deviations from trend were 10.5 in 2021 and 25.1 in 2022. The strength of the excess deaths from neoplasms was of similar magnitude when we analysed younger individuals aged 15-44.

plot_USNeoplasms_7584_Fig2_1
plot_USNeoplasms_7584_Fig2_2


Excess MC Death Rates from Neoplasms, 75-84

In the figure (left) we can observe that the excess MC death rates from neoplasms were +3.4% in 2020, then rose to +9.2% in 2021, and +16.4% in 2022. By comparison, the excess UC death rates were -0.1% in 2020, +4.8% in 2021, and +11.5% in 2022. Of note is that the rise in excess mortality for MC deaths from cancer were greater than for UC deaths, particularly in 2020.

In terms of absolute numbers, the MC excess death rates from neoplasms correspond to 6488 excess deaths in 2020, 16806 in 2021 and 29231 in 2022. For UC excess death rates, the corresponding number of deaths were -208 in 2020, 7815 in 2021 and 18213 in 2022.

In terms of the statistical significance of the excess deaths, when looking at excess MC deaths from neoplasms, the Z-score in 2020 was 12.9, indicating that the increase in neoplasm-related deaths is a very strong signal. That trend however accelerated substantially in 2021 and 2022 where we observe Z-scores of 34.6 and 61.4, respectively. These are extreme events, akin to those observed for UC cancer deaths.

plot_USNeoplasms_7584_Fig3_3
plot_USNeoplasms_7584_Fig3_4


Analysis of Excess Death Rates from Neoplasms for Males and Females, Aged 75-84

We now compare excess deaths rates from neoplasms for males and females aged 75-84, as shown in the Figure below.

When comparing excess UC death rates from neoplasms for males and females, shown in the figure below, we observe that in 2020, while females had +1.27% excess mortality, males experienced only +0.45% excess mortality, with Z-scores of 2.8 and 1.8 respectively. The results indicate that the excess neoplasm mortality for females might point to a small signal, with weak statistical significance, in 2020.

In 2021 excess UC death rates from neoplasms for males was about +5.0% while +6.6% for females, both having Z-scores above 10, indicating very high statistical significance. For individuals aged 75-84 in the US, females experienced higher excess deaths rates from neoplasms compared to males in 2021. This is the opposite of our findings for ages 15 to 44 where males experienced almost double the excess deaths from neoplasms compared to females in 2021.

plot_USNeoplasms_7584_Fig4_1
plot_USNeoplasms_7584_Fig4_2






Analysis of Excess Death Rates from Neoplasms for All Ages, Both Sexes.

In this section we investigate the excess death rates from neoplasms as underlying cause in the US, for all age groups (10-year groups) for 2020, 2021 and 2022. The figure on the left refers to relative deviations from the 2010-2019 trend, while the figure on the right shows the Z-score (signal strength) for the deviations from trend.


Excess UC Death Rates from Neoplasms, All Ages (10-year age groups)

The figure below shows that the excess UC death rates from neoplasms seem to have started in 2021 and risen substantially in 2022 for ages 15 and above. One exception however is the 55-64 age group where excess death rates from neoplasms actually decreased over the same period. Individuals aged 5-14 also seem to have experienced excess death rates from neoplasms, but only in 2022, with low signal strength due to the small sample size. For age groups 1 and 1-4, we observe large negative excess deaths due to neoplasms albeit without statistical significance which we attribute to small sample sizes for these age groups.

In 2022, within younger individuals (aged 5-54), excess death rates were highest for age group 15-24. Excess death rates were negative for age group 55-64 which is an exception from the overall pattern of increasing excess deaths from cancers. This observation should be subject for further detailed investigation, to better understand the underlying phenomenon. Older individuals aged 75 and older show the highest rises in UC excess deaths from cancers in 2021 and 2022 with individuals 85 and older being the most affected. Signal strengths for the younger age-groups vis-à-vis older age groups is due to larger sample sizes for older individuals.

plot_USNeoplasms_allages_Fig5_1
plot_USNeoplasms_allages_Fig5_2

Summary:

  • Our analysis shows that the excess UC death rate from neoplasms that started in 2021 and increased further in 2022, occurred for all age groups from ages 15 and above, with the notable exception of the 55-64 age group.






Conclusions

    Excess deaths from neoplasms for age group 75 to 84:
  • Our results show that the excess UC death rates from neoplasms for the 75-84 age group were -0.1% in 2020, +4.8% in 2021, and +11.5% in 2022, with respective Z-scores of -0.3, 10.1 and 24.0, as shown in Table 1. The excess UC death rates in 2021 and 2022 can be considered extreme occurrences. In 2020 there was no significant deviation from the 2010-2019 trend in UC death rates.

  • When analysing MC death rates from neoplasms we show that the excess death rate from neoplasms was +3.4% in 2020, +9.2% in 2021, and +16.4% in 2022, with Z-scores of 13.2, 35.3 and 62.7, respectively, as shown in Table 1. The excess death rates were highly statistically significant in 2020, 2021 and 2022.

  • For comparison, excess mortality for all-cause deaths for individuals aged 75-84 was +16.6% in 2020, +20.9% in 2021, and +21.7% in 2022. Of note is that while excess all-cause mortality more or less stabilised in 2021 and 2022, excess deaths from neoplasms both as UC and MC rose substantially.
  • Females experienced higher excess death rates compared to males in 2020, 2021 and 2022, which was in contrast to the results found in our previous paper on cancer rates in individuals aged 15 to 44, where excess death rates for males much higher than for females in both 2021 and 2022.


    • Excess neoplasm deaths for all ages:
  • When investigating different age groups, we observe that excess UC death rates from neoplasms started in 2021 and rose substantially in 2022 for most age cohorts from age 15 and above (Table 1). Older individuals aged 75 and older show the highest rises in UC excess deaths from cancers with individuals 85 and older being the most affected. For younger cohorts (aged 5-54), excess death rates were highest for age group 15-24. Excess death rates were negative for age group 55-64 which is an exception from the overall pattern of increasing excess deaths from cancers.

  • Individuals aged 5-14 also experienced excess death rates from neoplasms, but only in 2022 and with low signal strength due to the small sample size. For age groups 1 and 1-4, we observe large negative excess deaths due to neoplasms albeit without statistical significance which we attribute to small sample sizes for these age groups. The lower signal strengths for the younger age-groups relative to older age groups is due to larger sample sizes for older individuals.
  • These observations should be subject for further detailed investigation, to better understand the underlying phenomenon.


    • Suggestions for further work:
  • Further research is needed to untangle the different contributions towards the rise in cancer-related death rates. Investigation of the underlying causes of increased cancer-related deaths is of the utmost importance, as the observations show an acceleration in deaths both directly due to neoplasms (UC) and with neoplasms as a contributing factor (MC).
  • Our analysis does not allow us to look in detail at whether cancer incidence has increased since 2020, and when this may have occurred. Given the case studies of neoplasms following COVID-19 vaccination cited above, future studies should focus on COVID-19 vaccinated and unvaccinated individuals and whether the vaccination rollout or COVID-19-related conditions such as Long COVID are contributing factors to the ongoing rise in neoplasm-related deaths.

  • For a more detailed analysis please read our full paper (Link to paper).