Causes of Death in 2020

The Journal of the American Medical Association (JAMA)  recently published an article tabulating the leading causes of death in the US in 2020. Although there has been plenty of misinformation claiming that the COVID-19 pandemic hasn’t changed the overall death rate, the number of death certificates filed simply doesn’t lie.  The number of total deaths in the US in 2020 was 3.4 million compared with 2.9 million in 2019.  That’s over 500,000 more deaths; an increase of almost 18% compared with 2019.  Although COVID-19 accounted for nearly 350,000 deaths, making it the third leading cause of death,  it didn’t account for all of the increase.  That leaves us nearly 160,000 additional deaths to account for.  Where they came from is interesting – and concerning.  

Heart disease accounted for nearly 32,000 more deaths, a 5% increase, which is actually the largest increase in heart disease deaths since 2012.  Similarly, stroke accounted for over 9,000 more deaths, a 6% increase.  Alzheimer’s disease accounted for nearly 12,000 more deaths, a 10% increase.  

Diabetes accounted for more than 13,000 additional deaths, a 15% increase, which was the largest relative increase in deaths out of all the leading causes (outside of COVID-19, of course). Attributing death from diabetes is tricky because diabetes itself isn’t usually the culprit – rather the process of having diabetes wreaks havoc on the other systems of the body (the kidneys, the heart, the blood vessels, the extremities, the immune system) and death due to malfunction those other systems is usually blamed on those systems.   In fact, nearly 98% of older American adults with type 2 diabetes have at least one comorbid condition and nearly 90% have at least two comorbidities, so it’s extremely difficult to disentangle the difference between diabetes as an underlying cause vs a contributing cause of death.

We don’t know the reason behind these numbers.  It could be due to disruptions in healthcare that hampered early detection and treatment.  However, cancer deaths were flat, as were kidney diseases.  This is a bit puzzling.  If the increases in the above-mentioned diseases were due to disruptions in care, we should have seen the same increases in deaths due to cancer and kidney disease – unless the care of these diseases was deemed more essential and was, therefore, less disrupted.  

Because this is a blog post on a site dedicated to the treatment and awareness of the disease of obesity, we are going to focus on these above-mentioned issues.  If you want to read the entire report, click HERE.  There are other interesting and puzzling statistics in there that don’t necessarily relate to obesity and that I’m not going to dive into, but feel free to ponder the questions on your own. 

For example, unintentional injuries like automobile accidents falls, and drug overdose deaths, increased by 11%. This is surprising, considering that most people must have driven far less in 2020.  There were almost 3,000 fewer suicides in 2020 compared to 2019, a 6% decrease. We know there was a huge flare of mental health issues in 2020.  Could this mean that this increase in mental health issues has not translated to actual suicide?

Interestingly, influenza and pneumonia (not related to COVID-19) accounted for nearly 4,000 additional deaths, an 8% increase.  This is surprising.  We didn’t hear much about influenza this year and I would have thought the masks and distancing would have dramatically reduced the spread of influenza.  

However, let’s stay on topic. We can’t ignore the fact that COVID-19 affected people with obesity and metabolic disease much more severely than those people without those diseases. The statistics were (and continue to be) staggering. Having one or more chronic diseases, including obesity, dramatically increases your odds of dying if you infected with COVID-19

Even if we exclude COVID-19 deaths, we still have an excess of 160,000 deaths in 2020 compared with 2019; the largest year-over-year increase since at least 2015. The relative and absolute increase in the number of deaths from heart disease, diabetes, stroke, and Alzheimer’s disease (chronic lifestyle disease) were all the largest since at least 2015. 

We as a nation are getting sicker. At this point in time, only 12% of American adults are considered to be metabolically healthy.  88% of us have one or more risk factors for metabolic disease.  These risk factors (increased abdominal obesity, elevated blood pressure, elevated cholesterol, impaired glucose tolerance) are lifestyle diseases.  These are classified as chronic lifestyle diseases.  These are not infectious diseases or natural disasters or senseless accidents caused by things outside of our control.  Lifestyle diseases are caused by our lifestyles.  Which means they can be altered by our lifestyles as well.  Is altering our lifestyle easy?  Of course not.  It’s hard.  It’s really freaking hard for some people.  Does that mean we shouldn’t do it?  Of course not!  Just because something is hard doesn’t make it impossible.  Birthing babies is hard.  Starting a new job is hard.  Leaving a toxic relationship is hard.  Burying a loved one is hard.  We do hard things all the time.  Most of the time, improving our lifestyle won’t be the hardest thing we’ve ever done.  

But it might be the most important one.  

Why?  Because how we manage our lifestyle now not only determines how we feel and live now, but it determines how we age.  How we die.  When we die.  Our life expectancy is decreasing.  Children born today have a shorter life expectancy than their parents.  If we collectively stay on this path, we are choosing to die younger.  We are choosing to die sicker.  We are choosing to borrow more from the healthcare system than we put in.  For many of us, it means we are choosing to depend on our dependents to take care of us.  

Changing our lifestyle to improve our health both now and in the future isn’t impossible.  It doesn’t mean we have to live in a tent and forgo all decadent foods, living on boiled vegetables and dry, unappetizing meats.  For most of us, it does mean changing the overall way we approach food and eating.  It means prioritizing health.  It means not consistently relying on convenience foods and highly processed foods.  It means taking time to understand what we do and consciously make improvements where we can.  

It doesn’t mean being perfect.  For most of us, it just means making a healthier choice more often. 

If you want to do this and need help executing it, you know where to find me.

Courtney Younglove, M.D.

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