The worst of the COVID-19 pandemic is behind us. Age-adjusted COVID-19 mortality rates peaked in 2021 at 104.12 per 100 000 population (per 100 000 hereafter) and fell to 44.45 per 100 000 in 2022.1,2 Provisional data suggest that COVID-19 mortality rates in 2023 were below 15.00 per 100 000.2 This progress is welcome but deceptive. The US mortality picture is hardly ideal. Like the sand revealed as the tide goes out, the receding COVID-19 pandemic draws attention to rising mortality rates from non-COVID causes, a trend that predates the pandemic. [JAMA Network]
After 2010, life expectancy flatlined in the US while continuing to increase in other high-income countries.3 The primary cause was rising mortality rates in midlife (individuals aged 25-64 years). In 2015, Case and Deaton were among the first to call attention to this trend, which they first observed in the middle-aged White population.4 Subsequent studies documented the trend among young adults (aged 25-44 years) and middle-aged adults (aged 45-64 years) and other racial and ethnic groups.5
The many factors responsible for this trend—ranging from the opioid epidemic and increasing obesity rates to intensifying economic precarity—continued claiming lives during the COVID-19 pandemic. Indeed, COVID-19 poured fuel on the fire, accelerating increases in non-COVID mortality. For example, drug overdose deaths in the US more than tripled between 2000 and 2019 (from 4.15 per 100 000 to 19.14 per 100 000, respectively)1 and then soared during the pandemic, peaking in 2022 at 30.14 per 100 000.2
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