COVID-19 Mortality Surged Among the Young in Third Quarter 2021

COVID-19 claimed a larger percentage of excess deaths in younger American ages 40 and under in the third quarter of 2021 than those ages 75 and older, according to data published in the 2022 Cause of Death Report, Third Quarter, 2021 Update.

The change in death by age accompanies a significant turn in the trend of the overall excess age-standardized mortality rate (ASMR) since the coronavirus’s advent in 2020. (See Figure 1.)

Released in August by RGA, the Society of Actuaries, LIMRA, and RGA subsidiary TAI, the findings are based on life insurance claims filed during the third quarter of 2021. Presented in a Tableau dashboard, the research is part six in a series of data reports that follow mortality trends in the life insurance population since second quarter 2020. (See Figure 2.)

The rate of COVID-19 deaths for the youngest insured cohort – represented by a weighted average age of 27.7 years – jumped nearly four times higher than its previously top rate when cases first surged in second quarter 2020. Claims from the coronavirus alone represented a 17% increase over all-cause expectation for younger Americans. That hike is significantly higher than the 5% and 2% upticks in coronavirus fatalities in the first and second quarters of 2021, respectively.

Importantly, overall excess deaths for the youngest cohort were tempered by a 9% decline in ASMRs from non-communicable diseases. Most of the good experience in non-communicable deaths was due to cancer ASMR coming in at 60% of expectation. Also, excess ASMR dropped for cardiovascular disease (78% of expected) and diabetes (35% of expected).

Non-COVID-19 excess deaths were higher than expected in the third quarter of 2021, but in insureds under 40 this was not the case. When modeling overall excess deaths as a function of COVID-19 deaths, the rise in overall COVID-19 ASMR combined with the reduction in all-cause excess ASMR below that of COVID-19 in the youngest cohort is profound, countering guidance based on evidence prior to the third quarter of 2021 that consistently demonstrated overall excess deaths well beyond COVID-19 deaths.

Other Findings

Consistent with previous trends, excess ASMR in the middle age group and oldest age group continued to be largely driven by COVID-19 deaths.

The prior study, the 2022 Cause of Death Report, demonstrates that the oldest group often showed excess ASMR lower than just COVID-19 ASMR, likely due to deaths that happened sooner than otherwise expected due to COVID-19 from prior periods. It is important to note that this phenomenon occurred following periods of high all-cause excess ASMR.

In general, deaths from the coronavirus largely accounted for all excess. Therefore, modeling implications remain unchanged for the middle and oldest groups.   

By regions specified by the U.S. Department of Health and Human Services (HHS), differences in excess ASMR continued to be extreme in the third quarter of 2021. In region 2 - comprising the northeastern states of Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont – the middle-aged cohort saw excess ASMR of only 2%, with 7% of that from the coronavirus. Non-communicable causes, especially cancer and cardiovascular-associated ASMRs, each declined the overall excess by 5% of expected estimates.

In contrast, HHS’s region 4 – encompassing the southern and southeastern states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee – ASMR excess for the middle age group was a significant 51%, with 44% from the coronavirus.

Face amount results are tied to policyholder age. Those in the younger and middle-aged cohorts had comparatively larger face amounts coupled with the worst experience in the third quarter of 2021. Policyholders with coverage valued at $1 million and higher were hit quite hard in the third quarter of 2021 with excess ASMR of 51% and 23% for the middle age group and oldest group, respectively.

Findings relating to underwriting class and smoker status remain consistent with prior reporting. Not surprisingly, preferred policyholders have much lower COVID-19 ASMR than standard policyholders. Non-smokers and smokers have similar COVID-19 ASMR among the three age cohorts. Cancer deaths for preferred smokers in the middle age group were higher than COVID-19 deaths. That is the fourth quarter in the seven quarters since 2020 where cancer outpaced COVID-19 deaths in that cohort.

The analysis is based on data from 28 companies representing approximately 69% of the life insurance industry face amount in force with a total of 2.9 million death claims from individual life policies from January 1, 2015 through September 30, 2021. To learn more about previous reports, please see Industrywide Research Initiative Provides Key COVID-19 Insights.