US and Georgia deaths rise well above norm - CDC data looks at possible causative factors

One set of NCHS data indicates that more than 75% of the excess deaths are due to COVID-related factors. A second set of NCHS data identify Alzheimer's/dementia as the factor behind a majority of this year's excess deaths. Hypertensive disease (high blood pressure) has also increased, contributing a significant portion of the excess death toll.

A review of the National Center for Health Statistic’s data regarding deaths in 2020 show that, since the last week in March, the total number of deaths in the United States has outpaced benchmark numbers from previous years. A similar pattern is seen in Georgia-specific numbers.

Although several data sets from the NCHS – which is a division of the Center for Disease Control and Prevention – indicate that a majority of those “excess deaths” have been attributed to COVID-19, another data set shows that increases in deaths attributed to dementia and Alzheimers, and increases in the number of hypertensive disease (high blood pressure) deaths, play a significant role in the high-than-normal death rate in 2020.


Graph A

Data charts from the NCHS website, updated Aug. 5, indicate that there have been between 156,354 and 212,979 “excess deaths” in the United States since Feb. 1. This figure includes all deaths, regardless of the cause of death (Graph A).



Graph B

Excluding deaths coded with U07.1 (COVID-19) as an underlying or multiple cause of death drops that range to 27,069 – 71,241 (Graph B), which indicates that between 129,285 and 141,738 of the total excess deaths have been attributed to COVID-19 – or approximately 75 percent on average.


Graph C

Data charts from the NCHS website, updated Aug. 5, indicate that there have been between 2,370 and 4,478 “excess deaths” in Georgia since Feb. 1. This figure includes all deaths, regardless of the cause of death (Graph C).



Graph D

Excluding deaths coded with U07.1 (COVID-19) as an underlying or multiple cause of death drops that range to 66 – 1,482 (Graph D), which indicates that between 2,304 and 2,996 of the excess deaths have been attributed to COVID-19 – or approximately 80 percent on average.


Data note: The range of excess death estimates are based on the total number of observed/reported deaths above the upper bound threshold based on a one-sided 95% prediction interval of those expected counts. The threshold line marks the upper limit of where an observed count would stand a 95% chance of falling under that line. (Roughly akin to a 5% margin) This provides the lower end of the range. The total number of observed/reported deaths above the average of the number of deaths reported over the past 5 years for that same time period provide the number at the upper end of the range.


A second set of data published by NCHS, also updated on Aug. 5, confirms the range of "excess deaths" in the United States, and in Georgia. However, this data set divides the excess deaths into diagnostic categories, including sepsis, renal failure, diabetes, cancer, influenza and pneumonia, chronic lower respiratory disease, other respiratory system diseases, Alzheimer/dementia, circulatory system diseases, cerebrovascular diseases, heart failure, ischemic heart disease and hypertensive diseases. This data does not address non-illness/medical deaths such as suicides, homicide and accidents. COVID-19 is not included as a category or subcategory in this data set; Sub-notes for the data set indicate that , in most cases, COVID-19 falls under the "other" subcategory of respiratory diseases, although it can fall under other categories in special circumstances.


In both the United States data set and the Georgia data set, Alzheimer's Disease/dementia is shown as contributing the bulk of fatalities to the "excess death" totals for 2020, while the "other" respiratory disease subcategory, and indeed, the entire respiratory category, are shown to be minor contributors to the excess death tolls in both the US and in the Georgia-specific figures.


According to an article on the Alzheimer's Foundation website, "some of these deaths are the direct result of a COVID-19 infection, but without a positive test, the death certificate may just list the neurodegenerative disease with which the patient had long been diagnosed. On the other hand, some deaths are not directly caused by a COVID-19 infection, but still the result of the perfect storm of dementia and the circumstances of a pandemic."


Table 1

Table 1 shows the total number of deaths above average since 2/1/2020 in Georgia, broken down by diagnostic category.


Table 2

Table 2 shows the total number of deaths above average since 2/1/2020 in the United States, broken down by diagnostic category.


Table 3

Table 3 shows the increase or decrease in the number of 2020 deaths in Georgia attributed to various causes of death, compared to an average from 2015-2019. Deaths due to Alzheimer diseased and dementia appear to be the largest-growing sector, followed by hypertensive deceased (high blood pressure) Malignant neoplasms (cancerous tumors) have also shown an increase. Although COVID-19 is not specifically identified in the charts, other CDC statistics include COVID-19 in the Respiratory diseases COD Classification.


Table 4

Table 4 shows the increase or decrease in the number of 2020 deaths in the United States attributed to various causes of death, compared to an average from 2015-2019. Deaths due to Alzheimer diseased and dementia appear to be the largest-growing sector, followed by hypertensive diseases (high blood pressure) Ischemic heart disease ( coronary artery disease) has also shown an increase. Although COVID-19 is not specifically identified in the charts, other CDC statistics include COVID-19 in the Respiratory diseases COD Classification.


Table 5

5. Table 5 shows the increase or decrease in the number of 2020 deaths in Georgia attributed only to the respiratory diseases category , compared to an average from 2015-2019. Although COVID-19 is not specifically identified in the charts other CDC statistics include COVID-19 in the Respiratory diseases COD Classification.


6. Table 6 shows the increase or decrease in the number of 2020 deaths in the United States attributed only to the respiratory diseases category , compared to an average from 2015-2019. Although COVID-19 is not specifically identified in the charts other CDC statistics include COVID-19 in the Respiratory diseases COD Classification.


Table 7

Table 7 shows the 2020 weekly death counts in Georgia due to sub-categories of respiratory diseases compared to the weekly averages for 2015-19. It can be seen that influenza and pneumonia, as well as chronic lower respiratory deaths, track fairly close to the averages from prior years. The “other” category, which is where a preponderance of COVID cases may be categorized, shows a deviation from the normal distribution. It is noted in the footnotes for these charts that “data in recent weeks are incomplete. Only 60% of death records are submitted to NCHS within 10 days of the date of death, and completeness varies by jurisdiction.


Table 8

Table 8 shows the 2020 weekly death counts in the United States due to sub-categories of respiratory diseases compared to the weekly averages for 2015-19. It can be seen that there was a non-standard spike in influenza and pneumonia deaths in weeks 12-5, with smaller upticks in the other two categories during the same time period. It is noted in the footnotes for these charts that “data in recent weeks are incomplete. Only 60% of death records are submitted to NCHS within 10 days of the date of death, and completeness varies by jurisdiction.


Table 9

Table 9 shows shows the 2020 weekly death counts in Georgia due to respiratory diseases (including all subcategories), as well as other categories of death, compared to the weekly averages for 2015-19. It is noted in the footnotes for these charts that “data in recent weeks are incomplete. Only 60% of death records are submitted to NCHS within 10 days of the date of death, and completeness varies by jurisdiction.


Table 10

Table 10 shows shows the 2020 weekly death counts in the United States due to respiratory diseases (including all subcategories), as well as other categories of death, compared to the weekly averages for 2015-19. It is noted in the footnotes for these charts that “data in recent weeks are incomplete. Only 60% of death records are submitted to NCHS within 10 days of the date of death, and completeness varies by jurisdiction.

Table 11

Table 11 shows compares the various age groups in relation to the 2020 weekly death counts in Georgia for all causes, compared to the weekly averages for 2015-19. The larger spikes in the older age groups matches with the at-risks age groups for not only COVID-19 but for the two categories that showed the most significant increase over previous years – Alzheimers/dementia, and hypertensive diseases.

Table 12

Table 12 compares the various age groups in relation to the 2020 weekly death counts in the United States for all causes, compared to the weekly averages for 2015-19. The larger spikes in the older age groups matches with the at-risks age groups for not only COVID-19 but for the two categories that showed the most significant increase over previous years – Alzheimers/dementia, and hypertensive diseases.

Table 13 shows, in the top bar, the percentage of deaths in Georgia attributed to all causes each week that are over a threshold based on the average deaths during the same week in previous years, plus a margin for error.(see below for an explanation of threshold). The lower bar shows the same data, but omitting deaths listed with COVID-19 as a cause of death



Table 14 shows, in the top bar, the percentage of deaths in the US attributed to all causes each week that are over a threshold based on the average deaths during the same week in previous years, plus a margin for error.(see below for an explanation of threshold). The lower bar shows the same data, but omitting deaths listed with COVID-19 as a cause of death


Table 15 shows, for each week, the number of deaths in Georgia reported that week compared to a threshold line calculated from averages from the previous year with a 95% accuracy upper margin. The green lines represent all deaths except those coded with U07.1 (COVID-19) as an underlying or multiple cause of death. The Dark blue line represents all deaths, including those coded with U07.1 (COVID-19) as an underlying or multiple cause of death.


Table 16 shows, for each week, the number of deaths in the United States reported that week compared to a threshold line calculated from averages from the previous year with a 95% accuracy upper margin. The green lines represent all deaths except those coded with U07.1 (COVID-19) as an underlying or multiple cause of death. The Dark blue line represents all deaths, including those coded with U07.1 (COVID-19) as an underlying or multiple cause of death.


For example, on the Georgia chart, (#15) for the week ending July 18, the average number of expected deaths for the week, based on averages from the past five years, was 1,584 – the calculated upper bound threshold (orange line) is 1,691. The number of deaths that occurred (adjusted observed/reported deaths) , excluding those coded as COVID-19 (Green line), was 1,634 – for a 0.0 - 3.2 percent excess death count. The number of deaths that occurred (adjusted observed/reported deaths) , including those coded as COVID-19 (blue line), was 1,824 – for a 7.9 - 15.2 percent excess death count The range is calculated by comparing the observed/reported deaths to the average of the last 5 years (lower end of range) and comparing the observed/reported deaths to the upper bound threshold (upper end of the range).

On the United States chart, (#16) for the week ending July 18, the average number of expected deaths for the week, based on averages from the past five years, was 52,076 – the calculated upper bound threshold (orange line) is 53,922. The number of deaths that occurred (adjusted observed/reported deaths) , excluding those coded as COVID-19 (Green line), was 54,555 – for a 1.2 - 4.8 percent excess death count. The number of deaths that occurred (adjusted observed/reported deaths) , including those coded as COVID-19 (blue line), was 60,510 – for a 12.2 - 16.2 percent excess death count The range is calculated by comparing the observed/reported deaths to the average of the last 5 years (lower end of range) and comparing the observed/reported deaths to the upper bound threshold (upper end of the range).


Data Notes: A plus sign+ indicates a week when the reported/observed number of deaths rose above the threshold.


Blue bars Shows the number of deaths, adjusted for incompleteness of reporting in the past 10 days, from all causes, including those coded with U07.1 (COVID-19) as an underlying or multiple cause of death.


Green bars Shows the number of deaths, adjusted for incompleteness of reporting in the past 10 days, from all causes, excluding those coded with U07.1 (COVID-19) as an underlying or multiple cause of death..


Orange line Threshold for excess deaths – Note – the threshold line on the charts are calculated using the expected counts (based on averages from the past five years for that time period), and calculating an upper bound threshold based on a one-sided 95% prediction interval of those expected counts. The threshold line marks the upper limit of where an observed count would stand a 95% chance of falling under that line. (Roughly akin to a 5% margin)


Death Counts were derived from the National Vital Statistics System database . For all data that specifies that it “excludes COVID-19 deaths” exclude any death certificate with U07.1 as an underlying or multiple causes of death.

Counts of deaths in the most recent weeks were compared with historical trends for 2013 to present to determine wither the number of deaths in recent weeks was significantly higher than expected. Using detailed scientific and statistical models (Significantly the Farrington Algorythm) Estimates of excess deaths are provided based on the observed number of deaths relative to two different thresholds . The lower end of the excess death estimate range is generated by comparing the observed counts to the upper bound threshold and a higher end of the excess estimate range is generated by comparing the observed count to the average number of expected deaths. Reported counties are weighted to account for potential underreporting tin the most recent weeks.

Cause of Death Determination and guidelines

Footnotes taken directly from CDC/NCHS website


As of June 3, 2020, weekly counts of deaths due to select causes of death are presented. These causes were selected based on analyses of co morbid conditions reported on death certificates where COVID-19 was listed as a cause of death (see https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#Comorbidities).


Some causes with insufficient numbers of deaths by week and jurisdiction were combined with other categories, and one cause was added to the Alzheimer disease and dementia category (ICD–10 code G31). These estimates are based on the underlying cause of death, and include: Respiratory diseases, Circulatory diseases, Malignant neoplasms, and Alzheimer disease and dementia. ICD–10 codes were used to classify deaths according to the following causes:

  • Respiratory diseases

  • Influenza and pneumonia (J09–J18)

  • Chronic lower respiratory diseases (J40–J47)

  • Other diseases of the respiratory system (J00–J06, J20–J39, J60–J70, J80–J86, J90–J96, J97–J99, R09.2, U04)

  • Circulatory diseases

  • Hypertensive diseases (I10–I15)

  • Ischemic heart disease (I20–I25)

  • Heart failure (I50)

  • Cerebrovascular diseases (I60–I69)

  • Other disease of the circulatory system (I00–I09, I26–I49, I51, I52, I70–I99)

  • Malignant neoplasms (C00–C97)

  • Alzheimer disease and dementia (G30, G31, F01, F03)

  • Other select causes of death

  • Diabetes (E10–E14)

  • Renal failure (N17–N19)

  • Sepsis (A40–A41)

Estimated numbers of deaths due to these other causes of death could represent misclassified COVID-19 deaths, or potentially could be indirectly related to COVID-19 (e.g., deaths from other causes occurring in the context of health care shortages or overburdened health care systems). Deaths with an underlying cause of death of COVID-19 are not included in these estimates of deaths due to other causes, but deaths where COVID-19 appeared on the death certificate as a multiple cause of death may be included in the cause-specific estimates. For example, in some cases, COVID-19 may have contributed to the death, but the underlying cause of death was another cause, such as terminal cancer. For the majority of deaths where COVID-19 is reported on the death certificate (approximately 95%), COVID-19 is selected as the underlying cause of death.


Deaths due to all other natural causes were excluded (ICD-10 codes: A00–A39, A42–B99, D00–E07, E15–E68, E70–E90, F00, F02, F04–G26, G31–H95, K00–K93, L00–M99, N00–N16, N20–N98, O00–O99, P00–P96, Q00–Q99). External causes of death (i.e. injuries) were excluded, as the reporting lag is substantially longer for external causes of death (4).


Additionally, causes of death where the underlying cause was unknown or ill-specified (i.e. R-codes) were excluded (except for R09.2, which is included under the Respiratory diseases category). Counts of deaths with unknown cause are typically substantially higher in provisional data, as many records are initially submitted without a specific cause of death and are then updated when more information becomes available (4). For deaths due to external causes of death or unknown cause, provisional data are highly unreliable and inaccurate in recent weeks, and it can take six to nine months to ensure sufficiently accurate estimates. Counts by cause provided here will not sum to the total number of deaths, given that some causes are excluded.


Weekly counts of deaths from all causes were examined, including deaths due to COVID-19. As many deaths due to COVID-19 may be assigned to other causes of deaths (for example, if COVID-19 was not mentioned on the death certificate as a suspected cause of death), tracking all-cause mortality can provide information about whether an excess number of deaths is observed, even when COVID-19 mortality may be undercounted. These estimates can also provide information about deaths that may be indirectly related to COVID-19. For example, if deaths due to other causes may increase as a result of health care shortages due to COVID-19. Additionally, deaths from all causes excluding COVID-19 were also estimated. These counts excluded deaths with U07.1 as an underlying or multiple cause of death.


Comparing these two sets of estimates — excess deaths with and without COVID-19 — can provide insight about how many excess deaths are identified as due to COVID-19, and how many excess deaths are due to other causes of death. Thes deaths could represent misclassified COVID-19 deaths, or potentially could be indirectly related to COVID-19.


Additionally, death certificates are often initially submitted without a cause of death, and then updated when cause of death information becomes available. It may be the case that some excess deaths that are not attributed directly to COVID-19 will be updated in coming weeks with cause-of-death information that includes COVID-19. These analyses will be updated periodically, and the numbers presented will change as more data are received.



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