It's Getting Worse

In the 2020-21 school year, 145 elementary/middle/secondary schools in the United States experienced a school shooting—a record high. Not only that, but 2020-21 was the first year in which there were more school shootings at elementary schools (59) than at high schools (57), according to an analysis of the K-12 School Shooting Database by the National Center for Education Statistics. 

Number of public or private elementary-secondary schools with shootings, 2015-16 to 2020-21

2020-21: 145 

2019-20: 114

2018-19: 113

2017-18:   89

2016-17:   47

2015-16:   38

Forty-six people died from school shootings in 2020-21, below the record high of 52 fatalities from school shootings in 2017-18—the year of the shooting at Marjory Stoneham Douglas High School in Parkland, Florida. The fatality data for 2021-22 have yet to be released.

Source: National Center for Education Statistics, Condition of Education, Violent Deaths at School and Away from School and School Shootings and Digest of Education Statistics, Table 228.12

382 Days with 1,000+ Covid Deaths

Twenty-five U.S. residents died of Covid-19 on April 10, 2022—the most recent data available from the CDC. This is the smallest daily death toll in more than two years—since March 16, 2020. There's a caveat here: April 10 was a Sunday, and fewer deaths are reported on weekends. But let's take our victories where we can. 

It's been a rough two years. A cumulative 982,809 U.S. residents have died of Covid-19 through April 10, 2022. Here are the stats on the daily count of deaths...

Number of days with more than 4,000 deaths: 2 

• February 1, 2022: 4,182 deaths
• January 13, 2021, 4,072 deaths. 

Number of days with 3,000-3,999 deaths: 41

Number of days with 2,000-2,999 deaths: 110

Number of days with 1,000-1,999 deaths: 229

Number of days with 500-999 deaths: 245

Number of days with 100-499 deaths: 120

Number of days with 1-99 deaths: 25

When will the daily death toll fall to zero on most days? Let's hope it's soon.

Source: Demo Memo analysis of the CDC's Covid Data Tracker

54,170 Violent Deaths

Here's something for all the doomscrollers out there: 54,170. That's the number of violent deaths in the United States in 2018 (the latest data available), according to the CDC's National Violent Death Reporting System (NVDRS). Yes, there is such a system. The deaths were reported by 39 of the 50 states and the District of Columbia. 

The NVDRS defines a violent death as "a death resulting from the intentional use of physical force or power, threatened or actual, against oneself, another person, or a group or community." There are five types of violent death: suicide, homicide, legal intervention, unintentional firearm death, and death due to undetermined intent that may have been violence. 

Number (and percent) of violent deaths by type, 2018

Total: 54,170 (100.0%)

Suicide: 34,726 (64.1%)

Homicide: 13,441 (24.8%)

Legal intervention: 764 (1.4%)

Unintentional firearm death: 337 (0.6%) 

Death of undetermined intent: 4,902 (9.0%)

Suicide is by far the leading cause of violent death, accounting for 64 percent of the total. Homicide accounts for another 25 percent. Firearms were used in 48 percent of suicides, 72 percent of homicides, and 90 percent of legal interventions. Among unintentional firearm deaths, nearly half (48 percent) were self-inflicted. Most often these deaths occur when kids (55 percent of the victims of unintentional firearm deaths are under age 25) are playing with a gun (42 percent) or showing a gun to others (15 percent).

The CDC collects and analyzes data on violent deaths for a reason. The data are used to "assist public health authorities in developing, implementing, and evaluating programs, policies, and practices to reduce and prevent violent deaths." 

Source: CDC, Morbidity and Mortality Weekly Report, Surveillance for Violent Deaths—National Violent Death Reporting System, 39 States, the District of Columbia, and Puerto Rico, 2018

The Covid Situation as 2022 Begins

It should be over by now, right? Unfortunately, we're still in the thick of the coronavirus pandemic. The first batch of 2022 results from the Census Bureau's Household Pulse Survey, fielded December 29-January 10, reveal just how deeply we are mired in Covid troubles...

• The number of Americans aged 18 or older who have been diagnosed with Covid climbed to 57 million in January, up from 45 million in early December. As of January 10, nearly one in four adults (23 percent) say they have been diagnosed with Covid.
• Fully 85 percent of adults have received at least one dose of a Covid vaccine. Fewer than half (43 percent) have received three or more doses (booster), but this is up from 33 percent in early December. 
• 17 million say they "will definitely not" get a Covid vaccine, 2 million fewer than in early December. That's progress, right?
• Among the nation's parents with school-aged children, just 57 percent say their children have gotten a Covid vaccine. 
• More than one-third (38 percent) of parents with children under age 5 report that their child has been unable to attend day care or another childcare arrangement in the past four weeks because of Covid safety concerns.
• Among adults who had planned to take classes from a post-secondary institution this term, nearly one in five (18 percent) canceled those plans.  
• The number of Americans who ate indoors at a restaurant in the past seven days fell to the lowest level since the Census Bureau first asked this question last summer. 
• As of January 18, 2022, Covid has killed 853,230 people in the United States, according to the CDC's Covid Data Tracker.

Source: Census Bureau, Week 41 Household Pulse Survey: December 29, 2021—January 10, 2022

A Forgettable Year

The final mortality statistics for 2020 were recently released by the National Center for Health Statistics. They document what we already know—2020 was a very bad year...

• Life expectancy fell 1.8 years between 2019 and 2020, to 77.0 years. 
• The overall age-adjusted death rate climbed 16.8 percent, to 835.4 deaths per 100,000 population (up from 715.2 in 2019).
• The age-adjusted death rate increased for both males and females. 
• The age-adjusted death rate increased for Blacks, Hispanics, and non-Hispanic whites. 
• The death rate increased in every age group 15 and older between 2019 and 2020. The biggest increase in the death rate occurred in the 25-to-44 age group (up 24 percent).
• The age-adjusted death rate increased for 6 of the 10 leading causes of death: heart disease, unintentional injuries, stroke, Alzheimer's disease, diabetes, and influenza/pneumonia. 
• Between 2019 and 2020, the death rate increased the most for unintentional injuries. 
• Many unintentional injury deaths are drug overdoses. 
• The age-adjusted death rate from drug overdoses increased 31 percent between 2019 and 2020. 
• The death rate from drug overdoses increased in every age group between 2019 and 2020. 
• The drug overdose death rate is highest for people aged 25 to 44, which is also the age group whose death rate increased the most in 2020. 

It wasn't just Covid creating all the misery in 2020, but Covid may be why so many other things got worse. When all the numbers are in for 2021, it is likely to have been just as bad a year as 2020. Let's hope 2022 is better.

Source: National Center for Health Statistics, Mortality in the United States, 2020 and Drug Overdose Deaths in the United States, 1999–2020

800,000 Deaths by Year's End

The first recorded death from Covid-19 occurred on February 27, 2020, according to the CDC. By the end of the year, the virus had killed 363,934 Americans and Covid was the third leading cause of death in the United States, behind only heart disease and cancer. 

So far in 2021, Covid has killed 388,000 Americans—24,000 more than it killed last year. The number of Covid deaths this year surpassed the 2020 figure a few weeks ago on October 18—despite the fact that we now have an effective vaccine for the virus. Here are a few of Covid's grim milestones...

2020

February 27, 2020: first death from Covid

May 24, 2020: cumulative Covid deaths exceed 100,000

September 12, 2020: cumulative Covid deaths exceed 200,000

September 24, 2020: Covid becomes 3rd leading cause of death in 2020

December 9, 2020: cumulative Covid deaths exceed 300,000

December 31, 2020: official 2020 death toll from Covid is 363,934

2021

January 12, 2021: cumulative Covid deaths exceed 400,000

February 15, 2021: cumulative Covid deaths exceed 500,000 

April 4, 2021: Covid becomes 3rd leading cause of death in 2021

June 17, 2021: cumulative Covid deaths exceed 600,000

September 30, 2021: cumulative Covid deaths exceed 700,000

October 18, 2021: Covid deaths in 2021 exceed number in 2020

At the rate things are going, the cumulative number of deaths from Covid-19 will exceed 800,000 by the end of the year, with deaths in 2021 alone topping 400,000. 

Source: CDC, Covid Data Tracker

Deaths Exceeded Births in 25 States in 2020

A new record was set in 2019. Deaths exceeded births in five states. Never before had so many states experienced negative natural increase, reports Kenneth M Johnson, a senior demographer at the Carsey School of Public Policy, University of New Hampshire. 

But wait. The numbers for 2020 make the 2019 record look quaint. Deaths exceeded births in half of all states in 2020, according to Johnson's analysis of data from the National Center for Health Statistics. The 25 states with more deaths than births in 2020 can be found in every region of the country including Arizona and Oregon in the West, Missouri and Wisconsin in the Midwest, Florida and South Carolina in the South, and Connecticut and Massachusetts in the Northeast. 

The trend could intensify in 2021. With births continuing to decline and Covid deaths in 2021 exceeding the 2020 number, Johnson predicts another year in which many states will experience negative natural increase, further reducing population growth in the United States. 

Source: Kenneth M. Johnson, Carsey School of Public Policy, University of New Hampshire, Deaths Exceeded Births in a Record Number of States in 2020

The Married Have Dramatically Lower Death Rates

Want to lower your chances of dying? Get married. That's one interpretation of a National Center for Health Statistics' analysis of death rates by marital status. Take a look...

Age-adjusted deaths per 100,000 population aged 25 or older by marital status, 2019

   747.0 deaths among the married

1,324.0 deaths among the divorced

1,423.2 deaths among those who have never married

1,627.0 deaths among the widowed

People who have never married as well as the divorced and widowed are just about twice as likely to die in a given year than people who are married. Don't forget, these are age-adjusted figures, a calculation which controls for the age distribution of each population—such as the older average age of widows and the younger average age of the never married.  

Not only is the overall death rate much lower for the married, but the death rate is lower for all 10 leading causes of death. Among the 10 leading causes of death, the biggest difference in death rates between the married and the unmarried is for unintentional injuries, a category that includes drug overdoses. The NCHS reports that the death rate for unintentional injuries is about three times higher for the unmarried than for the married. Cancer has the smallest disparity in death rates between the married and the unmarried, with cancer death rates for the unmarried 29 to 39 percent higher than for the married. 

Not only are death rates lower for the married, but the gap has been growing. Between 2010 and 2019, the death rate for married people fell 11 percent, NCHS reports. The rate fell only 3 percent for the divorced and the never married during those years. For the widowed, the death rate increased 4 percent between 2010 and 2019. 

What accounts for the dramatically lower death rate of married people? "Health research has persistently demonstrated lower mortality for married adults compared with unmarried adults," states the NCHS. "The mortality advantage for married adults has been attributed to either selectivity in entering marriage (that is, healthier people are more likely to marry) or health-protective effects of marriage, or a combination of the two."

Keep this in mind the next time your spouse nags you about taking your pills or calling a doctor.

Source: National Center for Health Statistics, Death Rates by Marital Status for Leading Causes of Death: United States, 2010–2019

Growing Gap in Death Rates between Urban and Rural

More bad news for rural America. The death rate in rural areas is higher than the rate in urban areas and the gap is growing, according to a National Center for Health Statistics report. The NCHS examined trends in age-adjusted death rates from 1999 to 2019...

Age-adjusted deaths per 100,000 people, 2019 (and 1999) 

Rural areas: 834.0 (923.8)

Urban areas: 693.4 (865.1)

While the death rate fell in both rural and urban areas between 1999 and 2019, the decline was much greater in urban areas. Between 1999 and 2010, both rural and urban areas saw their death rate fall. Since 2010, however, the death rate hasn't budged in rural areas while continuing to fall in urban areas. Consequently, the gap between rural and urban death rates has nearly tripled. The rural rate was just 7 percent greater than the urban rate in 1999. By 2019, it was 20 percent higher. 

What accounts for the widening gulf in death rates between rural and urban areas? The NCHS examined death rates by cause and found rates in rural areas exceeding rates in urban areas for all 10 leading causes of death. The biggest differences were for heart disease, cancer, and chronic lower respiratory disease.

"Those living in rural areas often face greater public health challenges as they have more limited access to health care, are less likely to be insured, and are more likely to live in poverty," the NCHS explains.

Source: National Center for Health Statistics, Trends in Death Rates in Urban and Rural Areas: United States, 1999–2019

Covid-19: Third Leading Cause of Death in 2021

Remember all the fanfare last week when the CDC announced that Covid-19 was the third leading cause of death in the United States in 2020? It took seven months for Covid to climb to the number-three spot on the top-10 cause of death list last year. 

This year, it took only three months. Covid-19 is already the third leading cause of death in 2021. More than 209,000 Americans have died from Covid through April 4 of this year. Let's hope vaccinations and mitigation will prevent Covid from rising even higher on the list in 2021. 

Source: CDC, Covid Data Tracker

11% of All Deaths in 2020 Due to Covid-19

It's official. Covid-19 was the third leading cause of death in the United States in 2020. The CDC's provisional count of deaths by cause in 2020 show Covid-19 behind only heart disease and cancer. Covid replaced suicide on the top-10 cause of death list, the CDC reports. Covid was the underlying or contributing cause of 377,833 deaths—11 percent of all deaths during the year. 

With Covid boosting deaths, the total number of deaths in 2020 exceeded the 2019 number by more than 500,000—an 18 percent increase. The overall age-adjusted mortality rate increased 16 percent. 

Total number of deaths

2020: 3,358,814 

2019: 2,854,838 

Change: +503,976

Age-adjusted mortality rate 

2020: 828.7 deaths per 100,000 population

2019: 715.2 deaths per 100,000 population

Source: CDC, Provisional Mortality Data—United States, 2020

20% Increase in the Mortality Rate

File this story in the Not Surprising But Still Shocking category: the age-adjusted mortality rate in the United States in the second quarter of 2020 (April, May, June) was a stunning 20 percent higher than the age-adjusted mortality rate in the second quarter of 2019, the National Center for Health Statistics reports. 

There were 840 deaths per 100,000 population in the second quarter of 2020, NCHS reports, compared with 702 deaths per 100,000 population in April, May, and June of 2019—a 19.7 percent increase. 

Percent change in 2nd quarter mortality rate by age group, 2019–20 

Age 1 to 4:   -12.9%

Age 5 to 14:   -0.7%

Age 15 to 24: 21.4%

Age 25 to 34: 30.1%

Age 35 to 44: 29.3%

Age 45 to 54: 26.3%

Age 55 to 64: 20.6%

Age 65 to 74: 19.1%

Age 75 to 84: 17.4%

Age 85-plus:  19.4%

Children under age 15 were the only ones spared. Every other age group experienced a double-digit rise as Covid-19 deaths mounted in the spring of 2020. 

Source: National Center for Health Statistics, Vital Statistics Rapid Release, Mortality Dashboard

Third Leading Cause of Death

On February 29, 2020, the CDC logged the first Covid-19 death in the United States. The next day, no one died from Covid—the last day without a Covid death this year. The cumulative number of deaths from Covid-19 topped 1,000 on March 26. They exceeded 10,000 on April 6. On April 23, Covid-19 became a leading cause of death in the United States. 

The National Center for Health Statistics tracks leading causes of death, compiling the top-10 list each year. We will have to wait a while before the top-10 list of 2020 is released, but we already know Covid-19—a cause of death unknown a year ago—will be near the top of the list. It will be the 3rd leading cause of death in the United States.

10 Leading Causes of Death in 2019

Total deaths	2,854,838
1. Diseases of heart	659,041
2. Malignant neoplasms	599,601
3. Accidents (unintentional injuries)	173,040
4. Chronic lower respiratory diseases	156,979
5. Cerebrovascular diseases	150,005
6. Alzheimer disease	121,499
7. Diabetes mellitus	87,647
8. Nephritis	51,565
9. Influenza and pneumonia	49,783
10. Suicide	47,511

Let's see how the Covid-19 death count compares to the 10 leading causes of death in 2019. April 23 marks Covid's first appearance on the top-10 list. On that day, the cumulative number of Covid deaths in the U.S. surpassed the 47,511 suicides of 2019. The very next day, they exceeded the 49,783 deaths due to influenza and pneumonia. The day after that, they topped the 51,565 deaths from nephritis. So, in just three days in April, Covid not only made it onto the top-10 list, but had become the 8th leading cause of death. 

It didn't stop there. On May 16, Covid deaths surpassed those from diabetes, becoming the 7th leading cause of death. On June 24, Covid climbed into 6th place; on July 29th 5th place; on August 5th 4th place. A couple weeks later, on August 20, Covid-19 became the 3rd leading cause of death in the United States when the 173,490 cumulative Covid deaths surpassed the 173,040 deaths from accidents. 

On December 31, 2020, the CDC logged 3,298 deaths from Covid-19. The cumulative total for the year: 344,497, solidly in 3rd place as a cause of death. Let's hope Covid-19 is much lower on the list in 2021.

Source: National Center for Health Statistics, Mortality in the United States, 2019 and CDC Covid Data Tracker

Big Increase in Deaths due to Unintentional Injuries

The third leading cause of death in the United States is what the CDC calls "unintentional injuries"—or accidents. Because a growing number of people are dying from unintentional injuries, this cause of death has been rising among leading causes of death. From 2000 through 2012, it was the fifth leading cause of death. It rose to fourth place in 2013 and climbed into third place in 2015, behind only heart disease and cancer.

Not only were there 74 percent more accidental deaths in 2017 than in 2000, but the age-adjusted death rate per 100,000 population grew from 34.9 to 49.4 during those years. Three types of unintentional injuries account for the great majority of accidental deaths—drug overdoses, motor vehicle accidents, and falls. These three causes accounted for 80 percent of all unintentional injury deaths in 2017...

Unintentional injury deaths in 2017
Total deaths: 169,936 (100.0%)
Drug overdoses: 61,311 (36.1%)
Motor vehicles: 38,659 (22.7%)
Falling: 36,338 (21.4%)
Other: 33,628 (19.8%)

Drug overdoses are the most common type of accidental death, accounting for 36 percent of unintentional injury deaths in 2017. The number of accidental drug overdoses more than quadrupled between 2000 and 2017. The age-adjusted death rate per 100,000 population climbed from 4.1 to 19.1 during those years.

Motor vehicle accidents were once the most common type of accidental death, but drug overdoses surpassed them in 2013. The number of motor vehicle deaths has fallen slightly over the years—from 41,994 in 2000 to 38,659 in 2017. The age-adjusted death rate per 100,000 population fell from 14.9 to 11.5 during those years.

Falls, like drug overdoses, are a growing cause of accidental death. In 2017 there were almost as many deaths from falls as there were from motor vehicle accidents. This was not the case in 2000, when motor vehicle deaths outnumbered deaths from falls by more than three to one. Growth of the 85-plus population is one reason for the greater number of deaths from falls.

Source: National Center for Health Statistics, Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017

Suicide Rate Continues to Rise

The suicide rate in the United States continues to rise. A recent study by the National Center for Health Statistics examines the increase by sex, age, race, and Hispanic origin. The results are disturbing and a sign that something is very wrong.

The age-adjusted suicide rate climbed 33 percent between 1999 and 2017— from 10.5 to 14.0 deaths per 100,000 standard population. (To compare deaths over time, statisticians age-adjust the rates so that results are not affected by changes in the age structure of the population.) The 33 percent increase is bad, but it is dwarfed by even larger increases in some age groups...

• The age-adjusted male suicide rate rose 26 percent between 1999 and 2017. The rate increased significantly in all but the oldest age group (75-plus). The biggest increases in the rate occurred among 10-to-14-year-olds (up 74 percent) and 45-to-64-year-olds (up 45 percent). 
• The age-adjusted female suicide rate grew by 53 percent between 1999 and 2017, although females remain far less likely than males to commit suicide. In 2017, the age-adjusted female suicide rate was 6.1 deaths per 100,000 population versus the 22.4 deaths for males. The suicide rate among females increased significantly in all but the oldest age group (75-plus). Between 1999 and 2017, the biggest increases in the female suicide rate occurred in the 10-to-14 (up 240 percent) and 15-to-24 (up 93 percent) age groups.

Suicide is the 10th leading cause of death in the United States and the 8th leading cause of death among males. By race and Hispanic origin, the suicide rate for both males and females is highest among American Indians and non-Hispanic Whites.

Source: National Center for Health Statistics, Suicide Rates for Females and Males by Race and Ethnicity: United States, 1999 and 2017

The Risks of Rabies

Rabies is one of the most fearsome and feared diseases. More than 99 percent fatal, the symptoms of those infected with rabies are so frightening that some scholars surmise they gave rise to the vampire and zombie horror genres.

Fortunately, rabies deaths in the United States are rare these days, with an average of only two people dying from rabies each year, according to the CDC. But many other countries are struggling to bring rabies under control. Globally, human rabies killed 59,000 in 2018 alone.

Dog bites were once the cause of most human rabies in the U.S. The incidence of human rabies has declined because we are vigilant about vaccinating our dogs against rabies and have done so since 1947. Other countries have not made as much progress with dog vaccinations, and the CDC wants Americans to be aware of this danger. Since 1960, there have been 36 human rabies cases in the U.S. caused by dog bites received while people were traveling internationally. "Increased awareness of rabies while traveling abroad is needed," warns the CDC.

Today, bats are the primary cause of rabies in the U.S. Of the 89 cases of human rabies originating in the U.S. between 1960 and 2018, the bat variant accounted for 62 percent. But most bats do not have rabies. Of bats submitted for testing, 94 percent were free of rabies, notes the CDC, which cautions that the "widespread killing of bats is not recommended to prevent rabies."

If treated before symptoms appear, rabies can be prevented. Each year, 55,000 Americans avail themselves of PEP—the lifesaving treatment for those who have been bitten or scratched by a wild animal. "Understanding the need for timely administration of PEP (post exposure prophylaxis) to prevent death is critical," concludes the CDC.

Source: CDC, Vital Signs: Trends in Human Rabies Deaths and Exposures—United States, 1938–2018

Life Expectancy Gap Grew in 2016

In the United States, women live longer than men. But the female advantage has been shrinking for decades—until now. In 2016 the life expectancy gap between females and males widened for the first time since 1990, according to the National Center for Health Statistics report, Deaths: Final Data for 2016, increasing from 4.8 to 5.0 years between 2015 and 2016. Here is the trend since 1950...

Gap in female-male life expectancy
2016: 5.0 years (first increase since 1989-90)
2015: 4.8 years
2010: 4.8 years
2000: 5.2 years
1990: 7.0 years
1980: 7.4 years
1979: 7.8 years (biggest gap)
1970: 7.6 years
1960: 6.5 years
1950: 5.5 years

Since 1950, the life expectancy of both males and females has increased substantially—rising from 65.6 to 76.1 years (+10.5 years) for males, and from 71.1 to 81.1 years (+10.0 years) for females. During those years, the female-male life expectancy gap grew from 5.5 years in 1950 to a peak of 7.8 years in 1979. The gap then began to shrink, falling to 4.8 years from 2010 through 2015.

Behind the 1950-to-1979 increase in the female-male life expectancy gap were higher rates of smoking and heart disease among men. As smoking rates fell and heart disease was better controlled, the life expectancy gap began to decline. The decline has come to a halt, at least temporarily, as male mortality rates rise faster than female for some causes of death. One of those causes is drug-induced deaths. Between 2015 and 2016, the drug-induced mortality rate of males climbed 26.0 percent. The female rate increased by a smaller 13.6 percent.

Source: National Center for Health Statistics, Mortality Data

Baby Bust Is Hurting Rural America

Forty percent of the nation's 3,000-plus counties have experienced more deaths than births since 2010, according to the Census Bureau's latest county population estimates. The aging of the population (more deaths), drug overdoses (more deaths), and the ongoing baby bust (fewer births) has resulted in negative natural increase (births minus deaths) in huge swaths of the country.

Rural areas have been hit particularly hard by the one-two punch of more deaths and fewer births. Negative natural increase is a big reason for the population decline in many rural counties. Nearly half or more of the counties ranking 6, 7, 8, and 9 on the Rural-Urban Continuum experienced more deaths than births in the 2010-to-2017 time period.

The Rural-Urban Continuum (RUC) is the federal government's way of classifying counties by their degree of urbanity. The continuum is a scale ranging from 1 (the most urban counties, in metropolitan areas of 1 million or more) to 9 (the most rural counties, lacking any settlements of 2,500 or more people and not adjacent to a metropolitan area). If you sort the nation's 3,000-plus counties by their rank on the continuum, then measure the percentage of counties in each rank in which deaths outnumbered births from 2010 to 2017, this is the result...

Percent of counties with more deaths than births by RUC rank, 2010-2017
1. 13.2% of counties in metros with 1 million or more people
2. 26.7% of counties in metros of 250,000 to 1 million people
3. 27.5% of counties in metros with less than 250,000 people
4. 34.1% of nonmetro counties with urban pop of 20,000-plus, adjacent to metro
5. 23.9% of nonmetro counties with urban pop of 20,000-plus, not adjacent to metro
6. 48.6% of nonmetro counties with urban pop of 2,500–19,999, adjacent to metro
7. 48.7% of nonmetro counties with urban pop of 2,500–19,999, not adjacent to metro 
8. 68.3% of nonmetro counties with urban pop less than 2,500, adjacent to metro 
9. 59.1% of nonmetro counties with urban pop less than 2,500, not adjacent to metro 

The most urban counties were least likely to have negative natural increase—only 13 percent of big-city counties experienced more deaths than births since 2010.

Source: USDA, Economic Research Service, Rural-Urban Continuum Codes and Census Bureau, County Population Totals and Components of Change: 2010–2017

Surprises in the 2017 Population Projections

The Census Bureau's new population projections (vintage 2017) are interesting for a number of reasons—slowing growth, the aging of the population, the decline in non-Hispanic Whites, and minorities becoming the majority. Also interesting is how they differ from the previous projection series, produced in 2014. A look at how the bureau revised its estimates of births, deaths, and net international migration reveals the unexpected trends reshaping us now.

• The population is growing more slowly than expected. The size of the American population in the future will be less than what the Bureau had projected just a few years ago, and the differences will pile up quickly. The 2020 population will be smaller by 2 million than what the bureau projected for that date in its 2014 vintage projections. In 2060, the population will be 13 million less than the previous projection for that year (404 million versus 417 million). 
• Women will have fewer babies than expected. Compared to the 2014 projection series, the latest series forecasts 3 million fewer births during the 2017 to 2060 time period. The ongoing baby bust and reduced immigration are behind the muted births. Overall, the annual number of births is forecast to rise from about 4 million today to 4.38 million in 2060. The earlier projection series forecast 4.52 million births a year by 2060. 
• Fewer immigrants will come to the United States. Compared to the 2014 projection series, the latest series projects 14 million fewer net international migrants over the 2017 to 2060 time period. Even this smaller projected number of migrants may be too optimistic because it does not take into account Trump administration policies that could further curb immigration. The annual net number of international migrants is forecast to be about 1.1 million during most of the 2017 to 2060 period, down from the 1.3 to 1.5 million previously projected.
• Fewer deaths will occur during the forecast period. Compared to the 2014 series, the bureau projects 5 million fewer deaths during the 2017 to 2060 time period. This makes sense since the population will be smaller. The annual number of deaths is projected to rise from 2.7 million today to 3.9 million by 2060—less than the projected 4.1 million annual deaths by 2060 in the earlier projection series. But this forecast of fewer deaths may be overly optimistic. According to Tom Lawler, a housing economist writing in Calculated Risk, the latest mortality projections do not incorporate the recent increase in deaths among young and middle-aged adults. Indeed, the bureau assumes rising life expectancy for all groups rather than the decline of the past two years. 

If the number of immigrants is further reduced by Trump's policies, and if there are more deaths than predicted, then U.S. population growth over the next few decades may be even slower than forecast by the new projections.

Source: Demo Memo analysis of the Census Bureau's 2017 National Population Projections

Life Expectancy Declines, Again

Big, big news: Life expectancy at birth fell for the second year in a row in 2016, according to the National Center for Health Statistics. This is the first two-year life expectancy decline since flu outbreaks in 1962 and 1963 drove life expectancy down, according to NCHS. Life expectancy at birth in 2016 was 78.6 years, 0.1 year less than in 2015. Life expectancy at birth peaked at 78.9 years in 2014.

Drug overdose deaths are behind the life expectancy decline. There were 63,632 overdose deaths in 2016—21 percent (!) more than in 2015. The increase in drug overdose deaths has managed to rearrange the list of leading causes of death. "Unintentional injuries," which includes most drug overdose deaths, is now the 3rd leading cause of death. It was 4th in 2015.

Drug overdose deaths are highest among 25-to-54-year-olds and uncommon among people aged 65 or older. In fact, life expectancy at age 65 increased by 0.1 years in 2016 to 19.4 years as death rates from heart disease and cancer declined.

Source: National Center for Health Statistics, Mortality in the United States, 2016 and Drug Overdose Deaths in the United States, 1999–2016