Mortality (Longevity):

Contributing Factors in the Past and 

for Projections, and Implications for 

the Future

Steve Goss, Chief Actuary

US Social Security Administration

Expert Forum on Demographic Transitions: Impact on Longevity, Health and Economy 

in collaboration with the Global Longevity Council of the World Demographic & Ageing Forum

January 27, 2023
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Outline

 First, current effects from COVID-19: future implications

 Level of mortality depends on exposed population and data source 

 Approaches for projecting mortality

– Extrapolation of past trends?

– Or developing assumptions by cause of death—consulting experts

 Future conditions

– Unlikely to replicate remarkable progress of the 20th century

– Obesity

– Health spending and climate change

– Human limits

 Noting recent deceleration—what we expect

 Implications of shifting age distribution

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COVID-19; Pandemics

 COVID-19 swept across the globe and continues 

– Enhanced population mobility

– Highly evolving virus

 Remarkable new MRNA vaccine; recent bivalent booster

– But only about 16% of eligible in US have taken it

 New variants are arriving regularly; mitigations have waned

 Now endemic?

 Will post-COVID conditions constrain longevity in the future?

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In the US, BQ Overtook BA in November; 

XBB Now Matches BQ, and Dominates in NY/NJ

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Across Europe and the Americas—

The Fall/Winter Wave Rising in December

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Reported Cases Rising Reported Deaths Increasing in the New Year
Rise in Hospitalizations in January Makes Clear 

that New Cases are Increasingly Underreported 

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Cases and Deaths are Lower for Those Vaccinated, 

But How Much Due to Care and Greater Mitigation?

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Relative Changes in Death Rates by Age, Total and PIC, Varied 

by Strain; Did Delta Reflect Earlier Vaccination for 65+?

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Note the Lag in Reporting of Deaths in the US;

Estimated Excess Deaths Rising in Late November 

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But Excess Deaths Are Not All From COVID;

Currently May Be Largely From Other-Than-PIC 

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For Latest Complete Provisional Quarter, 

Age-Sex-Adjusted Death Rates Are All Elevated Over 2019

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NCHS Provisional Age-Adjusted Death Rates 2019Q3 2021Q3

Ratio 

2021Q3/2019Q3

Alzheimer disease 27.6 29.7 1.08

COVID-19 #N/A 115.6 #N/A

Cancer 145.4 148.5 1.02

Chronic liver disease and cirrhosis 11.1 14.6 1.32

Chronic lower respiratory diseases 33.6 34.6 1.03

Diabetes 19.8 24.8 1.25

Drug overdose 22.4 33.5 1.50

Falls, ages 65 and over 64.2 75.7 1.18

Firearm-related injury 12.4 15.5 1.25

Heart disease 150.5 169.7 1.13

HIV disease 1.3 1.3 1.00

Homicide 6.4 8.7 1.36

Hypertension 8.2 10.3 1.26

Influenza and pneumonia 8.9 10.1 1.13

Kidney disease 11.7 13.1 1.12

Parkinson disease 8.3 9.6 1.16

Pneumonitis due to solids and liquids 4.1 4.9 1.20

Septicemia 8.7 10.2 1.17

Stroke 34.8 39.8 1.14

Suicide 14.7 14.7 1.00

Unintentional injuries 51.3 67.6 1.32

Total 645.4 852.5 1.32

Total w/o COVID 645.4 736.9 1.14
Now, Considerations in Projecting Mortality

 Frequency of future pandemics?

 Variation by age and over time periods 

 Variation by earnings level

 Changing causes of death

 Cohort considerations

 Health spending, obesity, smoking, opioids

 Our projections for the United States

 Is there a limit on human longevity?

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Pandemics in the Future

 Over the last 100 years, mortality has been about cause 

reduction

 But if pandemics raise deaths 15% for 2 years in every 20 years

– Then the level of mortality would be raised by 1.5% per year on average

 But how about residual compromising effects—post-COVID?

– How much will viability be diminished for the survivors? 

 Earlier death later in life might be the larger factor

– As with other compromising factors like smoking

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Variation by Age Has Been Substantial

Reduction in mortality at higher ages is inherently more difficult

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Mortality Decline Has Varied Over Time

Conditions: Antibiotics/economy 1936-54; Medicare/Medicaid 1968-82

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US Mortality Experience: All Ages

Reductions falling short of expectations since 2009

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700

750

800

850

900

950

1,000

1,050

1,100

1990 1995 2000 2005 2010 2015 2020 2025

Age-Sex-Adjusted Death Rates (per 100,000)

Total, All Ages

2014TR

2017TR

2020TR

2021TR

2022TR

Actual
US is Not Alone—United Kingdom Deceleration Since 2011

January 2023 Living to 100 Conference: Adrian Gallop, UK Government Actuary’s Office

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US Mortality Experience: Ages 65 and Over

Reductions falling short of expectations since 2009

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4,000

4,200

4,400

4,600

4,800

5,000

5,200

5,400

5,600

5,800

6,000

1990 1995 2000 2005 2010 2015 2020 2025

Age-Sex-Adjusted Death Rates (per 100,000)

Ages 65 and Older

2014TR

2017TR

2020TR

2021TR

2022TR

Actual
US Mortality Experience: Under Age 65

Experience far worse than expectations since 2009

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200

250

300

350

400

1990 1995 2000 2005 2010 2015 2020 2025

Age-Sex-Adjusted Death Rates (per 100,000)

Ages Under 65

2014TR

2017TR

2020TR

2021TR

2022TR

Actual
Mortality By Career-Average Earnings Level: Actuarial Study 124

So, crucial to scale to exposed population, but rate of change may be similar

Age group 65-69 relative mortality ratios—not diverging?

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US Mortality Decline by Cause of Death: 

Annual rate of decline from 1979 to 2019; note dementia vs. cardio over 50

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Age-Adjusted Death Rates for Heart Disease, Cancer, Stroke, 

and Unintentional Injuries: United States, 1900-2021

(courtesy Robert Anderson, NCHS)

Notes: Data are from the National Vital Statistics System. Prior to 1933, data are for death-registration States only. Data for 2021 are provisional.

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Heart disease

Cancer

Unintentional injury Stroke
Age-Adjusted Death Rates for Heart Disease, Cancer, Stroke, 

and Unintentional Injuries: United States, 2000-2021

(courtesy Robert Anderson, NCHS)

0

50

100

150

200

250

300

Age-adjusted death rate (per 100,000 population)

Heart disease

Cancer

Stroke Unintentional injury

Chronic liver disease

Notes: Data are from the National Vital Statistics System. Prior to 1933, data are for death-registration States only. Data for 2021 are provisional.

COVID-19

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Age-Adjusted Death Rates for Selected Causes: 

United States, 2000-2021

(courtesy Robert Anderson, NCHS)

0

5

10

15

20

25

30

35

Age-adjusted death rate (per 100,000 population)

Drug overdose

Suicide

Alcohol induced

Notes: Data are from the National Vital Statistics System. Data for 2021 are provisional.

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Developing Assumptions by Cause

 Scientific approach reflecting biology and epidemiology

 Trustees and SSA/OCACT develop in consultation with other 

experts

 Centers for Disease Control/National Institutes of Health

 Johns Hopkins survey of medical researchers and clinicians

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Cohort Considerations

 Post-World War 2 births—special conditions:

– Antibiotics when young; statins, etc. later

 What does change up to age x say above age x?

– If cohort is fundamentally healthier at x: 

Then expect lower mortality over age x

– But if medical interventions have just reduced deaths:

Then cohort mortality over age x could be worse, with increased numbers of 

impaired survivors

– What does one cohort imply for the next cohort?

Further changes depend on conditions, not trend

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How Future Conditions Might Change

 Smoking decline for women

– Started and stopped later than men

 Obesity—sedentary lifestyle

 Health spending—must decelerate

– An ageing population, and Climate Change will strain resources 

– Advances help only if they apply to all

 Human limits

– Increasing understanding of deceleration

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Trends in Obesity: US 1971-2006

Sam Preston 2010—must consider cumulative effects; increasing duration of obesity for aged in future

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Health Spending Cannot Continue to Rise at Historical Rates

Note Trustees’ projected deceleration

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Costs from Climate Change and the Increasing Share of the 

Adult Population over Age 65 will Strain Resources

Aging (change in age distribution) mainly due to drop in birth rates

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Excluding immigration as well as fertility effects:
Our Ultimate (2046 to 2096) Projected Rates of Decline: 

Similar to Period Since 1900 for Ages 50+

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1900 to 

2019

2009 to 

2019

Projected 

2046 to 

2096

Under Age 15 2.97 1.46 1.52

Ages 15 - 49 1.43 -0.55 0.85

Ages 50 - 64 0.99 0.03 0.96

Ages 65 - 74 0.91 0.92 0.71

Ages 85 + 0.58 0.24 0.55

Total 1.02 0.43 0.72
Assumed Ultimate Rates of Change by Age and Cause of Death

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Projected US Age-Sex-Adjusted Death Rates:

Only Modest Deceleration (note importance of log scale)

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Is There an Omega?

We have been rectangularizing the survival curve; few have actually lived beyond 100

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More Important for Most Annuities is Survival after 65 

Are we being overly optimistic in the percent who will survive from 65 to over 100?

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Death Rates Will Continue to Decline: 

But How Fast and for Whom?

 Must understand past and future conditions

– Persistent historical “age gradient”, lower improvement at high ages

– Avoid simple extrapolation of past periods

» Cannot ignore changing conditions

 “Limits” on longevity due to physiology

 Latter half of 20th century was extraordinary

» So deceleration seems likely

» Cause-specific rates allow scientific basis for assumptions

– Results: in the 1982 TR, we projected LE65 for 2015 to be 19.1; 

actual turned out to be 19.1
Ultimately, the Changing Age Distribution of the Population is the Main 

Factor for Financing Social Security and Retirement in General

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Whether your retirement is 

financed through “advance 

funding” or “pay-as-you go 

financing,” it will be the current 

working population that will both:

(1) produce the goods and 

services needed for all, and 

(2) maintain the value of 

investments held by all for 

their own current or future 

retirement. 
For More Information...

http://www.ssa.gov/oact/

 Documentation of Trustees Report data & assumptions 

https://www.ssa.gov/oact/TR/2022/2022_LongRange_Demographic_Assumptions.pdf

 2022 SOA ImpACT Conference, panel 13A with leading demographers 

https://www.ssa.gov/oact/presentations/scgoss_20221027.pdf

 Historical and projected mortality rates

https://www.ssa.gov/oact/HistEst/DeathHome.html

 Annual Trustees Reports 

https://www.ssa.gov/oact/TR/index.html

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