Mortality Projections: A US Perspective on 

Approaches and Challenges

Seminar on Demographic, Economic and Investment Perspectives for Canada

Years 2021 to 2070

Steve Goss, Chief Actuary

Karen Glenn, Deputy Chief Actuary

US Social Security Administration

September 13, 2021
Outline

• Our main focus today: approaches to projecting 

mortality and the inherent challenges

• Other topic 1: COVID-19

• Other topic 2: Dementia

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 2
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 3

Perspective: 

“Aging” Is Not 

Mainly from 

Mortality 

Aging (change in 

age distribution) is 

mainly due to drop 

in birth rates

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

0.50

1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100

Aged Dependency Ratio 2021 TR

Population 65+/(20-64) 

Actual and TR Intermediate

TFR remains at 3.0 after 1964

TFR remains at 3.3 after 1964

Historical Projected
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 4

Various Alternative Projection Approaches Using Data

Extrapolating past trends:

1) Age setback (early method)

2) Mortality rate by age and sex (Lee/Carter)

3) Life expectancy at birth (Vaupel/Oeppen)

4) Mortality rate by trend all ages (2011 Technical Panel, CBO 2013-5)

Or reflect changing conditions:

5) Improvement by cohort (UK CMI, SOA)

6) Mortality rate by age, sex, cause (OCACT/TR, 2015 Technical Panel)
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 5

2) Extrapolation by Age and Sex

• Example: Lee and Carter

• Fit the average trend of a selected period

• Future conditions must replicate the past—on average

• Age gradient never changes

• No deceleration in mortality decline
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 6

Mortality 

Decline Varies 

Over Time 

Antibiotics/economy 

1936-54

Medicare/Medicaid 

1968-82

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and older Total

Male Historical (2018 Trustees Report, Plus 2016 and 2017 Data) 

Annual Percent Reduction in U.S. Mortality Rates

1900 to 1936

1936 to 1954

1954 to 1968

1968 to 1982

1982 to 1999

1999 to 2009

2009 to 2017

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and older Total

Female Historical (2018 Trustees Report, Plus 2016 and 2017 Data) 

Annual Percent Reduction in U.S. Mortality Rates

1900 to 1936

1936 to 1954

1954 to 1968

1968 to 1982

1982 to 1999

1999 to 2009

2009 to 2017
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 7

3) Will Life Expectancy Rise Linearly?

Vaupel/Oeppen 2002; best nations

• Requires accelerating rate 

of decline in mortality rates 

if retain age gradient

• LE most affected by lowest 

ages—only so much gain 

possible

• Most disagree

– Vallin/Meslé
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 8

4) Extrapolate All Ages the Same

• Ignores historical age gradient

• Result: 

– Substantial bias for population age distribution

• Thus, large bias for cost as % of payroll

– Less mortality decline at young ages raises cost

– More mortality decline at older ages raises cost
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 9

Appropriate 

Data: by 

Age Critical

Age gradient in 

past reduction is 

clear
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 10

5) Extrapolation by Cohort

• U.K. (& SOA-RPEC): “Phantoms never die” data issues

• Post-WW2 births: antibiotics young, statins later

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

– Is cohort healthier at x if lower mortality up to x?

– Or is cohort compromised by impaired survivors?

– What does one cohort imply for the next cohort?

• Period effects from known changes in conditions are stronger—

especially in the U.S.
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 11

6) Projection by Age, Sex, Cause

• SSA/OCACT/Trustees Reports (2015 Technical Panel)

• Requires selecting ultimate rates of decline

• Allows change in age gradient

• Results in deceleration in mortality decline

AGE

1982-99 1999-2009 2009-13 2011-39 2011-89 2039-89 2011-39 2011-89 2039-89

2.79 1.22 2.14 0-14 2.77 2.74 2.72 1.58 1.57 1.57

0.63 0.61 1.06 15-49 1.07 1.06 1.05 0.97 0.93 0.90

1.61 1.27 0.05 50-64 1.34 1.34 1.34 1.17 1.09 1.06

0.92 2.11 0.91 65-84 1.06 1.06 1.05 1.09 0.86 0.74

-0.18 1.30 -0.11 85+ 0.65 0.64 0.63 0.64 0.53 0.48

0.51 1.78 0.48 65+ 0.88 0.86 0.85 0.89 0.71 0.61

0.75 1.59 0.48 Total 0.99 0.96 0.94 0.95 0.80 0.71

* Fit 1950-2011, using Medicare-enrollment data for 65 and over, rather than HMD data

 See Actuarial Note 158 https://www.ssa.gov/oact/NOTES/pdf_notes/note158.pdf

2015TR Intermediate

Comparison of Historical, 2015 Trustees Report, and Ron Lee* 

Average Annual Rates of Decline in Age-Sex-Adjusted Death Rates

Historical (Dec 2015 data) Ron Lee
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 12

Age-Sex Extrapolation vs. Age-Sex-Cause Projection 

Lee maintaining full age-gradient offsets lack of deceleration

Result: OASDI actuarial deficit unchanged using Lee estimates

7.5

8

8.5

9

9.5

1900 1920 1940 1960 1980 2000 2020 2040 2060 2080

Mortality Rate Comparison Age 65+ Unisex

Historical 2015TR Lee

0

1

2

3

4

5

6

7

8

1900 1920 1940 1960 1980 2000 2020 2040 2060 2080

Mortality Rate Comparison Age 0-14 Unisex

Historical 2015TR Lee
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 13

Age-adjusted Death Rates Due to Selected Leading 

Causes of Deaths: United States, 1900-2019

(courtesy Robert Anderson, NCHS)
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 14

Mortality Decline by Cause of Death: 

Rate of change from 1979 to 2018

-3

-2

-1

0

1

2

3

4

Under 15 15-49 50-64 65-84 85+

FEMALE

-3

-2

-1

0

1

2

3

4

Under 15 15-49 50-64 65-84 85+

Cardiovascular

Cancer

Violence

Respiratory

Other

MALE
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 15

Mortality 

Experience: 

All Ages

Reductions 

continue to fall 

short of 

expectations

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

2019TR 2020TR 2021TR Actual
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 16

Mortality 

Experience: 

Ages 65 and 

Older

Reductions since 

2009 continue to 

fall short of 

expectations

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

2019TR 2020TR 2021TR Actual
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 17

Mortality 

Experience: 

Ages Under 

65

Actual increase

since 2010

200

250

300

350

400

1990 1995 2000 2005 2010 2015 2020 2025

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

Ages Under 65

2019TR 2020TR 2021TR Actual
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 18

Developing Assumptions by Cause

• Scientific approach reflecting biology

• Trustees and SSA/OCACT develop in consultation with other 

experts

• Johns Hopkins recent survey of medical researchers and clinicians 

came to very similar medium term expectations—independently

– Trustees’ medium-term rates by cause had not been published 
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 19

Cardiovascular: 

JHU Less 

Optimistic than 

Trustees over 

Age 50 for Next 

30 Years

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Cardiovascular Disease-Female

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

0.5

JHU 

1.5 JHU 

1.6

JHU 

1.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Cardiovascular Disease-Male

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

1.1 JHU 

0.6

JHU 

1.5 JHU 

1.6
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 20

Respiratory: 

JHU More 

Optimistic 

under Age 50, 

Less Optimistic 

over Age 85

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Respiratory-Male

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

0.4 JHU 

0.4

JHU 

0.8

JHU 

1.5

-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Respiratory-Female

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

0.1 JHU 

0.5

JHU 

0.8 JHU 

1.7
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 21

Cancer: 

JHU Very 

Similar to 

Trustees’ 

Expectations

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Cancer-Female

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

0.4

JHU 

0.9

JHU 

1.3 JHU 

1.8

-1.0

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Under Age 15 Ages 15 - 49 Ages 50 - 64 Ages 65 - 84 Ages 85 and

older

Total

Cancer-Male

Average Annual Percent Reduction

JHU values are for the period 2009-2040

1979 to 2010

2010 to 2038

2038 to 2088

JHU 

0.6

JHU 

1.2

JHU 

1.1 JHU 

1.3
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 22

How Future Conditions Might Change

• Smoking decline for women

– Started and stopped later than men

• Obesity—sedentary lifestyle

• Difference by income/earnings

• Health spending—must decelerate

– Advances help only if apply to all

• Human limits

– Increasing understanding of deceleration
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 23

Trends in 

Obesity: US 

1971-2006 

Sam Preston 2010: 

must consider 

cumulative effects 

and increasing 

duration of obesity 

for aged in future
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 24

Death Rates Vary by Career Average Earnings Quintile 

Bosley, Morris, Glenn (2018): have the spreads stabilized? At ages 65-69:
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 25

Does Health 

Spending 

Affect 

Mortality?

Note rise, at least 

through 2009

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

National Health Expenditures With and Without 

Medicare and Medicaid as a Percent of GDP

NHE/GDP

(NHE-Med&Med)/GDP

NIPA NHE/GDP
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 26

Health 

Spending 

Cannot 

Continue to 

Rise at 

Historical 

Rates

Note Trustees’ 

deceleration -1%

0%

1%

2%

3%

4%

5%

1969-1979 1979-1989 1989-1999 1999-2009 2009-2019 2019-2029 2029-2039 2039-2049 2049-2059 2059-2069 2069-2079 2079-2089

Annual Percent Change in Medicare Cost per Enrollee, Relative to GDP per Worker: 

2020 TR Intermediate Assumptions

Historical Projected
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 27

Is There an 

Omega?

It appears we are 

rectangularizing

the survival curve
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 28

Death Rates Will Continue to Decline: But How 

Fast and for Whom?

• Must understand past and future conditions

– Persistent historical “age gradient”

– 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 basis for assumptions

• Results: in the 1982 TR, we projected LE65 in 2013 to be 19.0; 

actual was 19.1
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 29

Ultimately, the 

Changing Age 

Distribution of 

the Population 

Is the Main 

Factor for 

Social Security

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1940 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 2060 2070 2080 2090 2100

Percent of Population at Ages 25+

Age Distribution of the Population Age 25+, 1940 to 2100 (2021 TR)

25-44

45-64

65-84

85+

Boomers 

become 

25-44

Boomers 

become 

45-64

Boomers 

become 

65-84
1918: Three Waves COVID-19: So Far

30

Source: The Spanish Flu and the Stock Market: The Pandemic of 1919

by Bryan Taylor | Feb 27, 2020 | Economics, Historical, Insights

Figure 1. Death Rates of the Spanish Flu, June 1918 to May 1919

Source: https://covid.cdc.gov/covid-data-tracker

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
Change in Total Deaths by Age Pneumonia/Influenza/COVID

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 31

0.6

0.7

0.8

0.9

1.0

1.1

1.2

1.3

1.4

1.5

1.6

2020.012020.042020.072020.102020.132020.162020.192020.222020.252020.282020.312020.342020.372020.402020.432020.462020.492020.522021.022021.052021.082021.112021.142021.172021.202021.232021.262021.292021.32

Total Weekly Deaths: Ratio to 52/104 Weeks Prior

<18 18-64 65+

Incomplete

0

1

2

3

4

5

6

7

8

2020.012020.042020.072020.102020.132020.162020.192020.222020.252020.282020.312020.342020.372020.402020.432020.462020.492020.522021.022021.052021.082021.112021.142021.172021.202021.232021.262021.292021.32

PIC Deaths Last 4 Weeks: Ratio to 52/104 Weeks Prior

<18 18-64 65+

Incomplete
Death Reporting Lags Date of Death Estimated Complete—Rising

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 32

-5,000

0

5,000

10,000

15,000

20,000

25,000

30,000

202001202004202007202010202013202016202019202022202025202028202031202034202037202040202043202046202049202052202102202105202108202111202114202117202120202123202126202129202132

US Weekly Deaths Est Complete: Diff from 52/104 Weeks Prior

US Total Weekly Deaths Estimated Complete: Difference from 52/104 Weeks Prior

US Weekly Deaths Excluding Influenza, Pneumonia, or COVID Est Complete: Difference from 52/104 Weeks Prior

US Weekly Deaths from Influenza, Pneumonia, or COVID Est Complete: Difference from 52/104 Weeks Prior

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

0.90

1.00

1.10

1.20

1.30

1.40

1.50

202001202003202005202007202009202011202013202015202017202019202021202023202025202027202029202031202033202035202037202039202041202043202045202047202049202051202053202102202104202106202108202110202112202114202116202118202120202122202124202126202128202130202132

US Total Weekly Deaths: Ratio to 52/104 Weeks PriorAt Date of CDC Report

14-Aug 28-Aug Estimated Complete

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug
COVID-19 Longer-Term Implications 

• Raised death rates in US 16% in 2020, similar in 2021?

• Second coronavirus in 20 years

• Expect periodically in a now mobile world population?

• Reduced life expectancy for affected cohorts

• But hopefully transient, not affecting future cohorts

• Thus, possibly no implication for “trend rate” in mortality 

• But, if deaths are raised by 16% in 2 of every 20 years:

• Average level of mortality will be 1.6% above “trend”

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 33
Dementia

• Includes 4 categories of death (4 ICD-10 codes)

– Vascular dementia (F01)

– Unspecified dementia (F03)

– Alzheimer’s disease (G30)

– Other degenerative diseases of the nervous system not specified elsewhere (G31)

• Alzheimer’s disease was 46% of all dementia deaths in 2017

• Dementia has had an increasing share of all deaths, particularly in the past 20 years

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 34
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 35
36

Deaths per 100,000

Death Rates 

due to 

Dementia 

Have Been 

Rising 

Steadily for 

Men...

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
37

Deaths per 100,000

...And Even 

More So for 

Women

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
Similar Patterns Seen in the UK

Courtesy Adrian Gallop, UK Government Actuary’s Office

38

0

50

100

150

200

250

300

350

400

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Dementia and Alzheimers (F01, F03, G30) Ischaemic heart disease (I20-I25)

Cerebrovascular disease (I60-I89) Chronic lower respiratory disease (J40-J44)

Lung cancer (C33, C34)

Men Women

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
39

Mortality Decline by Cause of Death: “Other” Only

Average rates of improvement

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
40

Mortality Decline by Cause of Death: “Other” Only

Average rates of improvement

Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021
Mortality Projections: A US Perspective on Approaches and Challenges – September 13, 2021 41

For More Information...http://www.ssa.gov/oact/

• Documentation of Trustees Report data & assumptions 

https://www.ssa.gov/oact/TR/2021/2021_LongRange_Demographic_Assumptions.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
Thank you!

Social Security Administration

Office of the Chief Actuary

410-965-3000

Actuary@ssa.gov