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SESSION 3 - B - 1

Demographics Assumptions Setting 

Post-COVID
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May 1, 3 & 5

Section 2: Base Mortality
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May 1, 3 & 5

Social Security 

Area Mortality Experience: 

All Ages

Deceleration in 2009 to 2019. 

Increased mortality in the 

COVID-19 pandemic.

We assume return to pre-COVID 

trendline : balance selective 

mortality in pandemic and postCOVID conditions for survivors

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

2021TR

2022TR

2023TR

Actual
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US is Not Alone—United Kingdom Deceleration Since 2011 May 1, 3 & 5

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

Mortality Experience: 

Ages Under 65

Reversal of trend after 2009--

despair. Increased mortality in 

2020-2022 in the COVID-19 

pandemic.

Note spike in 2021 when 

COVID vaccine was not 

available at younger ages

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

2021TR

2022TR

2023TR

Actual
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Social Security Area 

Mortality Experience: 

Ages 65 and Older

Deceleration since 2009. 

Increased spike mortality in 

the COVID-19 pandemic.

What will the net effect of the 

pandemic be on mortality in 

the future?

Will offsetting effects balance 

for the residual population 

after the pandemic?

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

2021TR

2022TR

2023TR

Actual
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Ratio of Age-Sex 

Adjusted Death Rates to 

Same Quarter in 2019

Source: NCHS Quarterly Provisional Estimates as of March 20, 2023

1.00

1.05

1.10

1.15

1.20

1.25

1.30

1.35

2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2022 Q3

Ratio of Age-Sex-Adjusted Death Rates to Same Quarter in 2019 

Total: all causes

Total excluding 

COVID-19

Through 2022 death rates for 

causes other than COVID 

have been about 5% higher in 

the pandemic period than 

they were in 2019.

Post-COVID conditions will 

continue to affect those 

surviving the pandemic.
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May 1, 3 & 5 Change in Age-Sex-Adjusted Death Rates

Cause of Death 2020 Q1 2020 Q2 2020 Q3 2020 Q4 2021 Q1 2021 Q2 2021 Q3 2021 Q4 2022 Q1 2022 Q2 2022 Q3

Alzheimer disease 1.013 1.119 1.134 1.082 1.076 0.979 1.076 1.003 1.054 0.965 1.007

COVID-19 -- -- -- -- -- -- -- -- -- -- --

Cancer 0.995 0.965 0.994 0.986 0.975 1.000 1.021 1.009 0.970 0.975 0.988

Chronic liver disease and cirrhosis 1.063 1.116 1.252 1.256 1.286 1.241 1.315 1.282 1.277 1.179 1.198

Chronic lower respiratory diseases 0.991 0.909 0.970 0.935 0.793 0.850 1.030 0.989 0.846 0.858 0.935

Diabetes 1.013 1.170 1.222 1.200 1.149 1.108 1.253 1.186 1.157 1.057 1.116

Drug overdose 1.212 1.495 1.330 1.197 1.542 1.605 1.496 1.355 1.562 -- --

Falls, ages 65 and over 1.007 1.013 1.069 1.084 1.123 1.167 1.184 1.215 1.183 1.159 --

Firearm-related injury 1.071 1.101 1.202 1.212 1.204 1.244 1.250 1.246 1.221 1.235 --

Heart disease 0.992 1.048 1.070 1.054 1.039 1.033 1.128 1.102 1.064 1.015 1.055

HIV disease 1.000 1.000 1.000 1.077 0.933 0.857 1.000 1.077 0.933 0.929 1.000

Homicide 1.109 1.267 1.359 1.387 1.327 1.417 1.359 1.306 1.309 1.317 --

Hypertension 1.021 1.149 1.171 1.165 1.175 1.115 1.256 1.242 1.175 1.138 1.183

Influenza and pneumonia 1.143 1.052 1.045 0.939 0.629 0.774 1.135 1.053 0.674 0.835 0.966

Kidney disease 1.007 0.984 1.034 0.977 1.044 1.024 1.120 1.076 1.140 1.073 1.120

Parkinson disease 1.032 1.157 1.157 1.128 1.097 1.084 1.157 1.117 1.129 1.084 1.120

Pneumonitis due to solids and liquids 0.943 0.870 1.000 0.957 0.925 1.022 1.195 1.170 1.000 1.043 1.049

Septicemia 1.000 1.011 1.057 1.020 1.000 1.000 1.172 1.122 1.019 1.043 1.103

Stroke 1.018 1.042 1.080 1.060 1.098 1.095 1.144 1.112 1.127 1.073 1.103

Suicide 1.000 0.923 0.966 0.977 0.985 0.979 1.007 1.060 1.022 1.021 --

Unintentional injuries 1.086 1.216 1.216 1.146 1.307 1.355 1.318 1.269 1.341 1.255 --

Total 1.025 1.201 1.180 1.265 1.254 1.103 1.302 1.252 1.231 1.062 1.117

Total w/o COVID 1.016 1.046 1.077 1.055 1.044 1.054 1.132 1.104 1.069 1.042 1.081

Source: NCHS Quarterly Provisional Estimates as of March 20, 2023

Change in Age-Adjusted Death Rates from the Same Quarter in 2019, by Cause of Death
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Section 3: Projected Mortality
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Death Rates Will Continue to Decline: May 1, 3 & 5

But How Fast?

• Must understand past and likely future conditions

– Avoid simple extrapolation of past periods

• Latter half of 20th century was extraordinary Cardio and health advances

• So deceleration seems likely

• Cause-specific rates and human behavior

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

– Trustees Accuracy: 

• in the 1982 TR, we projected period LE65 for 2015 to be 19.1; 

• actual for 2015 turned out to be 19.1
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May 1, 3 & 5 US Mortality Decline from 1979-2019 by Cause of Death: 

Over age 50 several negatives, will Cardio Sustain Improvement
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Age May 1, 3 & 5 -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.

Heart disease

Cancer

Unintentional injury Stroke
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Future Conditions, Including Behavior

• Smoking decline but “deaths of despair” continue

• Obesity—sedentary lifestyle

• Health spending—will decelerate

– An ageing population, and Climate Change will strain resources 

• Periodic pandemics will elevate the average level of 

mortality in the future----diminishing life expectancy
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May 1, 3 & 5 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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May 1, 3 & 5

Health Spending Cannot Continue to Rise at Historical Rates

Trustees project deceleration, but beneficiaries rising faster than workers
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May 1, 3 & 5 COVID-19 is Not Over. More Waves and Pandemics to Come 

Vaccination in US age 18+ to date: primary series 79%, bivalent booster only 20%
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May 1, 3 & 5 Our Ultimate (2046 to 2096) Projected Rates of Decline: 

Less than 0.78% for ages 65 and over

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
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Mortality By Career May 1, 3 & 5 -Average Earnings Level: Actuarial Study 124

Crucial to scale to your exposed population, but rate of change may be similar

Age group 65-69 relative mortality ratios—not diverging
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Section 4: Retirement and Termination 
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Ratio of Employment 

to Population

Recovered more strongly 

from the brief but steep 

recession than did LFPRs. 

Recovered to pre-recession 

levels for women by 2022, 

but not for men. Projected 

to fall for men in 2023 and 

2024, due to the assumed 

slowdown in economic 

growth, before recovering 

to its long-term trend. 0.45

0.50

0.55

0.60

0.65

0.70

0.75

1981 1991 2001 2011 2021 2031 2041 2051 2061 2071 2081 2091

Ratio of Employment to Population 

(16 and older, age-sex-adjusted to 2011 population)

2022 TR

2023 TR

Age-sex-adjusted

Men (age-adjusted)

Women (age-adjusted)

Historical Projected
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Ratio of Employment to 

Population vs. Quits Rate

The quits rate represents the 

number of voluntary separations 

(when an employee voluntarily 

leaves a job, regardless of 

whether it is followed by taking a 

job with a different employer) as 

a percentage of total 

employment.

Elevated quits rates suggest a 

tight labor market, in which 

workers are able to switch jobs 

easily, and usually correspond to 

periods of a high (or rising) ratio 

of employment to population.

0

0.5

1

1.5

2

2.5

3

3.5

0.50

0.55

0.60

0.65

0.70

2001Q12001Q32002Q12002Q32003Q12003Q32004Q12004Q32005Q12005Q32006Q12006Q32007Q12007Q32008Q12008Q32009Q12009Q32010Q12010Q32011Q12011Q32012Q12012Q32013Q12013Q32014Q12014Q32015Q12015Q32016Q12016Q32017Q12017Q32018Q12018Q32019Q12019Q32020Q12020Q32021Q12021Q32022Q12022Q3

Quits Rate versus Ratio of Employment to Population

(16 and older, age-sex adjusted)

Quits Rate

E/Pop 
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22

Age of Starting Social Security Retirement Benefits

0

10

20

30

40

50

60

70

80

90

100

1975 1980 1985 1990 1995 2000 2005 2010 2015 2020

Male Retired Worker Beneficiaries In Current Payment Status as 

Percent of Insured Population 

(excluding those receiving only some other OASDI benefit)

62.5 63.5 64.5 65.5 66.5 67.5 68.5 69.5 70.5

Recession

Eliminate Earnings 

Test Over NRA

NRA starts

increase 

over 66

0

10

20

30

40

50

60

70

80

90

100

1975 1980 1985 1990 1995 2000 2005 2010 2015 2020

Female Retired Worker Beneficiaries In Current Payment Status as 

Percent of Insured Population 

(excluding those receiving only some other OASDI benefit)

62.5 63.5 64.5 65.5 66.5 67.5 68.5 69.5 70.5

Recession

Eliminate Earnings 

Test Over NRA

Deemed Filing 

applies to all Retired 

Workers