PC3026: Adolescent and Young Adult Mortality in the US: A 21 Year Analysis

Background: In 2002, the American Academy of Family Practice, American Academy of Pediatrics and American College of Physicians published a consensus statement focused on improving adolescent care when transitioning from a pediatrics to an adult model of care. Since 2002, there have been updated statements and “Got Transitions” to aid in the education of patients and providers. Healthy People 2020 included transition among their goals. No studies have focused on evaluating mortality trends among this group. This study analyzes United States mortality data for transition age adolescents and young adults (AYA) to determine if mortality has decreased.

Methods: National mortality data were obtained from the Center for Disease Control (CDC) mortality database. The population estimates are based on US Census Bureau data. Crude rates are the ratio of the death counts to population per 100,000 people. Ninety-five percent confidence intervals and standard errors were summarized. Data were evaluated by year and by demographic factors like age, sex, race, and ethnicity. All data analysis was performed in R studio.

Results: All-cause mortality by age declined from 1999 to 2014, followed by an increase in mortality rate from 2015-2020. Between 2015-2020 death rates did not appear to plateau as in year groups 1999-2004, 2005-2010, 2011-2014. Between ages 15-29, male mortality was more than 2 times the female rate. Black or African American (BAA) AYA had the highest mortality rates for ages 15-29 when compared to White and Asian or Pacific Islanders. Being of Hispanic or Latino origin did not have worse mortality rates. The largest increase in mortality since 1999 occurred in 2020 in AYA aged 15-29.

Conclusion: In the United States, there were improvements in AYA mortality until 2012-2015. During those years, the nadir for mortality was reached. From this dataset, mortality causation cannot be gleaned. Although most AYA do not have chronic medical conditions associated with lower long-term life expectancies, AYA through 21 years of age continue to demonstrate rapid increases in mortality rate slopes. This dataset also shines light on the discrepancy between BAA and males when compared to other races and genders. More data are needed regarding causes of death that have been attributed to either BAA or male AYA. Targeted interventions with these populations may improve equity.

The death registry only provides the data on the death certificate. To resolve this limitation, a national collaboration of medical center population health level data and AYA registries may be necessary.

In conclusion, though there were initial improvements in the mortality of AYA, outcomes have worsened in the previous 5 years (2015-2020), especially among BAA and male AYA. There is an urgent need to identify causes and target interventions to reduce mortality among these at-risk populations.