Fewer Coloradans died in 2022 than during the first two years of the pandemic, but it’s too soon to tell whether the state’s still-elevated death toll last year was a point of transition or the start of a new normal.

Nearly all of the improvement in Colorado’s death rates from 2021 to 2022 was because less than half as many people died of COVID-19. That was partially offset by an increase in deaths from other diseases, however, as overdose deaths stabilized well above their pre-pandemic levels.

The state’s mortality data is delayed three to four months, so it’s not yet known whether those same trends have continued into 2023, said Kirk Bol, manager of the vital statistics program at the Colorado Department of Public Health and Environment.

COVID-19 deaths will most likely be lower this year, because 2022 included the second half of the massive omicron-driven wave and nothing comparable has happened since, he said. But the trends aren’t as obvious for other causes of death.

“That’s tough to tell,” he said.

Colorado recorded 46,751 deaths in 2022, a decrease of about 1,500 from the previous year. Even after adjusting for population growth and aging, however, mortality in the state remained 12% higher than it was before the pandemic hit. COVID-19 caused more than two-fifths of the increase, and accidental drug overdoses were responsible for about 15%, even though both caused fewer deaths than in 2021.

Most other major causes of death also caused slightly lower mortality rates in 2022 than in 2021. The exceptions were chronic lower respiratory diseases, such as emphysema; transportation accidents; Alzheimer’s disease; and heart disease. Studies have found links between COVID-19 infection and later heart problems, though it’s not clear if that was a factor in the mortality rise.

Deaths from influenza and non-COVID pneumonia also were up, though still slightly below 2019 levels, as the country had its first relatively normal flu season in years.

It’s likely that people’s decisions to stop wearing masks and taking other precautions played some role in the increased deaths from other respiratory diseases, though it’s difficult to know how much, since the virulence of the circulating flu strains and how well vaccines match them also influence mortality, said Dr. Ned Calonge, chief medical officer at the state health department.

After adjusting for population growth and aging, the death rate also remained higher than it had been in 2019 for traffic accidents, heart disease and diabetes. Death rates in 2022 were lower, after adjusting, for cancer, chronic lower respiratory diseases, strokes, Alzheimer’s and suicide.

Some people may have delayed care during earlier phases of the pandemic, making them more likely to die of chronic diseases now, and the decrease in COVID-19 deaths may mean that people lived a bit longer before they were killed by other conditions, Calonge said. And of course, there’s some random variation from year to year, he said.

“While we can always observe things, we can’t always explain them,” he said.

Colorado’s mortality followed a similar trajectory to the rest of the country in 2022 and likely will this year, said Andrew Noymer, an epidemiologist and associate professor at the University of California Irvine.

In the first three months of 2023, all-cause mortality nationwide was still above what would have been expected before the pandemic, even adjusting for population aging. It appeared to drop to near-normal levels in the second quarter of the year, but the country will have to wait for the summer data before it’s clear if the excess deaths are really over, he said.

“That is really, really the question,” he said.

Overdoses hit young, COVID continues to kill older people

Fewer children under 10 died in Colorado last year than did, on average, in the three years before the pandemic, mostly because of a reduction in infant deaths and fatal injuries of older children.

Deaths increased among people between 10 and 17, however, as a rise in homicides and accidents, including drug overdoses, more than wiped out a small decrease in suicide deaths. Since most homicides involve guns, as do a non-trivial number of accidents, parents could reduce deaths by making it more difficult for youth to access firearms, said Dr. Maya Haasz, a pediatric emergency physician at Children’s Hospital Colorado.

Dr. Laurie Halmo, a pediatric hospitalist and medical toxicologist at Children’s Hospital Colorado, said most of the increase in overdose deaths was due to fentanyl poisoning in older teens. While it’s encouraging to see a small drop in suicide deaths, young people are clearly struggling with substance use, and more adults need to keep naloxone on hand so they’re prepared to respond to an overdose, she said.

A similar pattern held in adults under 25, who were less likely to die by suicide than before the pandemic but more likely to be killed by homicide, overdoses or other accidents.

For people between 25 and 44, the biggest increases were in overdoses and chronic liver disease deaths. While the state’s data on liver disease didn’t specify what caused patients’ illnesses, alcohol-related deaths have increased in younger people nationwide as drinking increased during the pandemic.

Unfortunately, those trends aren’t likely to reverse any time soon, said Beth Carlton, an associate professor of environmental and occupational health at the Colorado School of Public Health. “Deaths of despair,” including overdoses, liver disease and suicide, have been rising in working-age populations since the early 2010s, she said.

“That’s not just pandemic-related,” she said.

For people over 45, COVID-19 was still the largest contributor to increased deaths above the 2017-to-2019 average. Nationwide, the virus was still the fourth-leading cause of death in 2022, which is “pretty mind-blowing,” though it dropped to fifth place in Colorado, Carlton said.

COVID-19 killed 2,261 people in Colorado in 2022, down from 5,298 the prior year. While the virus will likely cause even fewer deaths this year, it’s still a significant factor that’s keeping mortality up, Carlson said.

“It’s hard for so many of us who lived through the pandemic… to see COVID is still a major cause of death and hold that in tension with that COVID is much less of a threat” than it was two years ago, she said.

Men, people of color see more improvement

Nationwide, groups that saw larger increases in deaths in 2020 and 2021 had larger decreases in 2022, according to preliminary data analyzed by the U.S. Census Bureau. Those included men and people who identified as Hispanic, Black, American Indian or Pacific Islanders.

A similar pattern appeared in Colorado. Men saw a bigger drop in their death rate from 2021 to 2022 than women did, after two years of a widening gap in mortality driven by COVID-19 and overdoses.

All ethnic groups in Colorado saw a decrease in death rates, except those identified as multiracial. The number of people whose death certificates list more than one race is so small, however, that it’s difficult to tell if that’s a trend or a blip.

White Coloradans had the smallest decrease in mortality, with increases in more cause-of-death categories than other groups, which partially offset their drop in COVID-19 deaths. Still, they had the third-lowest mortality rate, behind Asian and multiracial Coloradans.

Compared to 2021, American Indian and Pacific Islander Coloradans had the largest increases in life expectancy, though they still could expect shorter lives, on average, than Asian, multiracial and white residents. Men also posted a larger increase in life expectancy than women, or in the case of the multiracial population, a smaller decrease, but still died younger.

That may reflect that men and people of color were hit particularly hard by COVID-19, so they experienced more improvement as mortality trends came closer to normal, said Bol, of the state health department.

Calonge, the state’s chief medical officer, said it’s too early to be sure, but he hopes that Colorado’s increased investment in promoting health equity is helping to reduce mortality disparities. The health department started an office focused on equity during the pandemic, and both public- and privately-funded programs have listed closing health gaps as a new goal since 2020.

“Hopefully our culture and our society… will recover at least to where we were, if not better,” he said.

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