Summary Abstract

July 2024
We investigate trends in death rates from musculoskeletal diseases (ICD-10 codes M00-M99) for all age groups in the US using data from the CDC (Centers for Disease Control and Prevention). We also perform a detailed analysis for older individuals aged 75 to 84. We analyse trends in musculoskeletal diseases where these appear on the death certificate under multiple causes (MC) of death, or as the underlying cause (UC), as well as the trends in the ratio of multiple cause to underlying cause death rates.

For individuals aged 75 to 84, our results show that the excess UC death rates from musculoskeletal diseases (M00-M99) diseases for individuals aged 75 to 84 were 4.7% (Z-Score of 1.7) in 2020, then rose to 15.2% (Z-Score of 5.6) in 2021, 16.6% (Z-Score of 6.1) in 2022 and 26.6% (Z-Score of 9.8) in 2023. Excess death rates rose in each consecutive year from 2020 to 2023, and from 2021 onwards, statistical significance of excess deaths can be considered extreme occurrences. We also observe that the rises of MC* musculoskeletal excess death rates (deaths involving musculoskeletal diseases as either an underlying or contributory cause but where COVID-19-related deaths are excluded) in 2020, 2021, 2022 and 2023 mirror the excess UC death rates, suggests that a common underlying factor is at play.

When analysing the most common causes of death for older individuals aged 75-84, within the musculoskeletal system, namely arthropathies (icd10 codes: M00-M25) and osteopathies and chondropathies (icd10 codes: M80-M94) we find similar patterns of behaviour.
It should be mentioned that as musculoskeletal deaths tend to be classified as a contributing cause instead of underlying cause of death, acute COVID-19-associated deaths are an unlikely explanation to the observed excess mortality.

Inside the Report:
Underlying Cause Excess Death Rates from Musculoskeletal Diseases, 75-84

​We investigated excess death rates from musculoskeletal diseases in the US for the 75 to 84 age group from 2010 to 2023. The figure on the left (top figure when viewed in mobile) refers to relative deviations from the 2010-2019 trend, while the figure on the right (below in mobile) shows the Z-score (signal strength) for the deviations from trend.

In the left (or top) figure, we can observe that the excess death rates from musculoskeletal diseases as the underlying cause (UC) were 4.7% (Z-Score of 1.7) in 2020, then rose to 15.2% (Z-Score of 5.6) in 2021, 16.6% (Z-Score of 6.1) in 2022 and 26.6% (Z-Score of 9.8) in 2023.
By comparison, the excess mortality for all-cause deaths was 16.8% in 2020, 21.1% in 2021, 12.8% in 2022, and 10.5% in 2023. 
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It is noteworthy that while excess all-cause mortality peaked in 2021 and then dropped in 2022 and 2023, excess deaths from musculoskeletal diseases as the underlying cause rose consecutively in 2021, 2022 and 2023. Additionally, while excess all-cause deaths suffered an extreme rise of 16.8% (28 standard deviation rise) in 2020, excess musculoskeletal death rates were subdued at about 4.7% (Z-score of 1.7), showing low statistical significance.

Conclusions

  • For older age groups (65-74, 75-84 and 85+), we observe statistically significant excess UC death rates, that increased consecutively from 2020 to 2023. The signal strengths in 2020 were weaker than for younger individuals as illustrated by the 4.7% excess death rate for individuals aged 75 to 84 with a 1.7 Z-Score. For the same age group, UC excess death rates increased to 15.2% (Z-score of 5.6) in 2021, 16.6% (Z-score of 6.1) in 2022 and 26.6% (Z-Score of 9.8) in 2023, as shown in the tables above.
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  • The results suggest that there are different patterns for older individuals when compared to younger individuals. For older individuals, the pattern of excess mortality from musculoskeletal diseases is different, as for these individuals, excess deaths continued to rise in 2022 and 2023, indicating a worsening of the underlying phenomenon. Additionally, one must also consider the “dry tinder” effect where fragile individuals who suffer from chronic conditions were deceased earlier than expected. If this was the case, one would expect to observe low or negative excess death rates in 2022 and 2023, which is not the case.
 
  • As for possible causes for this phenomenon, a larger body of evidence is pointing towards the continuous uptake of COVID-19 inoculations within the older age groups being a factor that is driving the phenomenon, as for example, the from evidence of side effects from the vaccines is shown by Fraiman et. al., and in particular for inflammatory musculoskeletal diseases in shown in Park et. al.. Furthermore, the recent paper by Alessandria et al. points to higher all-cause mortality COVID-19 vaccinated individuals when compared to unvaccinated ones (Alessandria et. al.).
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  • One cannot exclude other possible contributing factors such as pandemic-related changes in lifestyles, inflammatory processes due to cumulative exposures to SARS-CoV-2, “Long COVID” (Jangnin, et. al.), or other factors. It should be mentioned that as musculoskeletal deaths tend to be classified as a contributing cause instead of underlying cause of death, acute COVID-19-associated deaths are an unlikely explanation to the observed excess mortality.
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