Long Covid appears in Colorado’s death data, even as COVID-19 deaths drop sharply

According to the state’s annual mortality data, COVID-19 is no longer among the top 10 causes of death in Colorado, but the virus still casts a shadow over the numbers.

According to the Colorado Department of Health and Environment, Long COVID is increasingly being listed as a “significant factor” in the deaths of some Coloradans.

Since January 2023, there have been 52 deaths among Colorado residents involving Long COVID.

“That doesn’t surprise me. It’s definitely something we should be paying attention to because there is Long COVID,” said Dr. Dana Dabelea, a professor of epidemiology at the School of Public Health in Colorado, where she is associate dean for research.

Last year, the state recorded 38 deaths in which Long Covid played a significant role, and so far in 2024, there have been 14. According to the state Department of Health, it has not yet been recorded as an “underlying cause of death.”

Long COVID is defined by the U.S. Centers for Disease Control and Prevention as a chronic illness that occurs after infection and is accompanied by a wide range of symptoms and lasts for at least three months.

“This is not surprising because when you look at the epidemiology of long COVID, the group that seems to suffer the most in terms of the more virulent properties of long COVID tends to be people who were severely ill with COVID to begin with,” said Dr. John Swartzberg, a professor and infectious disease expert at UC Berkeley. He said the largest group with severe COVID cases is the elderly.

Long COVID also has a number of other effects, for example it often makes physical activity more difficult. “That’s why it doesn’t surprise me at all that Long COVID contributes to the mortality rate,” he said.

CDPHE began collecting Long COVID death data after a December 2022 study described the use of death certificate text to identify the disease in the National Vital Statistics System.

How death data is collected

The state’s numbers are based on data collected through routine death certificate registration, according to the state Department of Health. This includes information about the cause of death provided by medical certifiers. Doctors, coroners or medical examiners can make the official determination.

The causes of death listed on death certificates are then sent to the CDC/National Center for Health Statistics, where staff code them by underlying cause of death codes and contributing factors, allowing systematic analysis of the data across the country and over time, including the most recent results.

Here are three takeaways from this year’s data, recently released by the state, which also provides data going back more than two decades online through the Colorado Health Information Dataset.

The death rate is still higher than before the pandemic

The age-adjusted death rate for all causes of death was 682 per 100,000 people in 2023. This is higher than the pre-COVID rate in 2019, which was 636 per 100,000.

Both the age-adjusted death rate and the total number of deaths jumped during the first two years of the pandemic before beginning to decline after COVID-19 vaccines became widely available and protection, prevention and treatment improved. The total number of deaths rose from about 39,300 deaths in 2019 to around 48,300 deaths in 2021, with the rate increasing from 636 per 100,000 in 2019 to 773 per 100,000 two years later, according to the state.

Among the countless causes of death, there is a combination of causes whose number has remained higher, the same or lower.

Other numbers that have steadily increased during this period include drug overdoses, other causes of injury (including falls, traffic accidents and homicide), chronic liver disease and cirrhosis, certain heart diseases (including high blood pressure and stroke), chronic kidney disease, nutrient deficiencies and certain types of cancer.

According to data from the Ministry of Health, overall cancer rates were the same as in 2019.

The top ten causes of death for Colorado residents in 2023 were cancer, heart disease, accidents, chronic lower respiratory disease, cerebrovascular disease, Alzheimer’s disease, suicide, chronic liver disease and cirrhosis, diabetes mellitus, and other respiratory diseases.

Not on that top 10 list: COVID-19. It fell to 12th place with 626 deaths. It was the third leading cause of death among Colorado residents in 2021 and 2020, according to the Department of Health. In 2022, the virus claimed more than 2,200 lives in the state, the fifth-highest number this year.

A lot has changed since the terrible first months and years of the pandemic, Swartzberg said.

“Vaccines work, personal protection works. With Omicron and all its subvariants, we have a less virulent variant than, for example, Alpha and Delta,” he said.

“There’s tremendous background immunity from people who have been previously infected,” Swartzberg said. “Ninety-six percent of the American population has some level of immunity from vaccination or previous infection or both. So it’s a very different thing than it was before.”

The effects of a drug overdose

One of the most striking trends of the last decade is the sharp increase in overdose deaths.

The number of drug overdose deaths in Colorado rose from 1,799 the previous year to 1,865 in 2023, nearly surpassing the record of 1,881 set in 2021. Over a decade ago, in 2010, the number was 683.

The main reason for these overdoses is fentanyl, a powerful synthetic opioid. Last year, it claimed nearly 1,100 lives in Colorado. Deaths from methamphetamine and cocaine overdoses also increased. Many of these deaths were due to the presence of other drugs, often fentanyl, in the victims’ bodies. Overdoses from a combination of drugs have been steadily increasing since Colorado began keeping records in 2016.

The total number of overdose deaths is nearly three times higher than in 2010. That same year, the state recorded fewer than 40 deaths due to fentanyl, so the number of fentanyl deaths is more than 25 times higher than it was over a decade ago.

Life expectancy recovered after a historic decline during the pandemic

In terms of life expectancy, there has been continued improvement from 2022 to 2023. Overall life expectancy has increased among Colorado residents, both women and men.

This was true across a number of demographic groups, including the white non-Hispanic population, the black/African American non-Hispanic population, the Asian non-Hispanic population, those identified as two or more races, and the Hispanic population (including all races).

Declines were seen among the non-Hispanic Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native populations. Because of the relatively small populations in these categories, the potential errors and discrepancies in life expectancy estimates are larger, and these differences are not statistically significant, according to the state Department of Health.

Life expectancy for all Colorado residents increased to 79.9 years in 2023, an increase of more than a year from 2020 but not returning to the pre-pandemic level (80.9). After a sharp decline early in the pandemic, life expectancy for Hispanic and Black Colorado residents increased again by about three years compared to 2020 and 2023 (to 79.1 and 75.7, respectively), but was still below that of white and Asian Colorado residents (80.7 and 87, respectively).

In Colorado, life expectancy fell in two consecutive pandemic years, 2020 and 2021. It was a decline not seen in decades.

The average life expectancy of Colorado residents fell to 78 years in 2021. While that’s slightly lower than in 2020, the first year of the pandemic, when it was 78.4 years, the decline represented a sustained and significant drop of nearly three years from 2019.

“The last time life expectancy fell this sharply was in 1943, the nation’s deadliest year of World War II,” Dr. Eric France, then the state’s chief medical officer, told CPR in 2022. The main causes of the decline were COVID-19 and overdose deaths.

The decline in life expectancy during the first year of the pandemic was most shocking in communities of color. Hispanics and blacks died in such relatively high numbers in 2020 that life expectancy for both groups fell by about four years. Among whites in Colorado, the decline was 1.4 years.

These numbers also highlight the significant health care disparities that still exist in Colorado, says Dr. Tamaan Osbourne-Roberts, a family medicine physician who cares for a diverse population at Daybreak Health in Denver.

Particularly striking is the sudden and significant decline in life expectancy among Colorado’s black and Hispanic residents compared to other demographic groups, he wrote by email, as well as the currently low life expectancy of Colorado’s black residents, despite a significant recovery in recent years.

“While Colorado consistently ranks among the top 10 U.S. states in terms of overall life expectancy in several surveys conducted in 2023, black Coloradans, if they represented a state, would consistently rank in the bottom 10 U.S. states on the same measure,” Osbourne-Roberts said.

He said the trends in these and other demographic groups are “indicative of a range of inequities they face in terms of health care, public health infrastructure and the social and political determinants of health.”

Colorado can be happy to have the pandemic behind it, he said, “but we still have a long way to go before we build a health care system that truly provides equitable care to all Coloradans.”

The big picture

For epidemiology professor Dabelea, there is both good news and bad news when it comes to the state’s health when viewed through the lens of death data.

“The good news is that we’re seeing this decline in deaths from chronic diseases, at least since today or over the last year,” she said. And deaths from COVID-19 have dropped sharply.

What is particularly worrying, however, is the information on deaths from overdoses, including those that were accidental and unintentional.

“I think that’s the bad news, and maybe things are getting a little better, but Colorado is the state with the second highest rate of unintentional overdoses among teens and adolescents in the country,” she said. “So that’s concerning.”