US Cardiovascular Mortality Decline Slows: A New Challenge for Actuaries

A large-scale study by American scientists, published in the JACC (Journal of the American College of Cardiology), has revealed a long-term slowdown in the rate of decline in cardiovascular disease (CVD) mortality in the United States. An analysis of data from 2000 to 2019 shows that after 2011, the positive trend weakened significantly. The main factors behind this deceleration were rising mortality from hypertensive heart disease, atrial fibrillation and flutter, and ischemic stroke.

Researchers analyzed death records from the US National Vital Statistics System, covering 3,110 counties. The study focused on 21 causes of death, including total CVD and 17 detailed diagnoses. The results demonstrated deep geographic and ethnic disparities. The highest mortality counties were concentrated in the South and Appalachia, while the lowest rates were recorded in the West, upper Midwest, and Northeast. Across racial and ethnic groups, the age-standardized mortality rate (ASMR) was highest in the Black population, followed by American Indian or Alaska Native (AIAN), white, and Latino populations. The lowest mortality rate was observed among Asian Americans.

For actuaries involved in life insurance, annuity, and pension planning, these findings are of fundamental importance. Traditional actuarial models of mortality extrapolation often assume a steady improvement in public health due to medical advancements. However, the slowdown in the decline of CVD mortality—a leading cause of death in developed nations—means that the pace of longevity growth may be lower than projected. This requires actuaries to adjust life tables, re-evaluate pension liability reserves, and revise life insurance tariffs. Analysts should pay close attention to regional and demographic risk segmentation, as the study proved that mortality varies far more at the county level than at the state level.

The study's authors emphasize the practical value of their findings for long-term planning and risk assessment. In their view, granular county-level data provides the necessary foundation for targeted interventions. They stated: “While declining CVD mortality reflects meaningful clinical and public health progress, persistent and pervasive disparities demand solutions-oriented, place-informed research to drive further progress. Critically, these pre-Covid data establish a baseline essential for isolating Covid-era–attributable shifts from preexisting trends.”

Integrating local epidemiology into actuarial underwriting is becoming a new standard. Insurers will have to revise their risk assessment approaches in the most vulnerable regions. For Kazakhstan and Central Asian countries, this precedent highlights how critical it is to have detailed regional mortality statistics to build accurate national life tables and effectively manage pension assets.

Actuarial Takeaway: Deceleration in mortality improvements challenges aggressive extrapolation assumptions in standard Lee-Carter and CMI projection models. Life and pension actuaries must recalibrate mortality improvement factors across older cohorts to prevent longevity reserve mispricing.