The COVID-19 pandemic’s effect on Tennessee’s population became clearer as new data show deaths surpassing births in consecutive years.
Tennessee was one of 16 states that saw a fertility increase in 2021. The surprising rebound resulted in a four-percent rise in births and came one year after they fell during the initial uncertainty surrounding the pandemic.
However, data from the National Center for Health Statistics show that in 2021 the number of deaths—primarily attributable to COVID-19—also spiked sharply for a second year.
That meant that for both 2020 and 2021, there were more deaths in the state than births—also called a natural decrease. Such an occurrence in Tennessee is new and likely unprecedented in recent history.
Natural decreases are widespread. In 2019, just five U.S. states experienced a natural decrease. But in both 2020 and 2021, that number more than quadrupled to include 24 states, including Tennessee.
Births Among Older Mothers Jump in 2021
After falling for six consecutive years, the number of births in Tennessee recovered in 2021. The state’s 81,717 live births were the most since 2009.
The jump comes just one year after pandemic-related missed conceptions in the first part of 2020 pushed births down to 77,482; the state’s lowest level since 2002.
That set the stage for a one-year increase of 3,028 births, which is among the largest in the state’s history.
Figure 1: Tennessee had 81,717 births in 2021, making it the highest level since 2009. The increase of 3,028 births came one year after births in 2020 fell to the lowest level since 2002.
The increase primarily comes from mothers who were over the age of 30. Births among females in this group accounted for 86 percent of the 2021 increase, while the group under age 30 saw more modest growth.
Figure 2: In 2021, there were 21,901 births to females ages 30 to 34. This was an increase of 1,693 births compared to 2020 and was the largest increase among all age groups. Females ages 35 to 39 had 668 more babies than the prior year, which was the second largest among all age groups.
Mothers who were 30 to 34 years of age added the most births, with almost 1,700 more than in 2021.
That data point shows women are delaying the decision to have children until later in their childbearing years. The average age of a mother at childbirth is another indicator, which grew from 26.2 years in 2003 to 28.2 years in 2021.
It is too soon to say what will follow Tennessee’s 2021 birth “bump.” Since the state’s fertility rate peaked in 2007at 68 births per 1,000 females aged 15 to 44, it has fallen to a historic low of 58 in 2020. That recent trend would suggest that the state’s fertility slide could continue.
However, national-level data through the third quarter of 2022 show that fertility rates remain elevated for the age groups that pushed the state’s births up in 2021. That could signal another strong year for births in Tennessee, followed by an eventual return to pre-pandemic trend levels.
| Age Group |
Births per 1,000 females |
||
|---|---|---|---|
| 2021 Q3 | 2022 Q3 | Change | |
| 15-19 years | 14.1 | 13.5 | -0.6 |
| 20-24 years | 61.5 | 60.6 | -0.9 |
| 25-29 years | 91.8 | 93.3 | 1.5 |
| 30-34 years | 95.9 | 97.1 | 1.2 |
| 35-39 years | 52.2 | 54.8 | 2.6 |
| 40-44 years | 11.7 | 12.4 | 0.7 |
| Total (15-44) | 55.6 | 56.2 | 0.6 |
Source: National Center for Health Statistics, Vital Statistics Rapid Release Program, 2023.
Tennessee Deaths Surge in 2020 and 2021
The 2021 data also show 91,130 deaths across Tennessee, which is an increase of 6,925 deaths since 2020 when 84,205 deaths occurred. The state saw just under 72,000 deaths in 2019. The past two years’ increase is a break from prior decades, which saw slow, but steady growth in the number of deaths that reflected both a growing and aging population.
Figure 3: Between 2000 and 2019, deaths grew steadily in Tennessee due to a growing and aging population. Beginning in 2020, the number of deaths in the state grew sharply as COVID-19 became one of the leading causes of death in the state.
The latest increase is primarily attributable to the emergence of COVID-19 in early 2020. It became the third-leading cause of death each of the past two years and was cited for 6,838 deaths in 2020 and 11,911 in 2021.
That resulted in both the number of deaths and death rates climbing over the past two years for all age groups, but especially for older adults and seniors.
Since 2019, death rates—measured as the number of deaths per 100,000 people—grew the most among those over age 85. It grew from 14,459 deaths per 100,000 people to over 17,500 in 2021.
| Age Group | Deaths per 100,000 people | ||
|---|---|---|---|
| 2019 | 2021 | Change | |
| 25-34 years | 174.5 | 263.9 | 89.4 |
| 35-44 years | 278.8 | 449 | 170.2 |
| 45-54 years | 564.8 | 794.4 | 229.6 |
| 55-64 years | 1210.4 | 1539.9 | 329.5 |
| 65-74 years | 2241.3 | 2792.7 | 551.4 |
| 75-84 years | 5190.0 | 6308.4 | 1118.4 |
| 85+ years | 14459.3 | 17581.1 | 3121.8 |
Source: National Center for Health Statistics, Vital Statistics Rapid Release Program, 2023.
Deaths among people ages 65 to 74 logged the largest numerical increase over the past two years, growing by 5,066 deaths since 2019. To a degree, a larger number of deaths is expected as baby boomers age into this cohort.
Figure 4: The number of adult deaths in Tennessee increased for all age groups between 2019 and 2021 but the most notable increases were for groups age 55 and over.