In 2020, heart disease and cancer were the leading causes of death in the US, with 1.29 million deaths, followed by COVID-19 , with 350,000 deaths. The pandemic may also have indirectly led to increases in other causes of death, including heart disease, diabetes, Alzheimer’s disease, and unintentional injuries. We examine the leading causes of death in the US, overall and across various age groups, from March 2020 to October 2021.
Methods
We obtained final national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention (accessed May 5, 2022). We excluded data more recent than October 2021 because it was incomplete.
We determined the top 5 causes of death by year and age group, and compared the period March to December 2020 with the period January to October 2021. Because the data is publicly available, the study did not require review of an institutional review board.
Results
From March 2020 to October 2021, heart disease (20.1%), cancer (17.5%), COVID-19 (12.2%), accidents (6.2%), and stroke Strokes (4.7%) were the most common causes of death in the US.
There were 2.875 million deaths from March to December 2020 and 2.855 million deaths from January to October 2021; The top 5 causes of death were the same in each year. Among those over 1 year of age, the number of deaths increased in all age groups.
Deaths from cancer, heart disease and COVID-19 accounted for the largest number of deaths in each age 55 and older group . The top 3 causes of death in these age groups were the same in 2020 and 2021.
Among people aged 85 and older , COVID-19 was ranked the second leading cause of death in 2020 (110,000 deaths, 12.8% of deaths), and third in 2021 (69,000, 8.9% of deaths) .
Among people ages 45 to 54 , COVID-19 was the fourth leading cause of death in 2020 (17,000 deaths, 10.4% of deaths), after heart disease, cancer, and accidents; in 2021, however, it was the leading cause of death (30,000 deaths, 16.8% of deaths).
In both time periods, accidents accounted for the largest number of deaths in each age group from 1 to 44 years.
Compared to 2020, COVID-19 increased from fifth (6,100 deaths) to second leading cause of death (13,000 deaths) among people aged 35 to 44 in 2021, became the fourth leading cause of death in 2021 among people from 25 years to 34 years (5,000 deaths), and from 15 to 24 years (1,100 deaths).
Leading causes of death in the US, March to December 2020 and January to October 2021. Bars indicate the number of deaths for each of the 5 most common causes of death by age group for people of 25 to 34 years old, 45 to 54 years old, 65 to 74 years old, and those over 85 years old. Colors are consistent across all age groups; however, the scales differ. COVID-19 indicates coronavirus disease 2019; CLRD: chronic lower respiratory disease.
Discussion
From March 2020 to October 2021, COVID-19 accounted for 1 in 8 deaths in the US and was a top 5 cause of death in every age group 15 years and older. Deaths from cancer and heart disease exceeded COVID-19 deaths overall and in most age groups, while accidents were the leading cause of death among people ages 1 to 44.
Compared with the 2020 period, COVID-19 deaths in the 2021 period decreased in ranking among people aged 85 and older, but increased in ranking among people aged 15 to 54, becoming the leading cause of death among people ages 45 to 54.
The increase in COVID-19 ranking as the leading cause of death in some age groups is consistent with a downward age shift in the distribution of COVID-19 deaths in the US driven by vaccination rates in 2021 in older age groups.
The pandemic has also had indirect effects on other causes of death in the U.S. From 2019 to 2020, death rates increased from heart disease, accidents, stroke, Alzheimer’s disease and diabetes. Possible explanations include fear of accessing medical care or misattribution of COVID-19 deaths to other causes.
Accidental deaths (including drug overdoses and unintentional alcohol poisoning), assaults, and suicide remain the leading causes of death in the US, particularly in younger age groups ; the pandemic may have contributed to some of these deaths.
Our analysis was limited by potential cause of death misclassification and incomplete death data for 2021, although we included a 6-month lag to increase the completeness of the interim data. Additionally, because our analysis only extended through October 2021, it does not include deaths that occurred during the Omicron wave of the pandemic in late 2021 and early 2022.
