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March 31, 2021

The Leading Causes of Death in the US for 2020

Author Affiliations
  • 1National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
  • 2National Center for Health Statistics, Mortality Statistics Branch, Division of Vital Statistics, Hyattsville, Maryland
JAMA. Published online March 31, 2021. doi:10.1001/jama.2021.5469

Vital statistics data provide the most complete assessment of annual mortality burden and contribute key measurements of the direct and indirect mortality burden during a public health pandemic. While mortality statistics have historically been produced annually, the COVID-19 pandemic introduced a pressing need for the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) to rapidly release reliable provisional mortality data. Provisional estimates indicate a 17.7% increase in the number of deaths in 2020 (the increase in the age-adjusted rate was 15.9%) compared with 2019, with increases in many leading causes of death.1 The provisional leading cause-of-death rankings for 2020 indicate that COVID-19 was the third leading cause of death in the US behind heart disease and cancer.1

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    4 Comments for this article
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    "Two Statisticians' View" of Leading Causes of Death
    Elisabet Englund, Professor | Lund University Hospital, Lund, Sweden
    Albeit of great interest, it is important to know that the given numbers come from death certificates.

    All of us who work with / read the reports from autopsy pathologists know that the reality is different when actually examining the deceased.

    A clinically unknown tumor is found in a large proportion of our cases, and so are unknown, potentially treatable infections. Clinically known/registered covid-19 patients die from various immediate causes. On top of that, a number of unknown covid-19 cases succumb - and this is shown only at autopsy with subsequent microscopical investigation.

    Perhaps paving way for
    an exchange of knowledge,

    Elisabet Englund, MD
    Lund, Sweden
    CONFLICT OF INTEREST: None Reported
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    Death Certificates May Not Tell All - Suicide
    Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired)
    Thank you for your interesting article. Death certificates may not tell the entire story. I was surprised by the suicide rate reported to have a major decrease in 2020. It seems from most other reports that the suicide rate has increased since the pandemic began. This may be explained by the fact that the category of "Unintentional Injury" had a major increase at the same time, and the fact that this category includes drug overdoses. As there is often inadequate history in a fatal drug overdose case, many of these may be purposeful and so suicidal. This would explain the perceived increase in suicide rate since the current pandemic began. Perhaps further analysis of the data would elucidate this incongruity. Thank you again for your presentation. Gary Joseph Ordog, MD.
    CONFLICT OF INTEREST: None Reported
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    The Biggest Pandemic
    Dean Ornish, M.D. | Founder & President, Preventive Medicine Research Institute; Clinical Professor of Medicine, UCSF
    Twice as many people died in 2020 of heart disease (690,8820 as from COVID-19 (345,323). This doesn't even include another 159,150 who died from stroke and another 106,106 from diabetes (mostly type 2), which have the same risk factors as heart disease.

    While Covid-19 is an airborne disease, and cardiovascular disease and type 2 diabetes are predominantly lifestyle and food-borne diseases, it would be wise for the CDC and HHS to put at least as much effort into preventing these chronic conditions as Covid-19.
    CONFLICT OF INTEREST: Book royalties; lecture honoraria; licensing fees from Sharecare.
    Death from Diabetes
    Frank Singer, MD | Straub Clinic & Hospital, Honolulu, HI
    How do you die from diabetes? Either diabetic ketoacidosis or hyperosmolar coma. The statistics for death from diabetes seem exaggerated.
    CONFLICT OF INTEREST: None Reported
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