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Figure.  Leading Causes of Death in the US, March to December 2020 and January to October 2021
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 those aged 25 to 34 years, 45 to 54 years, 65 to 74 years, and those aged 85 years and older. Colors are consistent by cause across age groups; however, scales differ. COVID-19 indicates coronavirus disease 2019; CLRD: chronic lower respiratory disease.

Table.  Five Leading Causes of Death by Age Group From March to December 2020 and January to October 2021
Five Leading Causes of Death by Age Group From March to December 2020 and January to October 2021
1.
Woolf  SH, Chapman  DA, Lee  JH.  COVID-19 as the leading cause of death in the United States.   JAMA. 2021;325(2):123-124. doi:10.1001/jama.2020.24865PubMedGoogle ScholarCrossref
2.
Murphy  SL, Kochanek  KD, Xu  J, Arias  E.  Mortality in the United States, 2020.   NCHS Data Brief. 2021;(427):1-8.PubMedGoogle Scholar
3.
Ahmad  FB, Anderson  RN.  The leading causes of death in the US for 2020.   JAMA. 2021;325(18):1829-1830. doi:10.1001/jama.2021.5469PubMedGoogle ScholarCrossref
4.
Shiels  MS, Haque  AT, Haozous  EA,  et al.  Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020.   Ann Intern Med. 2021;174(12):1693-1699. doi:10.7326/M21-2134PubMedGoogle ScholarCrossref
5.
National Center for Health Statistics. Provisional Multiple Cause of Death Data. Accessed May 5, 2022. https://wonder.cdc.gov/controller/datarequest/D176
6.
Truman  BI, Chang  MH, Moonesinghe  R.  Provisional COVID-19 age-adjusted death rates, by race and ethnicity - United States, 2020-2021.   MMWR Morb Mortal Wkly Rep. 2022;71(17):601-605. doi:10.15585/mmwr.mm7117e2PubMedGoogle ScholarCrossref
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    Research Letter
    July 5, 2022

    Leading Causes of Death in the US During the COVID-19 Pandemic, March 2020 to October 2021

    Author Affiliations
    • 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
    JAMA Intern Med. 2022;182(8):883-886. doi:10.1001/jamainternmed.2022.2476

    In 2020, heart disease and cancer were the leading causes of death in the US, accounting for 1.29 million deaths, followed by COVID-19, accounting for 350 000 deaths.1-3 The pandemic may also have indirectly led to increases in other causes of death, including heart disease, diabetes, Alzheimer disease, and unintentional injuries.2,4 We examined the leading causes of death in the US, overall and in 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, 20225). We excluded data more recent than October 2021 because they were incomplete. We determined the 5 leading 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 are publicly available, the study did not require institutional review board review.

    Results

    From March 2020 to October 2021, heart disease (20.1%), cancer (17.5%), COVID-19 (12.2%), accidents (6.2%), and stroke (4.7%) were the most common causes of death in the US. There were 2.875 million deaths in March to December 2020 and 2.855 million deaths in January to October 2021; the 5 leading causes of death were the same in each year. Among those older than 1 year, the number of deaths increased across age groups.

    Deaths from cancer, heart disease, and COVID-19 accounted for the largest number of deaths in every group aged 55 years and older (Table, Figure). The leading 3 causes of death in these age groups were the same in 2020 and 2021. Among people aged 85 years and older, COVID-19 was ranked as 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 those aged 45 to 54 years, COVID-19 was the fourth leading cause of death in 2020 (17 000 deaths, 10.4% of deaths), following 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 every age group 1 to 44 years. Compared with 2020, COVID-19 increased from the fifth (6100 deaths) to the second leading cause of death (13 000 deaths) among those aged 35 to 44 years in 2021, became the fourth leading cause of death in 2021 among those aged 25 to 34 years (5000 deaths), and those aged 15 to 24 years (1100 deaths).

    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 aged 15 years and older. Cancer and heart disease deaths exceeded COVID-19 deaths overall and in most age groups, whereas accidents were the leading cause of death among those aged 1 to 44 years. Compared with the 2020 time period, deaths from COVID-19 in the 2021 time period decreased in ranking among those aged 85 years or older but increased in ranking among those aged 15 to 54 years, and became the leading cause of death among those aged 45 to 54 years.

    The increased ranking of COVID-19 as a 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 in 2021 compared with 2020,6 perhaps driven by higher COVID-19 vaccination rates in 2021 in the oldest age groups.

    The pandemic also has had indirect effects on other causes of death in the US. From 2019 to 2020, death rates increased for heart disease, accidents, stroke, Alzheimer disease, and diabetes.2 Potential explanations are fear of accessing health care or misattribution of COVID-19 deaths to other causes.4 Accidental deaths (including drug overdoses and unintentional alcohol poisoning), assault, and suicide remain major 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 misclassification of the cause of death and incomplete death data for 2021, although we included a lag of 6 months to increase the completeness of the provisional data. Moreover, because our analysis only extended through October 2021, it does not include deaths that occurred during the Omicron wave of the pandemic of late 2021 and early 2022.

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    Article Information

    Accepted for Publication: May 9, 2022.

    Published Online: July 5, 2022. doi:10.1001/jamainternmed.2022.2476

    Corresponding Author: Meredith S. Shiels, PhD, MHS, National Institutes of Health, National Cancer Institute, 9609 Medical Center Dr, Room 6E-218 MSC 9767, Bethesda, MD 20892 (shielsms@mail.nih.gov).

    Author Contributions: Dr Shiels had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Shiels, Berrington de González, Freedman.

    Acquisition, analysis, or interpretation of data: Haque, Berrington de González.

    Drafting of the manuscript: Shiels.

    Critical revision of the manuscript for important intellectual content: Haque, Berrington de González, Freedman.

    Statistical analysis: Shiels, Haque, Berrington de González.

    Administrative, technical, or material support: Freedman.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work was funded by the Intramural Research Program of the National Cancer Institute.

    Role of the Funder/Sponsor: The National Cancer Institute had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation or review of the manuscript; and decision to submit the manuscript for publication. The funder did approve a final version of the manuscript before submission.

    References
    1.
    Woolf  SH, Chapman  DA, Lee  JH.  COVID-19 as the leading cause of death in the United States.   JAMA. 2021;325(2):123-124. doi:10.1001/jama.2020.24865PubMedGoogle ScholarCrossref
    2.
    Murphy  SL, Kochanek  KD, Xu  J, Arias  E.  Mortality in the United States, 2020.   NCHS Data Brief. 2021;(427):1-8.PubMedGoogle Scholar
    3.
    Ahmad  FB, Anderson  RN.  The leading causes of death in the US for 2020.   JAMA. 2021;325(18):1829-1830. doi:10.1001/jama.2021.5469PubMedGoogle ScholarCrossref
    4.
    Shiels  MS, Haque  AT, Haozous  EA,  et al.  Racial and ethnic disparities in excess deaths during the COVID-19 pandemic, March to December 2020.   Ann Intern Med. 2021;174(12):1693-1699. doi:10.7326/M21-2134PubMedGoogle ScholarCrossref
    5.
    National Center for Health Statistics. Provisional Multiple Cause of Death Data. Accessed May 5, 2022. https://wonder.cdc.gov/controller/datarequest/D176
    6.
    Truman  BI, Chang  MH, Moonesinghe  R.  Provisional COVID-19 age-adjusted death rates, by race and ethnicity - United States, 2020-2021.   MMWR Morb Mortal Wkly Rep. 2022;71(17):601-605. doi:10.15585/mmwr.mm7117e2PubMedGoogle ScholarCrossref
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