COVID-19 Third Leading Cause of Death in America in 2020 and 2021, Shows New Analysis

An analysis of US death certificate data found that COVID-19 was a top 5 cause of death in every age group aged 15 years and older.

COVID-19 was the third leading cause of death in the US between March 2020 and October 2021, accounting for 350 000 deaths, according to an analysis of national death certificate data by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health.

Researchers led by Meredith S. Shiels, PhD, MHS, a senior investigator for the NCI’s Division of Cancer Epidemiology and Genetics, examined final national death certificate data for 2020 and provisional data for 2021 from the Centers for Disease Control and Prevention. During the 20-month period studied, they found that COVID-19 was a top 5 cause of death in every age group aged ≥15 years.

The 5 leading causes of death between March 2020 and October 2021 were cardiovascular disease (CVD) (20.1%), followed by cancer (17.5%), COVID-19 (12.2%), accidents (6.2%), and stroke (4.7%), according to study authors.

When investigators analyzed deaths in 2020 (March-December) and in 2021 (January-October) separately, they observed that in 2020, COVID-19 was the fourth and fifth leading cause of death among individuals aged 45–54 years and 35–44 years, respectively. However, COVID-19 became the first and second leading cause of death in these age groups in 2021, according to the study published in JAMA Internal Medicine.

Among persons aged ≥85 years, COVID-19 was ranked as the second leading cause of death in 2020 (12.8%) but dropped to third in 2021 (8.9%), “perhaps driven by higher COVID-19 vaccination rates in 2021 in the oldest age groups,” wrote Shiels and colleagues.

The data also showed that the pandemic had indirect effects on other causes of death in the US. From 2019 to 2020, death rates increased for CVD, accidents, stroke, Alzheimer disease, and diabetes. “Potential explanations are fear of accessing health care or misattribution of COVID-19 deaths to other causes,” stated Shiels et al.

More insight into the pandemic’s impact on other causes of death may emerge in years to come, noted researchers. For example, the pandemic may have prevented many Americans from getting regular cancer screening, which may result in future increases in cancer-related 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,” concluded investigators. “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.”


Reference: Shiels MS, Haque AT, Berrington de González A, Freedman ND. Leading causes of death in the US during the COVID-19 pandemic, March 2020 to October 2021. JAMA Intern Med. Published online ahead of print July 5, 2022. DOI: 10.1001/jamainternmed.2022.2476.