Covid slips to 4th on list of U.S. causes of death

A ventilator is shown next to a hospital's intensive care bed set up for covid-19 patients in this Aug. 17, 2021, file photo. (AP/Rogelio V. Solis)

Covid-19 was the fourth leading cause of death in the United States last year, dropping from its place as the third leading cause in 2020 and 2021, when virus fatalities were superseded only by heart disease and cancer, the National Center for Health Statistics reported Thursday.

The data released by the center reported an overall drop of 5.3% in the death rate from all causes, a signal that the country last year had exited the worst phase of the pandemic. Deaths from covid dropped 47% between 2021 and 2022.

Unintentional injuries -- a category that includes drug overdoses and car crashes -- were responsible for more deaths than covid last year and were the nation's third leading cause of death. Deaths from heart disease and cancer both rose in 2022, compared with 2021.

Even though the population had built up high levels of immunity from vaccination and natural infection, covid was the fourth leading cause of death in 2022, behind heart disease (699,659 deaths), cancer (607,790) and "unintentional injury" (218,064). The CDC estimated that covid was the underlying cause of 186,702 deaths and a contributing factor in another 58,284.

A large proportion of covid deaths occurred during the first months of 2022.

Covid "has not gone away," William Schaffner, an infectious-disease doctor at Vanderbilt University School of Medicine, said in an email after reviewing the report. "It continues to smolder in our communities, picking off the most fragile among us, just as lions in Africa strike the older and slower antelopes."

This was the third straight year the age-adjusted death rate from heart disease has risen, and the second straight year for cancer deaths. The death rate from all causes in the United States in 2022 was almost as high as the rate in 2020, and much higher than in 2019.

Some of the increase in heart disease and cancer deaths may be an effect of the pandemic. For example, cancer screenings declined as many people chose to postpone medical visits. Heart disease may have also been exacerbated by inflammation related to covid.

But there has been a well-documented erosion of health in the country for working-age people, a trend that predated the pandemic. Life expectancy historically has improved along with improvements in infant and maternal mortality rates, as well as better public health measures, including vaccinations, that limit the ravages from infectious diseases. But the gains in U.S. life expectancy plateaued after 2010, and it declined for several years mid-decade before ticking up slightly just before the coronavirus appeared.

Against that recent history of poor health trends, the new CDC data is not encouraging.

"The increase should raise concerns that our recent history of substantial progress against heart disease has stalled, and even reversed," Harlan Krumholz, a cardiologist at the Yale School of Medicine, said in an email after reviewing the CDC report.

"The findings are even more impressive since the nation has lost many older people who were most vulnerable to heart disease through the course of the pandemic. This may represent further evidence that the health of Americans continues to decline despite the enormous sum we spend on health care."


Altogether, the virus played some role in about a quarter-million deaths last year, a 47% decrease from the 462,193 covid-related deaths in 2021.

The covid death rate fell by almost half last year, as the age-adjusted figure dropped to 61.3 deaths per 100,000 persons from 115.6 per 100,000 persons in 2021. The data is proof that the pandemic's toll eased considerably as 2022 wore on.

But the report's authors noted that even now, covid is killing Americans in large numbers.

"The death rate went down by a lot, but we also want to emphasize we're not out of the woods here," said Dr. Robert Anderson, chief of the mortality statistics branch at the National Center for Health Statistics. "There are still a lot of people who died, and we're still seeing deaths in 2023 as well."

Nearly 35,000 people have died of covid so far this year, he added. The number of total deaths in the United States is still higher than it was before the pandemic, which was 2.9 million, suggesting that covid has had a broader effect on death rates generally. The outbreak led some people to defer health care, for example, and exacerbated other illnesses they might have had.

"We would expect some increase in the number of deaths because the population is aging, but this is far and above what we would have expected without the pandemic," Anderson said.

Men, adults age 85 or older, and Native American or Alaska Native people were much more likely than other Americans to have died of covid last year. By contrast, Asian Americans and children ages 5 to 14 had the lowest death rates.

Black Americans and Native American or Alaska Native people had the highest age-adjusted death rates from all causes. Death rates were lowest for multiracial and Asian individuals.

Compared with the early days of the pandemic, covid was less likely to be lethal last year. It accounted for 76% of cases where it was listed on death certificates, compared with 90% during the first two years of the pandemic.

The number of deaths caused by covid is expected to continue to decline this year, but it still could exceed 100,000, Anderson said: "It looks like the number will continue to decline, but it is still not trivial."

Information for this article was contributed by Roni Caryn Rabin of The New York Times and by Joel Achenbach of The Washington Post.