COVID Drops to Tenth Leading Cause of Death in the U.S.

After years of being in the top five leading causes of death in the U.S., COVID-19 dropped to tenth in 2023, according to provisional data.

While more than 3 million people died in the U.S. in 2023, the mortality rate was 6.1% lower than in 2022 and it was 68.9% lower for COVID-19 deaths, reported Farida Ahmad, MPH, of the CDC’s Division of Vital Statistics at the National Center for Health Statistics in Hyattsville, Maryland, and colleagues in Morbidity and Mortality Weekly Report (MMWR).

“That’s a pretty dramatic change,” Ahmad told MedPage Today, adding that while provisional, this is the first comprehensive look at the 2023 data. Ahmad cautioned that “it’s not game-over for COVID” and that healthcare professionals still need to pay close attention to it.

In a related JAMA viewpoint, the authors noted that COVID-19 peaked in 2020 and 2021 as the third highest cause of mortality, fell to fourth in 2022, and dropped to tenth in 2023. Per 100,000 people, COVID-19 was the cause of death for 85 in 2020 (350,831 total), 104.1 in 2021 (416,893 total), 44.5 in 2022 (186,552 total), and 11.9 in 2023 (49,928 total).

In 2022, COVID-19 was the underlying cause of death for 5.7% of all deaths and dropped to just 1.6% in 2023, and people older than 85 still had higher rates of COVID-19 mortality than other groups, the researchers reported.

“It’s good news to see that COVID has dropped to tenth place … but we should remember that it is still one of the leading causes,” Ahmad said, noting that the leading causes of death “are generally pretty stable.”

The top 10 leading causes of mortality for 2023 were heart disease, cancer, unintentional injuries, stroke, chronic lower respiratory diseases, Alzheimer’s disease, diabetes, kidney disease, chronic liver disease and cirrhosis, and COVID-19; suicide and influenza and pneumonia were inched out of the top 10.

Heart disease and cancer have steadily been the top two leading causes of death, the researchers wrote. In the past 5 years, heart disease has been the underlying cause of death for between 161.5 and 173.8 people per 100,000. For cancer, the range has been between 141.8 and 146.6 per 100,000.

Ahmad noted there was an increase in alcohol and drug use during the pandemic, and chronic liver disease and cirrhosis, which are associated with excessive alcohol consumption, are still ranking in the top 10 while other causes are shifting back to pre-pandemic levels.

Unintentional injuries, which includes drug overdoses, dipped in rank during the pandemic but still increased in sheer amount. This category returned to its pre-pandemic slot of third.

Becky Smullin Dawson, PhD, MPH, of Allegheny College in Meadville, Pennsylvania, also pointed out the pervasiveness of unintentional injuries, which she noted is “a way of saying without saying a lot of people are dying of drug overdoses.”

Dawson also told MedPage Today that the provisional data show that “the pandemic effect on mortality appears to be over” and that the decrease in COVID-19 deaths is “a testament to the development of vaccines and treatments that effectively prevent and treat severe illness.”

The National Center for Health Statistics National Vital Statistics System tracks death certificate data from all 50 states plus the District of Columbia, including cause of death, which is marked with ICD-10 codes. Cause of death is determined by the underlying cause of death, defined as the “disease or condition responsible for initiating the chain of events leading to death.”

As for limitations, the authors noted the provisional nature of the data, that the timeliness of death certificate data can vary by jurisdiction, and the potential for misclassification of race.

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