Understand how we got here — and how to move forward.


April 1, 2021

Deaths in America climbed by 18% in 2020—and Covid-19 wasn't the only cause

Daily Briefing

    Covid-19 ranked as the third leading cause of death in the United States in 2020, according to provisional mortality data published Wednesday in three separate reports by CDC researchers.

    Good? Bad? Ugly? We've updated our take on what's next for the epidemic.

    Covid-19 drove an increase in total deaths in 2020

    The three reports—one published in CDC's Morbidity and Mortality Weekly Report (MMWR), a second also published in MMWR, and third published as viewpoint published in JAMA—are based on provisional mortality data for 2020. The first report provided a breakdown of the provisional mortality data, the second report examined the data to assess the accuracy of Covid-19 mortality data, and the third report examined mortality trends in the context of the pandemic.

    Overall, the researchers found an estimated 3,358,814 deaths occurred in the United States in 2020—up by 17.7% from 2,854,838 deaths in 2019. The researchers also found the estimated age-adjusted death rate increased by 15.9% from 715.2 per 100,000 population in 2019 to 828.7 deaths per 100,000 population in 2020.

    The researchers found Covid-19 was the primary factor driving the increase in total deaths from 2019 to 2020—with the disease accounting for an estimated 11.3% of total deaths (as either the underlying or contributing cause of death) and ranking as the third leading cause of death in 2020.

    However, the researchers also found substantial increases in the numbers of deaths attributed to other leading causes of death. For example, deaths from heart disease—which ranked as the leading cause of death in the United States in 2020—increased by 4.8% from 659,041 in 2019 to 690,882 in 2020, marking the largest increase in heart disease deaths since 2012. Similarly, the researchers found deaths increased by 15.4% for diabetes, 11.1% for unintentional injury, and 9.8% for Alzheimer's disease.

    "During the Covid-19 pandemic, changes in leading causes provide insight into the direct and indirect effects of the pandemic on mortality burden," the researchers wrote in the JAMA viewpoint. For example, the researchers said increases among other leading causes of death may "reflect disruptions in health care that hampered early detection and disease management" or "indicate, to some extent, underreporting of Covid-19" deaths as a result of "limited testing in the beginning of the pandemic."

    Robert Anderson—chief of the mortality statistics branch at CDC's National Center for Health Statistics and a senior author on the viewpoint and one of the MMWR reports—said, "Since the beginning of the pandemic, people were claiming deaths were simply being attributed to [Covid-19] when people were dying of other causes," but CDC's findings "show that's not the case."

    CDC Director Rochelle Walensky said, "The data should serve again as a catalyst for each of us to continue to do our part to drive down cases and reduce the spread of COVID-19 and get people vaccinated as quickly as possible."

    Where America's coronavirus epidemic stands

    The findings come as recent data indicates the number of coronavirus cases is climbing once again—and the United States could be on the verge of a fourth surge in coronavirus cases. Experts have said the recent uptick in coronavirus cases likely stems from two key factors: states easing coronavirus-related restrictions, and the spread of more transmissible coronavirus variants.

    According to data compiled by the Times, the United States' average daily number of newly reported coronavirus cases over the past week was 64,396—up by 17% compared with the average from two weeks ago.

    The Times' data showed that, as of Thursday morning, the rates of newly reported coronavirus cases were "staying high" in Washington, D.C and 27 states that have reported a daily average of at least 15 newly reported cases per 100,000 people over the past week. Those states are Alaska, Colorado, Connecticut, Delaware, Florida, Idaho, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Pennsylvania, Rhode Island, South Carolina, South Dakota, Vermont, Virginia, and West Virginia.

    In addition, the rate of newly reported coronavirus cases was "going up" as of Thursday morning in Hawaii, Indiana, Oregon, Puerto Rico, U.S. Virgin Islands, and Washington, which have had comparatively lower case rates, the Times reports.

    Although the United States may be on the brink of a fourth surge, experts have said they expect any fourth wave to be less deadly than previous ones because 73% of seniors in the United States have received at least one dose of a Covid-19 vaccine, Axios' "Vitals" reports.

    Even as cases are increasing, data shows new hospitalizations and deaths are continuing to decline. According to the Times' data, 40,709 Americans with Covid-19 were hospitalized on Wednesday—down by 2% from the average from two weeks ago. Further, 1,138 new deaths were linked to the coronavirus on Wednesday, down 26% from the average two weeks ago.

    (Rabin, New York Times, 3/31; Johnson, Associated Press, 3/31; Treisman, NPR, 3/31; CDC's MMWR, 3/31 [1]; CDC's MMWR, 3/31 [2]; Ahmad/Anderson, JAMA, 3/31; Wilson, The Hill, 3/30; Tufekci, The Atlantic, 3/30; Owens, "Vitals," Axios, 4/1; New York Times, 4/1).

    'Stay Up to Date' with the latest vaccine news and more

    Join Ford Koles and Christopher Kerns for a weekly update on the biggest challenges facing health care leaders.

    Register now

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.