Weekend Long Reads: The Leading Causes of Death in 2020

by Kevin Schofield

Now that we're a few months into 2021, the final statistics on the dumpster fire that was 2020 are now trickling out. This week's long read — admittedly not a very long one but an important one for us to reflect on — is a look at the leading causes of death last year.

You may be surprised to learn that COVID-19 was only #3 on the list — and a distant third at that. That said, the COVID pandemic still had an obvious and outsized impact on nearly every aspect of the mortality figures.

Overall, the number of deaths that occurred in the U.S. climbed by 17.7% last year, to 3,358,814. That's a huge spike compared to the prior several years where the figures were in the 2.7 to 2.8 million range, slowly inching up with the overall population.

As you can see in this graph from the report, the usual seasonality of deaths (slightly higher in the winter months) was completely eclipsed by the three COVID spikes, starting in March.

As in past years, the leading cause of death in the United States last year was heart disease. That too increased sharply, by 4.8%, to about 690,000 — twice the number of COVID deaths (345,000). The second leading cause continued to be cancer, at just under 600,000. Several other categories saw big jumps, including Alzheimer's disease, stroke, and diabetes. Experts suggest that these most likely represent under-reporting of COVID cases, especially in the early days of the pandemic before testing became more widespread. Now they have all been identified as "co-morbidities," i.e., diseases that increase one's risk of serious complications or death from contracting COVID-19. However, the increases in deaths from these other diseases could also partly reflect the disruptions in healthcare services that occurred last year, which otherwise might have been able to detect, diagnose, and treat many of those cases and would have saved lives.

Deaths due to "unintentional injuries" also climbed last year, though tragically according to the report the increase is in large part due to drug overdoses.

Influenza deaths also increased last year, though again that could easily be misreported COVID cases. Influenza is very seasonal, and the 2020 flu season was wrapping up just as COVID was coming in last spring, so this result isn't that surprising. Experts predict this year's flu numbers to look very different, though, with the push for more people to get flu shots last fall and the extra precautions we are all taking to prevent the spread of COVID.

The mortality figures for 2020 are one more sign of all the ways that COVID-19 impacted our lives last year. They remind us of the mistakes we made in handling the pandemic that cost too many lives; but they equally remind us of the other public health emergencies that we are largely choosing to ignore, including heart disease, cancer, drug overdoses, Alzheimer's disease, and diabetes. Cutting the heart disease mortality rate in half — something that is entirely within our ability to achieve — would save as many lives as we lost to COVID last year.

The Leading Causes of Death in the US for 2020

Featured image: detail of table via report "The Leading Causes of Death in the US for 2020" atJAMA.