The spread of COVID-19 has been slowing, but the virus still remained one of the leading causes of death for Americans in 2022, falling from third place to fourth place last year.
Among nearly 3.3 million fatalities reported to the Centers for Disease Control and Prevention's National Center for Health Statistics in 2022, COVID-19 was the underlying cause listed on 186,702 death certificates, substantially down from 416,893 in 2021.
That means the virus now ranks behind heart disease, cancer, and unintentional injuries — a category largely driven by drug overdoses — which each caused the loss of more lives last year.
"COVID-19, the third leading cause of death in 2021, fell to fourth place in 2022 because of the large decrease in COVID-19–associated deaths compared with those in 2021," NCHS authors wrote in an analysis of the agency's provisional mortality data published Thursday.
The disease's ranking is a change from earlier predictions by the agency and outside experts, which had forecast that COVID-19 could be on track to remain the third leading cause of death, based on incomplete data from earlier in 2022.
"If it was a really bad, huge surge, maybe there would have been a change. But COVID deaths, after last February or March, really kind of changed. And a lot of the characteristics of those deaths changed," said Farida Ahmad, the mortality surveillance lead for NCHS and an author of the report.
Ahmad said the figures remain a preliminary estimate. NCHS typically publishes a report each December examining the official final mortality counts from the prior year.
However, those generally only see small changes from their earlier provisional figures. Ahmad said only a few causes – like unintentional injuries – typically see bigger increases after states finish sending in their final death certificates.
"Unintentional injuries, that can include suicides or homicides, but mainly drug overdose deaths, those often take longer to complete," Ahmad said.
Who is dying from COVID-19
The COVID-19 death rate ultimately declined in 2022 for all racial and ethnic groups compared to 2021, as well as for all age groups except children under 15 years old.
However, disparities persisted in COVID-19's toll last year.
The death rate from the virus remained the worst last year among people who are Black or are American Indian or Alaska Native. Death rates continue to be lowest among Americans ages 5 through 14 years old and highest among seniors ages 85 and older.
The COVID-19 death rate also continues to be worse among men compared to women.
Where COVID-19 deaths are
A separate report published Thursday by the agency found age-adjusted death rates from the virus remain highest in the south central United States, across the region encompassing Arkansas, Louisiana, New Mexico, Oklahoma, and Texas. Deaths were still lowest in the region spanning New England.
Around 6 in 10 deaths from COVID-19 last year were in hospital beds, down from close to 7 in 10 during the first two years of the pandemic. Instead, a larger percentage of deaths happened either at home or in long-term care facilities.
That is consistent with a shift observed in March last year among seniors, which authorities theorized could be driven by less severe disease in hospitals or more foregoing hospital care.
Other causes of death
Heart disease remains the leading cause of death in the U.S. at 699,659 lives claimed last year. Cancer was the next highest, causing 607,790 deaths.
Age-adjusted death rates from both have continued to worsen for a third straight year, a turnaround since the pandemic began that warrants "further analysis" the NCHS authors said.
There were another 218,064 deaths blamed on "unintentional injury" tallied last year, "largely driven by a high number of drug overdose deaths."
Overdose deaths remain substantially worse than pre-pandemic tallies in other preliminary estimates published by NCHS, though steep accelerations seen during the first two years of the COVID-19 pandemic now appear to have begun to plateau.
COVID-19's toll increases to 244,986 when including fatalities where doctors or coroners also listed it as a "contributing cause of death" or "part of the chain of events leading to death."
In those cases, heart disease and cancer were the most frequent "underlying" causes, meaning the disease or injury that had "initiated the chain of morbid events leading directly to death." Other causes range from unintentional injuries to Alzheimer's or kidney disease.
"If you're, say, already trying to recover from an accident, or your body's already dealing with a severe condition, and then you add COVID on top of that, that can make it that much harder for you to recover from what you were trying to recover from," said Ahmad.
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