COVID-19 dropped to the fourth leading cause of death in 2022, down from third place in 2020 and 2021, according to provisional mortality data from the CDC.

Taking its place was “unintentional injury,” which followed heart disease and cancer as the longstanding top killers, reported Farida B. Ahmad, MPH, and colleagues in Morbidity and Mortality Weekly Report (MMWR).

Unintentional injury deaths, driven in large part by drug overdose deaths, actually dropped slightly compared with 2021, but COVID-19 deaths dropped more — by 47%. COVID-19 was listed as the underlying or contributing cause of 244,986 deaths (61.3 per 100,000) in 2022 compared with 462,193 deaths (115.6 per 100,000) in 2021.

The overall age-adjusted death rate also decreased 5.3%, from 879.7 to 832.8 per 100,000 from 2021 to 2022 (P<0.05).

The decrease in COVID-19-associated deaths came as “a welcome relief, given the overall burden of the pandemic since its global eruption in late 2019,” said David Aronoff, MD, director of the Division of Infectious Diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee, and a member of the MedPage Today editorial board.

The highest weekly numbers of overall and COVID-19-associated deaths happened in the early months of 2022; they have since fallen further in 2023.

Though Aronoff predicted that the CDC will keep providing guidance on preventing COVID-19, “cancer, heart disease, and unintentional injuries (including drug overdoses) remain major causes of illness and death, and it is likely that these will remain front and center in public health improvement strategies led by the CDC, state, and local health departments.”

Ahmad and colleagues suggested that their data “can guide public health policies and interventions aimed at reducing mortality directly or indirectly associated with the COVID-19 pandemic and among persons most affected, including persons who are older, male, or from members of certain racial and ethnic minority groups.”

Both COVID-19 and overall death rates were highest among non-Hispanic Black and non-Hispanic American Indian or Alaska Native people.

COVID-19-associated death rates were higher in males than females (76.3 vs 49.8 per 100,000), which was true for deaths overall as well. Of people who had COVID-19 on their death certificate, around 76% had it listed as the primary cause, while 5.9%, 3.9%, 1.6%, respectively, had heart disease, cancer, and chronic respiratory disease listed as the primary cause, as was detailed in a related MMWR.

In 2022, heart disease caused 699,659 deaths, cancer caused 607,790 deaths, and unintentional injury caused 218,064 deaths. The number of unintentional injuries was slightly higher in 2021, at 219,487.

Deaths from drug overdose have more than doubled since 2015, according to CDC data, and rose from 2021 to 2022. Deaths from opioids and synthetic opioids like fentanyl have increased dramatically, and hit 106,699 in 2021 — a rate of 32.4 per 100,000.

The report drew on National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS), which is based off of U.S. death certificate data. It uses provisional data, or an early estimate of deaths before a final release of data, based on the flow of death certificate data to the system. Trends in deaths throughout the year used the number of deaths each week from all causes and from COVID-19.

COVID-19-associated death rates decreased for many demographic groups in 2022, but increased for those younger than 15. They decreased in those ages 85 or older, although still remaining higher than in other age groups.

A higher proportion of COVID-19 deaths occurred at homes, nursing homes, or long-term care facilities. The proportion of inpatient hospital deaths decreased but still made up most of the COVID-19 deaths.

Limitations to the study included the use of provisional data, which are estimates. The authors also mentioned the variation in timeliness of death certificate date by jurisdiction and the potential for misclassification of some categories of race and Hispanic ethnicity reported on death certificates.

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