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Disclosures: The authors report no relevant financial disclosures.
March 31, 2021
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COVID-19 third leading cause of death in 2020, CDC says

Disclosures: The authors report no relevant financial disclosures.
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COVID-19 accounted for an estimated 11.3% of the deaths that occurred in the U.S. in 2020, making it the third leading cause of death after heart disease and cancer, according to provisional data published in MMWR.

Farida B. Ahmad, MPH, a researcher in the CDC’s National Center for Health Statistics, and colleagues reported that certain populations had higher overall death rates due to COVID-19, including adults aged at least 85 years (1,797.8 deaths per 100,000 population), as well as a higher age-adjusted death rate for men compared with women (115 vs. 72.5 deaths per 100,000 population). Deaths associated with COVID-19 also varied by race and ethnicity: the highest death rates occurred in Native American and Native Alaskan populations (187.8 deaths per 100,000 population) and Hispanic populations (164.3 deaths per 100,000 per population).

Source: CDC
Source: CDC

Overall, the age-adjusted death rate in the country increased by 15.9% in 2020 vs. 2019, representing the first increase since 2017, according to the CDC. The report showed that COVID-19 was the underlying or contributing cause of death for 345,323 people in 2020.

In another report that evaluated death certificates from 2020, data showed that 378,048 death certificates that were reported to the CDC by Feb. 22, 2021, listed the ICD-10 code for COVID-19.

Concerns have previously been raised about whether some deaths were being misclassified as COVID-19, but the CDC’s assessment of the data does not support these concerns, according to Adi V. Gundlapalli, MD, PhD, chief public health informatics officer for the Center for Surveillance, Epidemiology and Laboratory Services and member of the CDC COVID-19 response team, and colleagues.

Among the death certificates that included the COVID-19 code, 357,133 (94.5%) listed at least one other ICD-10 code. Of that, 97.3% had “a co-occurring diagnosis that was a plausible chain-of-event condition (eg, pneumonia or respiratory failure), a significant contributing condition (eg, hypertension or diabetes), or both,” Gundlapalli and colleagues wrote in the report.

The data showed that 330,198 death certificates listed COVID-19 in Part I of the ICD-10 diagnosis code. Of these, the most frequent chain-of-event diagnoses were pneumonia (45%) and acute respiratory failure (20%), and the most frequent significant contributing conditions were essential hypertension (18%) and diabetes (10%). Gundlapalli and colleagues wrote that these conditions “were consistent with those reported in clinical and epidemiologic studies to occur among patients with severe COVID-19-associated outcomes.”

For the remaining 5.5% of death certificates that listed COVID-19 without any other conditions, the report said “attributability of death to COVID-19 could not be evaluated ... and represents an opportunity for improvement in documentation.”

“These findings support the accuracy of COVID-19 mortality surveillance in the United States using official death certificates,” the researchers wrote.

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