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Settings of COVID-19–Related Deaths

Updated Nov. 16, 2022

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In this section, we present data showing that an increasing proportion of COVID-19–related deaths in 2022 were reported from non-hospital settings. In both hospital and non-hospital settings, COVID-19 is less frequently reported as the underlying (primary) cause of death, compared to earlier in the pandemic. This topic is discussed in more detail in the section: COVID-19 as the Underlying or Contributing Cause of Death. Mortality data presented are from the National Center for Health Statistics. See Data Source Notes for additional information.

Shift from In-Hospital Deaths to COVID-19–Related Deaths in Other Settings

Adults ≥65 years have accounted for ~75% of all COVID-19–related deaths.¹⁷ During March 2020–December 2021, the majority (57–78%) of COVID-19–related deaths in this age group occurred in the hospital (Figure 12). From January to April 2022, an increasing proportion of COVID-19–related deaths among adults aged ≥65 years occurred in other settings such as nursing homes, the decedent’s home, and hospice facilities. And, in each month during April–September 2022, inpatient deaths have accounted for less than 50% of COVID-19–related deaths among adults ≥65 years.

The reasons for the increased proportion of COVID-19–related deaths reported from non-hospital settings are likely multifactorial and might include: 1) Less severe COVID-19 disease occurring among hospitalized patients during the later Omicron period (this topic is covered in more detail in the section: Indicators of Disease Severity Among Hospitalized Patients with In-Hospital Death Declined) potentially contributing to the lower proportion of in-hospital deaths observed in 2022; 2) the increased proportion of COVID-19–related deaths accounted for by older persons with multiple comorbidities, who might not have tolerated or benefited from hospital-based interventions or who decided to forego additional medical care, and were either not hospitalized or were discharged to receive palliative care elsewhere; this hypothesis is supported by the increased proportion of deaths reported from hospice facilities (Figure 12); or 3) that people who survived infection with SARS-CoV-2 continued to suffer COVID-19–related long-term health effects that contributed to their death.

Although additional analyses are needed to understand this change in the location of COVID-19–related deaths, the increased proportion of COVID-19–related deaths that occurred in nursing homes and long-term care facilities does not reflect an increase in the total number of COVID-19–related deaths reported from these facilities.

Figure 12. Provisional COVID-19–Related Deaths among Persons Aged ≥65 Years by Month and Place of Death,* United States, January 2021–September 2022

*Place of death noted on the death certificate is determined by where the death was pronounced and on the physical location where the death occurred. Healthcare settings includes hospitals, clinics, medical facilities, or other licensed institutions providing diagnostic and therapeutic services by medical staff. Healthcare settings are separated into two categories: inpatient and outpatient/emergency room which includes all other healthcare settings. Decedent’s home includes independent living units such as private homes, apartments, bungalows, and cottages. Hospice facility refers to a licensed institution providing hospice care (e.g., palliative and supportive care for the dying), but not to hospice care that might be provided in other settings, such as a patient’s home. Nursing home/long-term care facility refers to a facility that is not a hospital but provides patient care beyond custodial care, such as a nursing home, skilled nursing facility, a long-term care facility, convalescent care facility, intermediate care facility, or residential care facility.

Abbreviations: ER=Emergency Room; LTC=Long-term Care Facility

Source: National Center for Health Statistics. National Vital Statistics System. Provisional COVID-19 Deaths by Place of Death and Age. Date accessed 10/26/2022. Available from https://data.cdc.gov/dataset/4va6-ph5s

Data for 2020 are final; data for 2021 and 2022 are provisional. These data include deaths that occurred within the 50 U.S. states and the District of Columbia. Deaths with confirmed or presumed COVID-19 as an underlying or contributing cause of death, with International Classification of Diseases, Tenth Revision code U07.1. For additional information, see: https://www.cdc.gov/nchs/nvss/vsrr/covid19/tech_notes.htm

While most COVID-19–related hospital inpatient deaths continue to have COVID-19 listed as the underlying cause of death, this proportion declined from 96% in 2020 to 88% during January–September 2022. (Table 2). An even larger shift in the reported cause of COVID-19–related deaths occurred in non-hospital settings such as long-term care facilities and the decedent’s home. The proportion of out-of-hospital deaths with COVID-19 listed as the underlying cause of death decreased from 91% in 2020 to 62% during January–September 2022.

Table 2. Provisional COVID-19–Related Deaths with COVID-19 Reported as the Underlying Cause of Death by Year and Place of Death*, United States, January 2020–September 2022

Table 2. Underlying Cause of Death Reported by Place of Death, United States, 2020–2022
Year	Hospital	Non-Hospital Location
2020	92%	91%
2021	96%	83%
2022^†	88%	62%

†Includes data for January–September 2022

Source: National Center for Health Statistics. National Vital Statistics System.

Data for 2020 are final; data for 2021 and 2022 are provisional. These data include deaths that occurred within the 50 U.S. states and the District of Columbia. Deaths with confirmed or presumed COVID-19 as an underlying or contributing cause of death, with International Classification of Diseases, Tenth Revision code U07.1. For additional information on certifying deaths due to COVID-19, see: https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf and for place of death coding see: https://www.cdc.gov/nchs/nvss/vsrr/covid19/tech_notes.htm