COVID-19 Data Review: Update on COVID-19–Related Mortality

As of November 9, 2022, 1,070,947 COVID-19-related deaths have been reported in the United States.¹ In the first two years of the pandemic, COVID-19 was identified as the third leading cause of death in the United States, trailing only heart disease and cancer.^{2, 3} Provisional mortality data indicate that, despite a lower number of COVID-19–related deaths reported to date in 2022, COVID-19 remains the third leading cause of death in the United States.³

Several factors have led to changing patterns of COVID-19 morbidity and mortality over the course of the pandemic, including the introduction and widespread availability of COVID-19 vaccines, high population prevalence of infection-induced immunity, increased availability of effective COVID-19 outpatient treatment, and changes in the SARS-CoV-2 virus itself. In this report, we provide an overview of COVID-19–related mortality in the United States as of November 9, 2022. In addition to overall trends, we present detailed analysis of recent trends during which Omicron subvariants have been the predominant circulating SARS-CoV-2 strains.

Throughout the pandemic, CDC has provided information on COVID-19–related mortality, including through data provided on COVID Data Tracker and scientific publications. This report builds on previous work and contains preliminary results, as well as pertinent data from previously published analyses, that can improve understanding of COVID-19–related deaths, drive public health action, and inform further scientific inquiry. Findings from several data sources are presented to provide a comprehensive and timely overview of COVID-19–related mortality in the United States. This report is intended for scientific and public health professionals, however, the information provided could be of use to other groups and the public. Additional information about the status of the pandemic, mortality data, guidance, and information for the general public can be accessed via https://www.cdc.gov/coronavirus/2019-ncov/index.html.

In this report, we examine trends in COVID-19–related mortality and ask the following questions:

1. Has the risk of COVID-19–related mortality changed overall and for specific demographic groups?
2. How effective are vaccines at reducing the risk of dying due to COVID-19?
3. Is COVID-19 the underlying cause of all reported COVID-19–related deaths?
4. Where do most COVID-19–related deaths occur?
5. What do we know about patients who died while hospitalized for COVID-19?
6. Are evidence-based medications that can reduce COVID-19–related mortality being used and, in which patients?

Summary

The data presented in this report show a rapid reduction in the overall U.S. COVID-19–related mortality rate in March 2022. From April through September 2022, COVID-19–related mortality rates remained relatively stable; to date, this has been the longest interval during the pandemic in which the COVID-19–related mortality rate was <22 deaths per 100,000 population for all age groups. However, during this period, 2,000–4,500 COVID-19–related deaths were reported weekly. Further, a higher number of overall (all-cause) deaths occurred compared to the number that would be expected based on previous years of data (excess deaths).

Although overall COVID-19–related mortality rates declined, adults aged ≥65 years continued to have the highest mortality rates. During April–September 2022, the proportion of COVID-19–related deaths accounted for by adults aged ≥85 years increased to ~40% despite accounting for <2% of the U.S. population. COVID-19–related deaths among children remained rare. Although racial and ethnic disparities in COVID-19–related mortality have decreased over the course of the pandemic, disparities persisted. COVID-19 vaccines continued to reduce the risk of dying from COVID-19 among all adult age groups, including adults aged ≥65 years, with the greatest protection observed among older adults who received ≥2 booster doses.

COVID-19 was reported as the underlying cause of death for most COVID-19–related deaths. However, a higher proportion of COVID-19–related deaths had COVID-19 listed as a contributing cause of death during January–September 2022 compared to previous years of the pandemic. This finding was observed among persons dying in hospitals and, to a greater extent, in non-hospital settings such as long-term care facilities and hospice facilities, where a higher proportion of COVID-19–related deaths occurred than earlier in the pandemic. The reasons for these changes are unclear but might signal that 1) people who died outside of the hospital had other health conditions where the severity of those conditions was exacerbated by having COVID-19; 2) people infected with SARS-CoV-2 might have been hospitalized for another condition, but COVID-19 contributed to their death; 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.

Risk of dying while hospitalized for COVID-19 declined steeply during March–April 2022 and remained lower through August 2022 compared to rates observed during June 2021–February 2022. Risk of in-hospital death was highest for patients hospitalized for COVID-19 with ≥5 underlying medical conditions, patients with disabilities, and patients aged ≥80 years. In-hospital death among persons aged 18–49 years hospitalized with COVID-19 during May–August 2022 was rare (1% of COVID-19–associated hospitalizations); most of these patients were unvaccinated. The proportion of patients hospitalized primarily for COVID-19 that had an indicator of severe disease (e.g., required intensive medical intervention) also declined. Less severe COVID-19 disease among hospitalized patients could contribute to the lower rate of in-hospital deaths observed. Decreased use of intensive medical interventions among patients who died in-hospital with COVID-19 could also reflect the increased occurrence of deaths among older people with multiple comorbidities who might not have tolerated or benefited from such interventions or, who did not agree to intensive medical intervention.

Early treatment with COVID-19 medication can reduce the risk of COVID-19–related hospitalization and mortality among patients at risk for severe COVID-19.^4-7 Use of outpatient COVID-19 treatment increased in 2022, particularly during April–July 2022 when nirmatrelvir/ritonavir (Paxlovid), an oral antiviral medication, became widely available. During this period, Paxlovid was the most commonly used outpatient COVID-19 medication among all age groups, with some differences in use by patient age, race and ethnicity, and type of immunocompromising condition.

Report Limitations

Data in this report are provided from multiple data sources to understand recent mortality trends. Variation across data sources in the time ranges presented are due to differences in data availability and reporting frequency, with the most recently available data ranging from June 2022 to November 2022 (see Data Source Notes for additional information). Due to differences in data collection methods, patient populations covered, variation in the hospitals and/or jurisdictions included in data systems, completeness of reporting, and availability of demographic or geographic information, all reported results may not be generalizable to the entire U.S. population. Additionally, there is variation in how event-based data are organized by date (e.g., event date compared to report date) across data sources. Most analyses include only descriptive results and do not control for confounding nor statistically assess trends or associations. Therefore, comparisons across populations, time, and data sets should be interpreted with caution.

Top Takeaway Messages

1. There were signs of improvement

• COVID-19–related deaths substantially decreased in the United States in March 2022. During April–early November 2022, this initial decline was largely sustained and the overall number of COVID-19–related deaths remained relatively stable.
• From January to April 2022, age-standardized COVID-19–related mortality rates decreased for all racial and ethnic groups.
• The risk of in-hospital death for patients hospitalized with COVID-19 declined among all adult age groups. During March–August 2022, risk of in-hospital death was lower than during June 2021–February 2022.
• Use of outpatient COVID-19 treatments that decrease risk for hospitalization and death increased from January to July 2022.

2. Vaccines continued to be effective in reducing COVID-19–related mortality

• COVID-19 vaccines continued to reduce the risk of dying among all age groups, including older adults, with the most protection observed among people who have received ≥2 booster doses.

3. Where and how COVID-19–related deaths occur appeared to be changing

• Although the highest proportion of COVID-19–related deaths occurred in hospitals during January–September 2022, an increased proportion of COVID-19–related deaths were reported in other settings such as homes, long-term care facilities and hospice facilities than in prior years of the pandemic.
• COVID-19 was listed as the underlying cause for most COVID-19–related deaths. However, during January–September 2022, COVID-19 was identified as a contributing cause of death rather than the underlying cause for a higher proportion of COVID-19–related deaths than in prior years of the pandemic.

4. Improvement is needed to decrease risk for COVID-19–related mortality

• During April–September 2022, 2,000–4,500 COVID-19–related deaths were reported weekly and, a higher number of all-cause deaths occurred in the United States compared to what was expected based on previous years of data (excess deaths).
• Adults aged ≥65 years continued to have the highest COVID-19–related mortality rates. Adults aged ≥85 years remained at particularly high risk of dying, with the proportion of COVID-19–related deaths accounted for by adults in this age group increasing during April–September 2022 from ~28% to ~40% of COVID-19–related deaths.
• Older adults, people with disabilities, and those with underlying medical conditions continued to account for the highest proportion of COVID-19–related in-hospital deaths.
• COVID-19–related deaths were rare among younger adults aged 18–49 years hospitalized during May–August 2022, but those that did occur were most often among unvaccinated persons.
• Disparities persisted. Although racial and ethnic disparities in COVID-19–related mortality have decreased over the course of the pandemic, disparities continued to exist in both COVID-19 treatment and mortality.