COVID-19 as the Underlying or Contributing Cause of Death

In this section, we present data showing that the majority of COVID-19–related deaths continue to have COVID-19 reported as the underlying cause of death. However, during 2022, the proportion of COVID-19–related deaths with COVID-19 reported as a contributing cause of death rather than the underlying cause of death increased. Note that guidance for certifying deaths due to COVID-19 has remained consistent throughout the pandemic. Mortality data presented are from the National Center for Health Statistics. See Data Source Notes for additional information.

Shift from COVID-19 as the Underlying Cause to a Contributing Cause of Death

Although most COVID-19–related deaths continue to have COVID-19 reported as the underlying (primary) cause of death, COVID-19 is increasingly cited on death certificates as a contributing cause of death rather than the underlying cause. This means that another health condition was identified as the underlying cause of death, with COVID-19 identified as contributing to the death. It is important to note that, when a condition is identified as a contributing cause of death, the cause of death certifier believed that the condition was significant enough to contribute to the fatal outcome and was not an incidental finding. For instance, COVID-19 could be listed as a contributing cause of death in cases when COVID-19 puts too much stress on a person’s already weakened heart, and the underlying cause of death is listed as acute ischemic heart disease.

In January 2022, the proportion of deaths with COVID-19 as the underlying cause of death was ~85%. By April 2022, it had declined to 60–70% and stayed at that level through September 2022. This trend was seen among both younger (aged <65 years) and older adults (aged ≥65 years) (Figure 11). During January–September 2022, 80% of COVID-19–related deaths among persons aged <65 years had COVID-19 reported as the underlying cause compared to 92% of COVID-19–related deaths in 2020; among adults aged ≥65 years this proportion decreased from 91% in 2020 to 77% in during January–September 2022 (Table 1).