Risk of COVID-19-Related Mortality

In this section, we present data showing trends in COVID-19–related mortality: 1) in comparison to trends in reported COVID-19 cases and hospitalizations; 2) by geography, specifically, Health and Human Services (HHS) regions; and, 3) by demographic characteristics of decedents (persons who died), including by age, sex, and race and ethnicity. Mortality data presented are both from aggregated jurisdictional reporting and from provisional mortality data available from the National Center for Health Statistics. See Data Source Notes for additional information. For additional COVID-19 case, hospitalization, and mortality trend data, see COVID Data Tracker.

COVID-19–Related Deaths Substantially Decreased in the United States

To understand recent trends in COVID-19–related mortality in the United States, it is important to also examine recent trends in reported COVID-19 cases and hospitalizations. However, all COVID-19 trend data must be interpreted in the context of the changing landscape of population immunity levels due to both vaccination and prior infection, availability of effective COVID-19 treatment, testing practices, community mitigation measures, and the predominant circulating SARS-CoV-2 variants, which have exhibited variable transmissibility and severity.

Since the initial waves of COVID-19–related deaths in 2020 and early 2021, which coincided with widespread transmission of the first SARS-CoV-2 variants in the United States, two additional waves of COVID-19–related deaths have occurred, coinciding with the emergence of new genomic variants (Delta and Omicron). We refer to these two waves in this report as the Delta and early Omicron periods. At the end of 2021 and into 2022, subvariants of Omicron emerged. We refer to the three-month period following the initial (early) Omicron wave as the later Omicron subvariant period. Specifically, we present data during the Delta (B.1.617.2) variant period (>50% of sequenced isolates beginning the week ending June 26, 2021), Omicron B.1.1.529/BA.1 subvariant period or the early Omicron subvariant wave (>50% of sequenced isolates beginning the week ending December 25, 2021), and the later Omicron BA.2 subvariant period (>50% of sequenced isolates beginning the week ending March 26, 2022).⁸ In this report, we classify these three periods as: Delta (July–October 2021), early Omicron (January–March 2022), and later Omicron (April–June 2022).⁸ During July–October 2022, Omicron BA.5 was the predominant subvariant. As of early November 2022, a mix of BA.5-related subvariants that included BA.5, BF.7, BQ.1.1., and BQ.1 accounted for >50% of sequenced isolates; however, no individual subvariant was predominant. We present provisional mortality estimates for the BA.5 period and the BA.5-related subvariant period, but comparative analysis to earlier variant and subvariant periods is not provided because data were not yet available from all sources.

Compared to the large number of COVID-19–related deaths that occurred during the Delta and early Omicron periods (Figures 1 and 2), the number of COVID-19–related deaths during the later Omicron period and continuing into the BA.5 and later subvariant periods was relatively low (2,000–4,500 deaths weekly). For example, during July–August 2022, as BA.5 was increasing in predominance, an increase in reported COVID-19 cases occurred; the highest weekly number of cases in this period (923,934) was reported during the week of July 27, 2022 (Figure 1). A peak in new COVID-19 hospital admissions (7-day total: 44,574) was also reported the week of July 27, 2022 (Figure 2); subsequently, an increase in COVID-19–related deaths (3,940) occurred the week of August 31, 2022 (Figures 1 and 2).

Despite the increase in reported cases during the BA.5 period, COVID-19–related deaths did not increase proportionally when compared to earlier phases of the pandemic. For example, during the Delta period, weekly COVID-19 cases peaked at 1,181,551 for the week of September 1, 2021, which was similar to the number of COVID-19 cases reported during the BA.5 peak. The Delta period COVID-19 case peak was followed by a peak in COVID-19–related deaths (14,557) the week of September 29, 2021 with an estimated ratio of ~12 deaths per 1,000 reported cases. During the BA.5 weekly case and death peaks, this ratio decreased to ~4 deaths per 1,000 reported cases. Furthermore, the degree of overestimation in the death-to-case ratio likely increased during the BA.5 period, as higher rates of self-testing for SARS-CoV-2 infection, with subsequent reduction in the proportion of COVID-19 cases reported to public health, coincided with this peak.⁹

A similar pattern was seen between the number of new COVID-19 hospital admissions and the number of COVID-19–related deaths. Although an increase in the number of new COVID-19 hospital admissions was seen during the BA.5 period case peak, the number of COVID-19–related deaths reported following the hospitalization peak represents a smaller relative increase than observed during earlier phases of the pandemic (Figure 2). This suggests that a lower proportion of COVID-19 hospitalizations resulted in COVID-19–related deaths during April–October 2022. We examine the risk of in-hospital death in more detail in the section: COVID-19–Related In-Hospital Deaths

Excess deaths are defined as the difference between the observed numbers of deaths from all causes in a specific period compared to the expected numbers of deaths in the same period based on predictions from past years of data. Since the beginning of the pandemic, significant and sustained elevations in excess deaths have been observed across the United States. During March–September 2022, an estimated 117,173 excess deaths were reported in the United States. COVID-19–related deaths are estimated to have accounted for 57% of excess deaths during this period. Although the number of reported COVID-19–related deaths remained relatively low during April–early November 2022 as compared to previous phases of the pandemic, excess deaths continued to occur in the United States and may be attributable to the ongoing direct and indirect effects of the COVID-19 pandemic.

Lastly, while the number of COVID-19–related deaths nationally was relatively low during April 2022­–November 9, 2022, at the sub-national level, some differences from this sustained decline occurred. Specifically, increases in the number of COVID-19–related deaths in some HHS Regions were reported during July–November 2022 (Figure 3). However, the number of weekly COVID-19–related deaths in most HHS Regions remained well below the number of deaths reported during January–February 2022.

COVID-19–Related Mortality Rates Declined for Most Demographic Groups

Age

Age has been an important risk factor for COVID-19–related mortality in all phases of the pandemic, with adults aged ≥65 years consistently having the highest mortality rates. By contrast, throughout the pandemic, children aged <18 years have accounted for the lowest proportion of deaths. Although children account for ~23% of the US population, they have accounted for ~0.1% of reported COVID-19 deaths (data not shown). Additional information on COVID-19 disease among children is available here.

Trends in COVID-19-related mortality during March–September 2022, corresponding with Omicron subvariant-predominant periods, have differed by age group. Among persons aged <65 years, the lowest weekly COVID-19–related mortality rates since the beginning of the pandemic occurred from early April–late September 2022, ranging from 0.10–0.20 deaths per 100,000 population (Figure 4). Among adults aged 65–74 years and 75–84 years, the lowest weekly COVID-19–related mortality rates in this period occurred in late April with 0.78 and 2.27 deaths per 100,000 population, respectively. Rates in both age groups increased slightly from late April to mid-August before declining again. However, the COVID-19-related mortality rates in these age groups remained relatively low compared to previous phases of the pandemic. Among adults aged ≥85 years, from mid-March–mid-May 2022, weekly mortality rates decreased to <10 deaths per 100,000 population. However, from mid-May to end of July 2022, weekly COVID-19–mortality rates increased from 11.2 to 19.7 deaths per 100,000 population; rates then began to decline and by the end of September were 13.9 deaths per 100,000 population.

Adults aged ≥65 years, especially those aged ≥85 years, have accounted for a disproportionate share of COVID-19–related deaths since the beginning of the pandemic. During April–September 2022, this disparity increased for adults aged ≥85 years, compared with the Delta and early Omicron periods (Figure 5). From April 2022 to September 2022, the proportion of COVID-19–related deaths accounted for by adults aged ≥85 years increased from ~28% to ~40% of COVID-19–related deaths, despite this age group accounting for only ~2% of the U.S. population.¹⁰ In contrast, starting in January 2022, the proportion of deaths accounted for by persons aged <65 years began to decline, and while this age group comprises ~84% of the U.S. population, deaths in this age group accounted for <15% of COVID-19–related deaths during July­–September 2022.¹⁰

Sex

Throughout the pandemic, the COVID-19–related mortality rate among men has been higher than among women. Although the weekly age-standardized mortality rates for both men and women were relatively low during March–September 2022, rates among men were 1.2–1.7 times higher than among women (Figure 6). The reasons for this disparity are likely complex and include differences in health behaviors, occupational exposures, and pre-existing health conditions, among other factors.¹¹

Race/Ethnicity

Disparities in COVID-19-related mortality rates among racial and ethnic groups have occurred throughout the pandemic. Black, Hispanic/Latino, American Indian and Alaska Native, and Native Hawaiian and Pacific Islander persons have been disproportionately affected by COVID-19–related mortality compared with Non-Hispanic (NH) White persons. Different racial and ethnic groups have been most affected at different points during the pandemic (Figure 7). During the first few months of the pandemic, Black and Hispanic persons had the highest age-standardized mortality rates compared to persons of other racial and ethnic groups. During the second half of 2020 through most of 2022, American Indian and Alaska Native persons generally had the highest age-standardized mortality rates. During June–August 2022, for the first time, age-standardized mortality rates among NH White persons were higher than among all other racial and ethnic groups in some weeks.

Although disparities in COVID-19–related mortality have decreased over the course of the pandemic, differences among racial and ethnic groups persist. From January to April 2022, monthly COVID-19–related mortality rates decreased for all racial and ethnic groups among both younger persons (aged <65 years) and older adults (aged ≥65 years) (Figures 8a and Figure 8b). Among persons aged <65 years, during May–September 2022, monthly COVID-19–related mortality rates among specific racial and ethnic groups ranged from 0.2–1.6 deaths per 100,000 population, with the highest mortality rates among American Indian and Alaska Native persons (Figure 8a). Among adults aged ≥65 years, during May–September 2022, monthly COVID-19–related mortality rates among specific racial and ethnic groups ranged from 7.4–22.6 deaths per 100,000 population, with the highest mortality rates among NH White persons during May–August 2022 (Figure 8b). During September 2022, the COVID-19–related mortality rate was highest among NH American Indian and Alaska Native persons (Figure 8b). As disparities in the mortality rates among racial and ethnic groups narrow, month-to-month variation can result in different racial or ethnic groups accounting for the highest monthly mortality rate.