While SARS-CoV-2 infections continue to influence trends in U.S. death rates, COVID-19 is no longer among the nation’s top three killers. The tragic trio are heart disease, cancer and unintentional injury, showing substantial room for America’s physicians to play a role in preventing disease and saving lives.
Provisional 2023 data on the leading mortality causes “indicate a shift in the top causes of death, driven largely by a decrease in COVID-19 deaths,” says a JAMA® Viewpoint essay written by officials from the Centers for Disease Control and Prevention’s National Center for Health Statistics. The article summarizes an agency report on the leading causes of death from 2019 to 2023.
More than 3 million people died in the U.S. last year. From 2022 to 2023, the overall age-adjusted death rate declined by 6.1%, according to the agency’s data. Heart disease, cancer and unintentional injury were the top three leading causes of death. Meanwhile, COVID-19 deaths fell by 69% from 2022, ranking as the 10th leading cause of death in 2023.
This is a big shift from 2020, when COVID-19 was the third leading cause of death, trailing only heart disease and cancer.
COVID-19 “shook things up”
Based on the latest provisional data, “it’s very clear that the pandemic really shook things up. It introduced an entirely new category of cause of death that we didn't have before. And it continues to be in the top 10 causes of death,” said Kate Kirley, MD, MS, a family physician and the AMA’s director of chronic disease prevention.
Vaccines and treatments for COVID-19 as well as other public health interventions to prevent transmission have helped reduce deaths from SARS-CoV-2 infection. The reduction in deaths also reflects how the virus has evolved over time, said Dr. Kirley.
BP control crucial to reducing deaths
“In comparison with prepandemic rates from 2019, other causes of death have seen changes in recent years as well,” says the JAMA Viewpoint. For example, heart disease rates rose 0.4% from 2019 to 2023, exhibiting sharper increases during the height of the COVID-19 public health emergency.
Heart disease has been the leading cause of death over the last century, said Neha Sachdev, MD, MS, a family physician and director of clinical engagement and equitable care at the AMA. Cardiovascular disease claims more than 900,000 lives annually in the U.S., according to American Heart Association estimates.
“It’s so important for physicians and care teams to talk with patients about their risk of cardiovascular disease and support patients in taking action to improve their health,” said Dr. Sachdev.
“Physicians should ensure that patients with high blood pressure or high cholesterol get diagnosed and treated,” Dr. Kirley emphasized, adding that physicians should also “help patients adhere to treatment and make changes to improve nutrition or increase physical activity, if necessary.”
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Diabetes death rates on the rise
In other findings highlighted in JAMA, stroke and diabetes ranked as 4th and 7th leading causes of death in 2023, respectively, although deaths from diabetes have risen in number and rate since 2019.
“We continue to see an increase in deaths because we continue to see an increase in the rate of diabetes, the rate of prediabetes,” said Dr. Kirley.
New and improved treatments for diabetes have the potential to turn those statistics around, although many are newer to the market and haven’t been widely accessible until relatively recently.
The Medicare Diabetes Prevention Program is another important tool for patients who are at risk of developing diabetes. “We've seen increases in the use of that program, but we want to see that continue to grow,” said Dr. Kirley.
Additionally, physicians should continue efforts to decrease tobacco use. From a public health standpoint, they should look at ways to improve nutrition, which continues to be a struggle in the U.S., said Dr. Kirley.
“Healthy lifestyles can impact pretty much everything on this list” of causes of mortality, she added.
The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage their risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.
Certain health behaviors play a role
Increases in substance- and alcohol-use disorders during the pandemic may have also affected death rates in unintentional injuries and chronic liver disease and cirrhosis, says the JAMA Viewpoint.
A spike in drug-overdose deaths led to a 26.3% rise in the unintentional injuries death rate category. Additionally, death rates for chronic liver disease and cirrhosis increased 15.3% from 2019 to 2023.
The cause might be multifactorial, Dr. Kirley offered. Rising death rates in liver disease closely relate to heart disease, stroke and diabetes risk, “all of those sorts of metabolic conditions running together.”
Flu, cancer, Alzheimer’s see declines
Comparatively, the JAMA Viewpoint reported declines in death rates due to cancer, chronic lower respiratory disease, Alzheimer’s disease, and influenza and pneumonia. “The cancer death rate declined steadily from prepandemic rates, except for a brief increase in 2021,” says the article.
While it’s promising to see statistics on declining mortality rates due to flu, physicians should continue to promote vaccine uptake, Dr. Kirley said.
“When the pandemic started, we saw some bumps in flu-vaccine coverage, but it’s been dropping since then, and that is concerning to me,” she added.
But the key here is that almost all causes of death on this list relate to chronic illnesses and conditions.
“Chronic disease is going to continue to be a significant challenge in our country, and prevention efforts really need to be prioritized more than they are now,” said Dr. Kirley.
Learn more about how these health systems are transforming chronic disease care.
