Deaths: Leading Causes for 2020.

Objectives-This report presents final 2020 data on the 10 leading causes of death in the United States by age, race and Hispanic origin, and sex. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2020," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2020. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD-10) are ranked according to the number of deaths. Cause-of-death statistics are based on the underlying cause of death. Race and Hispanicorigin data are based on the Office of Management and Budget's 1997 standards for reporting race and Hispanic origin. Results-In 2020, many of the 10 leading causes of death changed rank order due to the emergence of COVID-19 as a leading cause of death in the United States. The 10 leading causes of death in 2020 were, in rank order: Diseases of heart; Malignant neoplasms; COVID-19; Accidents (unintentional injuries); Cerebrovascular diseases; Chronic lower respiratory diseases; Alzheimer disease; Diabetes mellitus; Influenza and pneumonia; and Nephritis, nephrotic syndrome and nephrosis. They accounted for 74.1% of all deaths occurring in the United States. Differences in the rankings are evident by age, race and Hispanic origin, and sex. Leading causes of infant death for 2020 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by maternal complications of pregnancy; Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage.

Death Rates by Marital Status for Leading Causes of Death: United States, 2010-2019.

Objectives-This report presents age-adjusted death rates by marital status (married, never married, widowed, and divorced) among adults aged 25 and over. Rates for all-cause mortality are presented for 2010-2019 and for the 10 leading causes of death for 2010 and 2019.

Mortality Profile of the Non-Hispanic American Indian or Alaska Native Population, 2019.

Objectives-This report presents a mortality profile of the U.S. non-Hispanic American Indian or Alaska Native (AIAN) population for 2019. Standard mortality statistics, adjusted for race and Hispanic-origin misclassification on death certificates, are provided along with comparisons with the three major U.S. populations: non-Hispanic white, non-Hispanic black, and Hispanic.

State Suicide Rates Among Adolescents and Young Adults Aged 10-24: United States, 2000-2018.

Objectives-This report presents suicide death rates among persons aged 10-24 for the United States and by state for 2000 through 2018 and percent change between 3-year periods of 2007-2009 and 2016-2018. Suicide rates are compared among states for 2016-2018. Methods-Data are from death certificates from all 50 states and the District of Columbia. Suicide rates among persons aged 10-24 per 100,000 population are computed for each year from 2000 through 2018 for the states and years where sufficient cases existed to produce reliable rates. Percent change between 3-year averages of suicide rates for 2007-2009 and 2016-2018 are computed for each area except the District of Columbia. Suicide rates for 2016-2018 are compared among states. Results-Nationally, the suicide rate among persons aged 10-24 was statistically stable from 2000 to 2007 and then increased 57.4%, from 6.8 per 100,000 in 2007 to 10.7 in 2018. Between 2007-2009 and 2016-2018, suicide rates increased significantly in 42 states, increased nonsignificantly in 8 states, and were not possible to assess in the District of Columbia due to small numbers. Significant increases ranged from 21.7% in Maryland to a more than doubling of the rate in New Hampshire. In 2016-2018, suicide rates for persons aged 10-24 were highest in Alaska, while some of the lowest rates in the country were among states in the Northeast.

U.S. Decennial Life Tables for 2009-2011, Methodology of the United States Life Tables.

Objectives-This report describes the methodology used in the preparation of the 2009-2011 decennial life tables for the United States by race, Hispanic origin, and sex based on the age-specific death rates for the period 2009-2011, appearing in the report, "U.S. Decennial Life Tables for 2009-2011, United States Life Tables" (1). Methods-Data used to prepare these life tables include population data by age on the census date April 1, 2010; deaths occurring in the 3-year period 2009-2011 classified by age at death; births for each of the years 2007-2011; and Medicare data for ages 66-99 for the 3 years 2009-2011. The methods used differ from those applied to the 1999-2001 decennial life tables in the estimation of mortality for ages 66 and over. For the total, white, black, non-Hispanic white, and non-Hispanic black populations, the method developed for the U.S. annual life tables beginning with data year 2008 was used. It consists of the application of the Kannisto logistic model to smooth death rates in the age range 85-99 and predict death rates for ages 100-120 (2,3). For the Hispanic population, which is added to the decennial series for the first time with the 2009-2011 set, the method developed for the U.S. annual life tables beginning with data year 2006 was used. This method consists of using the Brass relational logit model to estimate mortality for ages 80-120 (4).

U.S. Decennial Life Tables for 2009-2011, United States Life Tables.

Objectives-This report presents period life tables for the United States, based on age-specific death rates for the period 2009-2011. These tables are the most recent in a 110-year series of decennial life tables for the United States. Methods-This report presents complete life tables for the United States by race, Hispanic origin, and sex, based on age- specific death rates during 2009-2011. This is the first set of life tables by Hispanic origin presented in the U.S. decennial life table series. Data used to prepare these life tables include population estimates based on the 2010 decennial census; deaths occurring in the United States to U.S. residents in the 3 years 2009 through 2011; counts of U.S. resident births in the years 2007 through 2011; and population and death counts from the Medicare program for years 2009 through 2011. The methodology used to estimate life tables for the Hispanic population is based on the method first implemented with the 2006 annual U.S. life tables by Hispanic origin. The methodology used to estimate the life tables for all other groups is based on the method first implemented with the 2008 annual U.S. life tables. Results-During 2009-2011, life expectancy at birth was 78.60 years for the total U.S. population, representing an increase of 29.36 years from a life expectancy of 49.24 years in 1900. Between 1900 and 2010, life expectancy increased by 42.88 years for black females (from 35.04 to 77.92), by 39.21 years for black males (from 32.54 to 71.75), by 30.15 years for white females (from 51.08 to 81.23), and by 28.26 years for white males (from 48.23 to 76.49). During 2009-2011, Hispanic females had the highest life expectancy at birth (84.05), followed by non-Hispanic white females (81.06), Hispanic males (78.83), non-Hispanic black females (77.62), non-Hispanic white males (76.30), and non-Hispanic black males (71.41).

Trends in Cancer and Heart Disease Death Rates Among Adults Aged 45-64: United States, 1999-2017.

Objectives-This report presents death rates for cancer and heart disease among adults aged 45-64 in the United States for 1999-2017. Rates for 1999-2017 are presented by sex and race and ethnicity (non-Hispanic white, non-Hispanic black, and Hispanic). Methods-Mortality statistics in this report are based on information from death certificates filed in all 50 states and the District of Columbia. Cancer deaths are classified by the International Classification of Diseases, 10th Revision (ICD-10) underlying cause-of-death codes C00-C97; heart disease deaths are classified with ICD-10 underlying cause-of-death codes I00-I09, I11, I13, and I20-I51. Death rates are calculated per 100,000 population. Trends were evaluated using the National Cancer Institute's Joinpoint Regression Program. Results-Cancer death rates for middle-aged adults aged 45-64 declined by 19% from 1999 to 2017 (224.9 deaths per 100,000 to 182.6), whereas heart disease death rates declined by 22% from 1999 (164.3) to 2011 (127.9) and then increased 4% from 2011 to 2017 (133.6). The same trend patterns were observed for both men and women. The cancer death rate was always higher than the heart disease death rate from 1999 to 2017, and was 37% higher in 2017. For non-Hispanic white and non-Hispanic black men and women, cancer death rates declined over the 1999-2017 period, whereas heart disease death rates declined and then increased since 2009 for non-Hispanic white men and women, and since 2011 for non-Hispanic black men and women. Hispanic men and women experienced different trends than their non-Hispanic white and black counterparts-both cancer and heart disease death rates for this group had periods of decline and stability.

Suicide Mortality in the United States, 2001-2021.

In 2021, suicide was the 11th leading cause of death in the United States, changing from the 10th leading cause in 2019 and the 12th leading cause in 2020 (1). As the second leading cause of death in people aged 10-34 and the fifth in people aged 35-54, suicide contributes to premature mortality (1). After peaking in 2018, rates declined through 2020 but then increased again in 2021, according to provisional data (2,3). This report updates previous data by presenting final suicide rates from 2001 through 2021 by sex and age as well as rates by race and Hispanic origin for 2020 and 2021.

Suicide and Homicide Death Rates Among Youth and Young Adults Aged 10-24: United States, 2001-2021.

Deaths due to suicide and homicide, often referred to collectively as violent deaths, have been a leading cause of premature death to people aged 10-24 in the United States (1-3). A previous version of this report with data through 2017 showed that suicide and homicide rates for people aged 10-24 were trending upward (4). This report updates the previous report using the most recent data from the National Vital Statistics System and presents trends from 2001 through 2021 in suicide and homicide rates for people aged 10-24 and for age groups 10-14, 15-19, and 20-24.

Declines in Cancer Death Rates Among Youth: United States, 2001-2021.

Since the mid-1970s, cancer death rates for youth in the United States have declined significantly despite a slow increase in incidence for some of the major types (1-3). A previous report with trends from 1999 through 2014 showed declines for all 5-year age groups of youth (0-4, 5-9, 10-14, 15-19) (4). This Data Brief updates that report by presenting trends in cancer death rates through 2021. Rates from 2001 to 2021 are presented in total and for females and males. Rates for 2001, 2011, and 2021 are presented by 5-year age groups and for White, Black, and Hispanic youth. Trends are shown for the three most common types of cancer in youth.

COVID-19 Death Rates in Urban and Rural Areas: United States, 2020.

Death rates in the United States are higher in rural than urban areas, and the difference has grown over the last 2 decades (1). Death rates for all of the 10 leading causes of death in 2019 were higher in rural than urban areas (1). In 2020, deaths due to COVID-19 became the third leading cause of death in the United States (2). This report presents COVID-19 death rates for rural and urban areas in 2020 by sex and age group (under age 65 and 65 and over). Rates are presented for the six categories of urbanicity according to the decedent's county of residence (3). Urban areas include large central metropolitan, large fringe metropolitan, medium metropolitan, and small metropolitan; rural areas include micropolitan and noncore (nonmetropolitan).

Suicide Mortality in the United States, 2000-2020.

In 2020, suicide was the 12th leading cause of death for all ages in the United States, changing from the 10th leading cause in 2019 due to the emergence of COVID-19 deaths and increases in deaths from chronic liver disease and cirrhosis (1). As the second leading cause of death in people aged 10-34 and the fifth leading cause in people aged 35-54, suicide is a major contributor to premature mortality (1). Suicide rates increased from 2000 to 2018 (2-5), but recent data have shown declines between 2018 and 2020 (6,7). This report presents final suicide rates from 2000 through 2020, in total and by sex, age group, and means of suicide, using mortality data from the National Vital Statistics System (NVSS). This report updates a provisional 2020 report and a previous report with final data through 2019 (6,7).

Alcohol-induced Death Rates in the United States, 2019-2020.

Alcohol use is a known risk factor for mortality, and the rates of alcohol induced deaths have risen over the past several years (1). Alcohol use in the United States increased during the first year of the Coronavirus Disease 2019 (COVID-19) pandemic, which may have affected mortality rates, especially for alcohol-induced deaths (2). Understanding trends in alcohol-induced mortality, with a particular focus on differences from 2019 to 2020, may help identify groups particularly affected during the COVID-19 pandemic. This report presents overall and sex-specific trends in alcohol-induced death rates from 2000 to 2020, and then focuses on the rates for 2019 and 2020 by sex, age group, and underlying cause of death.

Suicide Rates for the Three Leading Methods by Race and Ethnicity:United States, 2000-2020.

Suicide rates in the United States have traditionally been higher for non-Hispanic White than non-Hispanic Black and Hispanic people (1). However, provisional data demonstrated that patterns have changed recently with rates declining for non-Hispanic White people but increasing for non-Hispanic Black and Hispanic people (2). This report presents suicide rates from 2000 to 2020 using final data for non-Hispanic White, non-Hispanic Black, and Hispanic people, for the total population and for the three leading methods in 2020 (firearms, suffocation, and poisoning).

Guidance for Selecting Model Options in the National Cancer Institute Joinpoint Regression Software.

The purpose of this report is to provide guidance to users of NCHS data in the selection of modeling options when using the NCI Joinpoint regression software to analyze trends. This report complements another report, "National Center for Health Statistics Guidelines for Analysis of Trends." Considerations are presented for selecting the modeling options, with examples illustrating the choices. The tradeoffs and consequences of choosing the various modeling options using data from NCHS data systems are discussed.encounters.

Trends in Death Rates in Urban and Rural Areas: United States, 1999-2019.

In the United States, approximately 15% of the population resides in counties located in rural areas (1). Those living in rural areas often face greater public health challenges as they have more limited access to health care, are less likely to be insured, and are more likely to live in poverty (1,2). This report provides the latest national data for trends in age-adjusted death rates for all causes of death among rural and urban areas by sex. Rates for rural and urban areas for the 10 leading causes of death in 2019 are also presented by urbanrural status along with trends in selected causes of death.

Suicide Mortality in the United States, 1999-2019.

In 2019, suicide was the 10th leading cause of death for all ages in the United States (1). As the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54, suicide is a major contributor to premature mortality (2). Recent reports have documented a steady increase in suicide rates over the past two decades (3-6). This Data Brief uses final mortality data from the National Vital Statistics System to update trends in suicide rates from 1999 through 2019 and to describe differences by sex, age group, and means of suicide.

Urban-rural Differences in Suicide Rates, by Sex and Three Leading Methods: United States, 2000-2018.

Suicide has remained the 10th leading cause of death in the United States since 2008, with deaths due to firearms, suffocation (including hangings), and poisoning representing the leading methods of suicide (1,2). There are known differences in suicide rates by sex and geographic distribution (3). This report uses final mortality data from the National Vital Statistics System to present trends in suicide mortality from 2000 through 2018 among all ages by urban-rural classification of the decedent's county of residence and sex for the leading methods of suicide-firearms, suffocation, and poisoning.

Increase in Suicide Mortality in the United States, 1999-2018.

Suicide is the 10th leading cause of death for all ages in the United States (1). Suicide is a major contributor to premature mortality as it ranks as the second leading cause of death for ages 10-34 and the fourth leading cause for ages 35-54 (1). Despite national goals to lower the suicide rate (2), several recent reports have documented a steady increase in suicide rates in recent years (3-6). This data brief uses final mortality data from the National Vital Statistics System (NVSS) to update trends in suicide rates from 1999 through 2018 and to describe differences by sex, age group, and urbanicity of county of residence.

Rates of Alcohol-induced Deaths Among Adults Aged 25 and Over in Urban and Rural Areas: United States, 2000-2018.

Excessive alcohol consumption is a well-known risk factor for mortality and has been causally linked to many diseases, conditions and injuries, including alcohol-attributable cancer, liver cirrhosis, and alcohol poisonings (1). Alcohol-induced deaths, or deaths from dependent and nondependent use of alcohol, as well as accidental poisoning by alcohol (2), have been increasing in the United States since 1999 with differences by sex, age, urban-rural classification, and other demographic characteristics (3,4). This Data Brief focuses on alcohol-induced deaths among adults aged 25 and over, which account for more than 99% of the alcohol-induced deaths in the United States. The report presents trends from 2000 through 2018 by sex and urbanization level of county of residence.