US Death Rate Drops 17.7% Over 2 Years — Here’s a Breakdown by Cause

Some much-needed good news for U.S. citizens: Between the first quarters of 2021 and 2023, the national age-adjusted death rate fell by 17.7%, according to the latest ValuePenguin study.

Our study also looked at death rates by cause and the leading causes by state. Perhaps unsurprisingly given increased vaccination access and herd immunity, COVID-19 deaths fell most precipitously over that time. Deaths from most other causes showed a decline, too.

Here’s what we found.

Key findings

Between the first quarters of 2021 and 2023, the U.S. death rate fell 17.7%

Over the two years the study examined, the U.S. death rate — defined as the age-adjusted number of deaths per 100,000 residents — fell by 17.7%. In the first quarter of 2021, 940.7 of every 100,000 U.S. residents died, a figure that dropped to 773.8 in the first quarter of 2023.

This dynamic follows a pattern with historic precedent, ValuePenguin health insurance expert Divya Sangameshwar says. "Thanks to advances in science and medicine and the end of years of wars, mortality rates have been declining at a relatively constant rate of 1% to 2% a year since 1900," she says, citing the National Bureau of Economic Research.

This latest downward trend follows a temporary bump in the death rate (no) thanks to the pandemic — though COVID-19 wasn’t the only culprit, Sangameshwar says. "Broader economic and social consequences from the lockdowns, reduced access to health care and overcrowded hospitals were other factors that contributed to the rising death rates," she says.

U.S. death rate by quarter

Despite the downward trend, rates bounced from quarter to quarter. In fact, two quarters (the second and third of 2022) had a lower death rate than the first quarter of 2023.

Further, the second quarters of 2021 and 2022 had the lowest death rates of each year, perhaps owing to the change in seasons and the onset of warmer weather. (According to the Mayo Clinic, respiratory illnesses surge in the winter months, thanks in part to the increased humidity making germ-laden droplets fall more quickly.)

COVID-19 death rate falls 87.8% over 2 years — the most across causes

While most causes of death declined over the studied period, the COVID-19 death rate fell most steeply. In the first quarter of 2021, 157.7 of every 100,000 residents died of COVID-19, but that figure dropped 87.8% by the first quarter of 2023 to 19.3.

It’s important to keep timelines in context here, as no state in the fourth quarter of 2020 — one quarter before the start of our analyzed period — had a death rate lower than the 19.3 seen in the first quarter of 2023. In fact, 41 states had a death rate of at least 100.0 per 100,000 in the fourth quarter of 2020. This suggests that social distancing, mask-wearing and vaccine campaigns made a difference in preventing COVID-19-related deaths.

While the decrease in COVID-19-related deaths wasn’t linear, the rate went down sharply during the second quarter in both 2021 and 2022. This may, again, point to the lowered risk of respiratory virus transmission during warmer months, in which outdoor gatherings are also more comfortable. Additionally, vaccines against the disease first became available to the general public around April 2021, which may have also played a part in the trend.

Causes of death by decrease/increase in death rate

While COVID-19 deaths dropped most steeply, other causes of death declined, too — particularly Alzheimer’s (which fell 16.5% over the studied period) and diabetes (which fell 11.9%).

While there’s no cure, Alzheimer’s patients have benefited from a new treatment called lecanemab, which the Food and Drug Administration (FDA) gave an accelerated approval in January 2023. In the same month, insulin cost caps went into effect for Medicare Part D enrollees, making the treatment more accessible for thousands.

Flu and pneumonia death rate rose the most — here’s how men and women were affected across causes

While the death rates of many causes fell over the two years between the first quarters of 2021 and 2023, a few bucked the trend. Specifically, deaths related to flu and pneumonia increased by 16.4% over the studied period.

The leap was far more pronounced among women, who saw an increase of 25.0% in deaths related to flu and pneumonia, compared with a mere 8.6% rise among men.

Changes in death rates by cause and gender

Other causes of death that rose over the studied period include chronic lower respiratory diseases (4.3%), suicide (3.7%) and septicemia, or blood poisoning (1.0%).

Once again, rate changes varied substantially between the genders, with women seeing steeper increases in lower respiratory disease-related deaths (8.2%, versus 0.5% among men) and suicides (3.6%, versus 3.2% among men). Women also saw a slight decrease in blood infection deaths (2.1%) despite the overall rise (buoyed by an increase of 2.6% among men).

There was also a significant increase in the rate of HIV deaths among women, although the overall HIV death rate stayed static over the examined two-year period. The HIV death rate among women rose from 0.6 deaths per 100,000 U.S. residents in the first quarter of 2021 to 0.7 deaths in the first quarter of 2023, so while the rate change was small, the jump represented a 16.7% increase. (Men are still more likely to die from HIV than women, in part due to the increased risk of contracting the disease during male-to-male sexual contact — and the persistent stigma against homosexuality, potentially discouraging such men from getting tested.)

District of Columbia residents 371.4% more likely to die from HIV

Our study also looked at standout causes of death in the states and D.C.

While heart disease is the leading cause of death in the vast majority of states, our study compared the death rate for specific death causes in each state to the national death rate for that same cause, and ranked the disparities. (Note: Only one cause of death per state is highlighted in our study. These figures, unlike those above, come from the first quarter of 2023 but are based on a 12-month average ending during that time frame.)

Using this metric, District of Columbia residents were a whopping 371.4% more likely to die from HIV than the average U.S. resident. The nationwide rate of HIV-related deaths was 1.4 per 100,000 residents during the studied period, compared to 6.6 in D.C. This represents the largest discrepancy by cause of death and state in our research.

States where HIV is the cause of death with the biggest disparity from the national rate

D.C. has a storied history of higher-than-average HIV rates — though cases are down compared to historic highs. According to the district’s 2023 Annual Epidemiology and Surveillance Report, 210 new HIV cases were diagnosed in 2022, down from a high of 1,374 in 2007. While no babies were born with HIV in D.C. in 2022, the instances caused by injectable drug use more than doubled year over year.

Other states in which HIV was the cause of death with the biggest discrepancy included Georgia (92.9%), Florida (78.6%) and Maryland (50.0%). Experts point to socioeconomic underpinnings that help explain these higher-than-average cases; poverty and racial inequity can decrease patient access to testing and treatment. In these three states, Black and African American people are more likely to be diagnosed with HIV and AIDS.

Mississippi residents 165.8% more likely to die by homicide

Mississippi had the second-highest disparity by cause of death and state. Mississippi’s homicide death rate was 20.2 per 100,000 residents during the studied period, compared to a national homicide death rate of 7.6. In other words, Mississippi residents were 165.8% more likely to die by homicide than the average American.

Other states with higher-than-national-average homicide rates include Louisiana (152.6% higher than the national average), Alabama (107.9%), South Carolina (59.2%) and Illinois (42.1%).

Each state's biggest discrepancy in death rates by cause

Other states exhibited various standout causes of death — notably, New Mexico had a substantial deviation in deaths related to chronic liver disease and cirrhosis. New Mexico residents were 153.7% more likely to die due to these causes than the average U.S. citizen. (New Mexico has a higher-than-average percentage of Native American residents, who may be more likely than other groups to suffer from alcohol use disorders — a long-persisting consequence of colonialism and displacement.)

While sicker populations will, in theory, spend more on health care — potentially driving up the health insurance premiums in that geographical area — "mortality rates alone don’t determine how much you’ll pay for health insurance," Sangameshwar says. Other important factors include price negotiations between insurers and health care providers, as well as the number of insurers competing for business in a given state.

Further, she says, uninsured rates have little correlation with death rates, as counterintuitive as that may seem.

Staying healthy amid falling death rates: Expert tips for insurance and more

The declining death rate is great news for Americans, but it’s still important to prioritize health to reduce the likelihood of preventable diseases. Learn how to maximize the benefit of your health insurance policy and take other healthy steps with these expert tips.