By Nathaniel
What the new numbers show
The United States is seeing a rare piece of good news in public health: the U.S. death rate fell 3.8% in 2024 to its lowest level since 2020, according to provisional figures released by the CDC’s National Center for Health Statistics. The agency estimates 3,072,039 deaths last year, or 722 deaths per 100,000 people, down from 750.5 per 100,000 in 2023. It’s the clearest sign yet that the country has pulled back from the worst years of the pandemic.
Here’s the headline shift: for the first time since 2020, COVID-19 is no longer a top-10 cause of death in America. Suicide now sits at No. 10, edging COVID out of the list. That doesn’t mean the virus vanished—far from it—but it does reflect a changed landscape driven by vaccination, prior infections, antivirals, and more targeted protection for people at highest risk.
The top three causes of death didn’t budge. Heart disease remained No. 1 with 683,037 deaths. Cancer followed with 619,812. Unintentional injuries—everything from drug overdoses to traffic crashes and falls—ranked third with 196,488. Rounding out the top 10 were stroke, chronic lower respiratory disease, Alzheimer’s disease, diabetes, kidney disease, chronic liver disease and cirrhosis, and suicide.
One twist: even as the overall death rate fell, deaths from heart disease and cancer ticked up compared with 2023. That tells us the broad decline isn’t coming from progress against those two big killers. It’s coming from improvements elsewhere—especially the retreat of COVID—as well as a return to more typical seasonal patterns for respiratory illness after the pandemic’s disruption.
These findings come from provisional death certificate data. The numbers can shift as more certificates are processed and causes are finalized. Still, they offer an early, credible read on where mortality is heading and what’s driving it.
The stubborn threats—and the gaps that won’t go away
Start with cardiovascular disease. Heart disease continues to lead U.S. mortality year after year, and the longer-term outlook isn’t comforting. A 2024 American Heart Association analysis projects that by 2050, about 61% of U.S. adults will be living with some form of cardiovascular disease. That includes high blood pressure, coronary disease, stroke, and heart failure—conditions that often build quietly for years.
Awareness is part of the problem. A Cleveland Clinic survey this year found plenty of adults overlook core heart risks like tobacco use, high blood pressure, and even air pollution. In practice, that means people don’t always recognize warning signs or take preventive steps early. Add in pandemic-era disruptions to routine care—missed blood pressure checks, delayed cholesterol management—and you get a risk profile that takes time to unwind.
Cancer remains a close second and is getting more complicated. The country has made real gains in screening for breast, colon, and cervical cancers, and new treatments are extending lives. But diagnoses tied to obesity and metabolic health are rising, and gaps in screening persist by income, insurance coverage, and geography. The net effect: more people living longer with cancer, yet a stubbornly high toll in raw numbers as the population ages.
Unintentional injuries hold the No. 3 spot, and much of the story runs through drug overdoses. The synthetic opioid fentanyl continues to drive high fatality rates, even as some states report signs of a plateau. Traffic deaths remain elevated compared with pre-2020 levels, and falls among older adults are a growing challenge as more Americans live into their 80s and 90s.
Suicide’s move into the 10th position is a warning light. Nationally, suicide deaths have climbed in recent years, with the highest rates among middle-aged and older men and rising concern for young people and rural communities. Access to firearms, gaps in mental health care, and social isolation all play a role. The tools to bend the curve—fast access to crisis lines, primary care screening, treatment for depression and substance use—are well known. Coverage and consistent follow-through are not.
COVID’s exit from the top 10 is meaningful, but it’s not an all-clear. The virus still killed tens of thousands last year, and the risk remains concentrated among older adults and people with chronic conditions. Hospitals are better at managing severe cases, and an updated vaccine has helped, but outcomes continue to depend on timing, access to care, and how quickly people seek treatment when symptoms start.
The demographic splits in the CDC’s report are familiar but frustrating. Death rates remain highest among men, older adults, and Black Americans. Men die more often from heart disease, cancer, injuries, and suicide. Black Americans face higher risks tied to hypertension, diabetes, and maternal health complications, reflecting long-standing inequities in housing, access to care, and economic stability. None of that changes quickly, which is why a lower national rate can hide very different realities across communities.
Geography also matters. Rural counties tend to have higher death rates from heart disease, stroke, and injury. Hospital closures, fewer specialists, longer travel for care, and limited behavioral health services add up. Urban areas, meanwhile, wrestle with overdoses and gun violence. Public health isn’t one story; it’s dozens, depending on the ZIP code.
Why did the overall death rate fall in 2024? Several forces likely converged:
- Lower COVID mortality, thanks to immunity, vaccines, and better treatment.
- A return to more predictable respiratory seasons after the pandemic shock.
- Catch-up in routine care, screenings, and elective procedures that were delayed in 2020–2022.
- Public health measures that stuck—like better testing, home monitoring devices, and faster use of antivirals for high-risk patients.
Still, two realities can be true at once. The country is clearly moving away from the emergency phase of the pandemic. And at the same time, the biggest drivers of death—heart disease, cancer, injuries, and suicide—demand steady, unglamorous work: blood pressure control, tobacco prevention, safer streets, naloxone access, mental health care, and consistent follow-up after a crisis.
There’s also the age factor. As the baby boomer generation moves deeper into older age, raw death counts will remain high even if rates per 100,000 fall. That’s a math problem and a planning problem. Health systems will see more complex patients. Long-term care, home health, and caregiver support will be stretched. And prevention will matter more, not less, to keep people independent longer.
Life expectancy offers another way to read the trend. After dropping sharply in 2020 and 2021, U.S. life expectancy began to rebound in 2022 and 2023. The 2024 decline in the death rate points in the same direction. But the U.S. still hasn’t fully climbed back to its pre-pandemic baseline, and it continues to lag peer countries on many core measures, including heart disease and maternal mortality.
One last caveat: the CDC report is provisional. Final numbers can shift as death certificates are completed and underlying causes are verified. That said, the big patterns here—COVID’s drop from the top 10, the rise of suicide into 10th, and the durability of heart disease and cancer at the top—are unlikely to change.
So where does that leave public health going into 2025? The priorities are clear even if the politics are messy. Keep older adults protected from respiratory viruses. Get blood pressure and cholesterol control back on track in primary care. Expand access to mental health services and crisis response. Keep pressing on overdose prevention with fentanyl test strips, medications for opioid use disorder, and naloxone everywhere it’s needed. None of it is flashy. All of it saves lives.
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