National Vital Statistics Reports Volume 69, Number 13 January 12, 2021

National Vital

Statistics Reports

Volume 69, Number 13 January 12, 2021

Deaths: Final Data for 2018

by Sherry L. Murphy, B.S., Jiaquan Xu, M.D., Kenneth D. Kochanek, M.A., Elizabeth Arias, Ph.D., and

Betzaida Tejada-Vera, M.S., Division of Vital Statistics

Abstract

Objectives—This report presents final 2018 data on U.S.

deaths, death rates, life expectancy, infant and maternal mortality,

and trends by selected characteristics such as age, sex, Hispanic

origin and race, state of residence, and cause of death. The race

categories are consistent with 1997 Office of Management and

Budget (OMB) standards, which are different from previous

reports (1977 OMB standards).

Methods—Information reported on death certificates is

presented in descriptive tabulations. The original records are filed

in state registration offices. Statistical information is compiled

in a national database through the Vital Statistics Cooperative

Program of the National Center for Health Statistics. Causes of

death are processed according to the International Classification

of Diseases, 10th Revision. As of 2018, all states and the District

of Columbia were using the 2003 revised certificate of death,

which includes the 1997 OMB revised standards for race. The

2018 data based on the revised standards are not completely

comparable to previous years. Selected estimates are presented

in this report for both the revised and previous race standards to

provide some reference for interpretation of trends.

Results—In 2018, a total of 2,839,205 deaths were reported

in the United States. The age-adjusted death rate was 723.6

deaths per 100,000 U.S. standard population, a decrease of

1.1% from the 2017 rate. Life expectancy at birth was 78.7 years,

an increase of 0.1 year from 2017. Age-specific death rates

decreased in 2018 from 2017 for age groups 15–24, 25–34,

45–54, 65–74, 75–84, and 85 and over. The 15 leading causes of

death in 2018 remained the same as in 2017. The infant mortality

rate decreased 2.2% to a historically low figure of 5.66 infant

deaths per 1,000 live births in 2018.

Conclusions—The age-adjusted death rate for the total,

male, and female populations decreased from 2017 to 2018, and

life expectancy at birth increased in 2018 for the total, male, and

female populations.

Keywords: mortality • cause of death • life expectancy •

National Vital Statistics System

Highlights

Mortality experience in 2018

• In 2018, a total of 2,839,205 resident deaths were registered

in the United States, yielding a crude death rate of 867.8 per

100,000 population.

• The age-adjusted death rate, which accounts for the aging of

the population, was 723.6 deaths per 100,000 U.S. standard

population.

• Life expectancy at birth was 78.7 years.

• The 15 leading causes of death in 2018 were:

1. Diseases of heart (heart disease)

2. Malignant neoplasms (cancer)

3. Accidents (unintentional injuries)

4. Chronic lower respiratory diseases

5. Cerebrovascular diseases (stroke)

6. Alzheimer disease

7. Diabetes mellitus (diabetes)

8. Influenza and pneumonia

9. Nephritis, nephrotic syndrome and nephrosis

(kidney disease)

10. Intentional self-harm (suicide)

11. Chronic liver disease and cirrhosis

12. Septicemia

13. Essential hypertension and hypertensive renal

disease (hypertension)

14. Parkinson disease

15. Pneumonitis due to solids and liquids

• In 2018, the infant mortality rate was 5.66 infant deaths per

1,000 live births.

• The 10 leading causes of infant death were:

1. Congenital malformations, deformations

and chromosomal abnormalities (congenital

malformations)

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

National Vital Statistics System

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.

2 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

2. Disorders related to short gestation and low

birth weight, not elsewhere classified (low birth

weight)

3. Newborn affected by maternal complications of

pregnancy (maternal complications)

4. Sudden infant death syndrome (SIDS)

5. Accidents (unintentional injuries)

6. Newborn affected by complications of placenta,

cord and membranes (cord and placental

complications)

7. Bacterial sepsis of newborn

8. Diseases of the circulatory system

9. Respiratory distress of newborn

10. Neonatal hemorrhage

Comparison to previous year

• The age-adjusted death rate decreased 1.1% from 731.9 per

100,000 standard population in 2017 to 723.6 in 2018.

• The age-adjusted death rate was 1.2 times greater for the

non-Hispanic black population (892.6) than for the non-

Hispanic white population (748.7).

• The age-adjusted death rate for the non-Hispanic white

population (748.7) was 1.4 times greater than for the

Hispanic population (524.1).

• Life expectancy for the total population increased 0.1 year

from 78.6 in 2017 to 78.7 in 2018.

• Life expectancy for females was 5.0 years higher than for

males, the same as in 2017. The difference in life expectancy

between the sexes has narrowed since 1979, when it was

7.8 years.

• The difference in life expectancy between the Hispanic and

non-Hispanic white populations was 3.2 years in 2018.

• The 15 leading causes of death in 2018 were the same as

in 2017.

• Age-adjusted death rates decreased signiﬁcantly in 2018

from 2017 for 8 of the 15 leading causes of death: heart

disease, cancer, unintentional injuries, Chronic lower

respiratory diseases, stroke, Alzheimer disease, Septicemia,

and Pneumonitis due to solids and liquids. Signiﬁcant

increases occurred in 2018 from 2017 for 4 of the 15 leading

causes of death: Inﬂuenza and pneumonia, suicide, Chronic

liver disease and cirrhosis, and Parkinson disease.

• Age-adjusted death rates decreased in 2018 from 2017 for

drug-induced causes (4.4%) and increased for alcohol-

induced causes (3.1%).

• The increase in life expectancy at birth for the total population

in 2018 was mainly due to decreases in mortality from

cancer, unintentional injuries, Chronic lower respiratory

diseases, heart disease, and homicide.

• The difference in life expectancy between the non-Hispanic

white and non-Hispanic black populations was 3.9 years in

2018.

• Among external causes of injury death, unintentional

poisoning has been the leading mechanism of injury

mortality since 2011.

• The infant mortality rate decreased 2.2% in 2018 to a record

low of 5.66 infant deaths per 1,000 live births.

• The 10 leading causes of infant death in 2018 remained the

same as in 2017.

Introduction

This report presents detailed 2018 data on deaths and

death rates according to a number of demographic and medical

characteristics. These data provide information on mortality

patterns among residents of the United States by such variables

as age, sex, Hispanic origin and race, state of residence, and

cause of death. Information on these mortality patterns is key to

understanding changes in the health and well-being of the U.S.

population (1). Companion reports present additional details on

leading causes of death and life expectancy in the United States

(2,3).

Mortality data in this report can be used to monitor and

evaluate the health status of the United States in terms of current

mortality levels and long-term mortality trends, and to identify

segments of the U.S. population at greater risk of death from

specific diseases and injuries. Differences in death rates among

various demographic subpopulations, including racial and

ethnic groups, may reflect subpopulation differences in factors

such as socioeconomic status, access to medical care, and the

prevalence of specific risk factors in a particular subpopulation.

Beginning with the 2018 data year, all 50 states and the

District of Columbia reported deaths based on the 2003 revision

of the U.S. Standard Certificate of Death for the entire year (4).

The 2003 revision uses the revised 1997 Office of Management

and Budget (OMB) standards for the collection of race and

Hispanic ethnicity, so it is possible to report mortality statistics

using the revised standards for the first time when reporting

2018 mortality data (5). The 1997 standards allowed individuals

to report more than one race and increased the race choices from

four to five by separating the Asian and Pacific Islander groups.

The category “Hispanic” did not change, remaining consistent

with previous reports.

The new categories in this report include non-Hispanic

white; non-Hispanic black or African American; non-Hispanic

American Indian or Alaska Native (AIAN); non-Hispanic Asian;

and non-Hispanic Native Hawaiian or Other Pacific Islander

(NHOPI). Data presented in this report according to the new

race and Hispanic-origin categories represent the official data

by race and origin for 2018. The new categories differ from the

bridged-race categories shown in previous reports. To evaluate

the impact of changing from reporting according to bridged-race

and Hispanic-origin categories to the single-race categories,

select 2018 results were tabulated using both categorizations.

See Methods and Technical Notes for additional information on

how race and Hispanic-origin categories were redefined and, an

accompanying report, “Comparability of Race-specific Mortality

Data Based on 1977 Versus 1997 Reporting Standards,” (6) for

more information on differences between single- and bridged-

race groups.

In addition to the tabulations included in this report, more

detailed analysis is possible by using the annual mortality public-

use file. The data file may be downloaded from: https://www.

cdc.gov/nchs/data_access/Vitalstatsonline.htm (7). The public-

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 3

use file does not include geographic detail, but a file with this

information may be available upon request (8). Death data

also may be accessed via the Centers for Disease Control and

Prevention’s (CDC) Wide-ranging Online Data for Epidemiologic

Research (WONDER), a web-based system that makes CDC’s

information resources available to public health professionals

and the general public (9).

Methods

Data in this report are based on information from all

resident death certificates filed in the 50 states and the District

of Columbia. More than 99% of deaths occurring in this country

are believed to be registered (10). This report provides detailed

death data in Tables 1–16 and supplemental Internet Tables I–1

through I–27.

Tables showing data by state also provide information for

Puerto Rico, Guam, and the Commonwealth of the Northern

Mariana Islands (Northern Marianas). Cause-of-death statistics

presented in this report are classified according to the

International Classification of Diseases, 10th Revision (ICD–10)

(11–13). Selected causes are presented primarily based on their

impact on public health and future planning. A discussion of the

cause-of-death classification is provided in Technical Notes at

the end of this report.

Mortality data on specific demographic and medical

characteristics cover all 50 states and the District of Columbia.

Measures of mortality in this report include the number of deaths;

crude, age-specific, and age-adjusted death rates; infant, neonatal,

postneonatal, and maternal mortality rates; life expectancy; and

rate ratios. Changes in death rates in 2018 compared with 2017

and differences in death rates across demographic groups in

2018 were tested for statistical significance. Unless otherwise

specified, reported differences are statistically significant.

Additional information on these statistical methods, random

variation and relative standard error, the computation of derived

statistics and rates, population denominators, and the definition

of terms are presented in Technical Notes.

According to the revised standards issued by OMB in 1997,

the 2003 revision of the U.S. Standard Certificate of Death

provides for the reporting of more than one race (multiple races)

and increased the race choices from four to five by separating

the Asian and Pacific Islander groups (4,5). Starting in 2018, all

50 states and the District of Columbia reported deaths using the

2003 revision for the entire year.

The race and Hispanic-origin groups in this report follow

the 1997 standards and differ from the race categories used

in previous reports (14,15). The new categories include non-

Hispanic, single-race white; non-Hispanic, single-race black

or African American; non-Hispanic, single-race AIAN; non-

Hispanic, single-race Asian; non-Hispanic, single-race NHOPI;

and Hispanic. For brevity, text references to race refer to “single

race” in this report. Because the number of deaths reported with

more than one race in 2018 is relatively small (0.5%), these

deaths are included in totals but are shown separately in only

one report table (Table 2).

Jurisdictions adopted the 2003 standard certificate at

different times throughout the period 2003–2017. To provide

consistent mortality statistics by race and Hispanic origin during

the period 2003–2017, multiple-race data for states that had

adopted the 2003 standard certificate were bridged back to the

1977 OMB standard single-race categories; see Technical Notes.

Because all states collected data on race according to the 1997

OMB guidelines for the full data year in 2018, use of the bridged-

race process is no longer necessary. Data presented in this report

by the revised race and Hispanic-origin categories represent the

official statistics by race and origin for 2018. Because single-race

data are not available for the entire United States before 2018,

data by race for 2018 are not completely comparable with data

for previous years, and comparisons should be made with this

consideration. However, data for select estimates for 2018 also

were tabulated for bridged-race categories to evaluate the impact

of the change in categorization. The Hispanic-origin category is

a separate item on the death certificate and was not affected by

the revised standards; therefore, data by Hispanic origin for 2018

and earlier years are comparable.

Consequently, the changes in rates and life expectancies in

2018 from 2017 are discussed primarily for the total, male, female,

Hispanic, Hispanic male, and Hispanic female populations in this

report. However, for the continuity of trend data by bridged-race,

age-adjusted death rates by race (based on both bridged and

single race), Hispanic origin and sex for 2018, which provides

a comparison of data by bridged- and single-race categories,

are presented also (Tables A, 1, 4, and 13). Tables I–20 through

I–27 show trend data by bridged-race categories for 2018 and

previous years and single-race data for 2018. A more detailed

analysis of bridged-race data compared with single-race data is

available in “Comparability of Race-specific Mortality Data Based

on 1977 Versus 1997 Reporting Standards” (6).

The population data used to calculate death rates for 2018

shown in this report are postcensal population estimates based

on the 2010 decennial census and are available from the U.S.

Census website: https://www2.census.gov/programs-surveys/

popest/datasets/2010-2018/state/asrh/sc-est2018-alldata6.csv

(16). Reflecting the 1997 OMB guidelines on race and ethnicity

reporting, the 2010 census included an option for individuals

to report more than one race and provided for the reporting of

Asian persons separately from NHOPI persons (5).

The populations used to calculate death rates for

2000–2017 and for 2018 for selected tables were produced

under a collaborative arrangement with the U.S. Census Bureau

whereby population data for multiple-race persons were bridged

back to single-race categories. Populations for 2010–2018 and

the intercensal period 2001–2009 are consistent with the 2010

census (16–25). In addition, the 2010 census counts were

modified to be consistent with the 1977 OMB race categories,

that is, to report the data for Asian persons and NHOPI persons

as a combined category (Asian or Pacific Islander) and to reflect

age as of the census reference date (15). The procedures used

to produce the bridged populations are described elsewhere

(26,27).

Data presented in this report and other mortality tabulations

are available from the National Center for Health Statistics

4 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

(NCHS), National Vital Statistics System website: https://www.

cdc.gov/nchs/deaths.htm. The availability of mortality microdata

is described in Technical Notes.

Results and Discussion

Deaths and death rates

In 2018, a total of 2,839,205 resident deaths were registered

in the United States—25,702 more deaths than in 2017. The

crude death rate for 2018 (867.8 deaths per 100,000 population)

was 0.5% higher than the 2017 rate (863.8) (Tables B, 1, 2, 5,

7, and 9).

The age-adjusted death rate in 2018 was 723.6 deaths per

100,000 U.S. standard population—1.1% lower than the rate of

731.9 in 2017 (Tables B and 1). Age-adjusted death rates should

be viewed as relative indexes rather than as actual measures of

mortality risk. They are constructs that show what the level of

mortality would be if no changes occurred in the age composition

of the population from year to year. (For a discussion of age-

adjusted death rates, see Technical Notes.) Thus, age-adjusted

death rates are better indicators than unadjusted (crude) death

rates for examining changes in the risk of death over a period

of time when the age distribution of the population is changing.

Age-adjusted death rates also are better indicators of relative risk

when comparing mortality across geographic areas or between

sex or race subgroups of the population that have different age

distributions; see Technical Notes. Since 1980, the age-adjusted

death rate has decreased significantly every year except for

1983, 1985, 1988, 1993, 1999, 2005, 2010, 2013, 2015, and

2017 (Figure 1) (9).

Table A. Age-adjusted death rates based on bridged race versus unbridged race, by race and Hispanic origin and sex:

United States, 2018

[Age-adjusted rates are per 100,000 U.S. standard population. Bridged-race categories are consistent with the 1977 Office of Management and Budget (OMB)

standards; unbridged categories are consistent with 1997 OMB standards. Race and Hispanic origin are reported separately on the death certificate. Hispanic persons

may be of any race. Data for specified categories other than non-Hispanic white and non-Hispanic black should be interpreted with caution because of inconsistencies

between reporting these items on death certificates and on censuses and surveys; see Technical Notes in this report]

Bridged race

Single race

Race and Hispanic origin and sex Age-adjusted death rate Race and Hispanic origin and sex Age-adjusted death rate

All races and origins

. . . . . . . . . . . . . . . . . . . . . . . . . 723.6 All races and origins

. . . . . . . . . . . . . . . . . . . . . . . . . 723.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855.5 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 855.5

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.3 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611.3

Non-Hispanic: Non-Hispanic:

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 745.7 White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 748.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 874.3 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 878.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 634.1 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879.5 Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,085.2 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,102.8

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 724.2 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733.7

American Indian or Alaska Native

. . . . . . . . . . . . . 780.8 American Indian or Alaska Native

. . . . . . . . . . . . . 790.8

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 937.4 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 918.7

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641.7 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673.1

Asian or Pacific Islander

. . . . . . . . . . . . . . . . . . . . 392.2 Asian or Pacific Islander

. . . . . . . . . . . . . . . . . . . . …

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467.6 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332.4 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . …

Asian

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Asian

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381.2

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324.1

Native Hawaiian or Other Pacific Islander . . . . . . . . … Native Hawaiian or Other Pacific Islander . . . . . . . . 675.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597.3

Non-Hispanic, two or more races

. . . . . . . . . . . . . … Non-Hispanic, two or more races

. . . . . . . . . . . . . 338.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . … Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283.0

Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524.1 Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633.1 Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431.7 Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431.7

… Category not applicable.

Multiple-race data reported according to 1997 OMB standards were bridged to single-race categories of 1977 OMB standards; see Technical Notes in this report.

Multiple-race data reported according to 1997 OMB standards. For race-specific categories, only one race was reported on the death certificate; see Technical Notes in this report.

Includes deaths for origin not stated or not classifiable; see Technical Notes in this report.

Includes Aleut and Eskimo persons.

Includes Chinese, Filipino, Hawaiian, Japanese, and other Asian or Pacific Islander persons.

Includes Chinese, Filipino, Japanese, and other Asian persons.

Two or more races were reported on the death certificate.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 5

Death rates by race and Hispanic origin

In 2018, age-adjusted death rates for the major race and

ethnicity groups (Table 1) were:

• Non-Hispanic white population: 748.7 deaths per 100,000

U.S. standard population

• Non-Hispanic black population: 892.6

• Hispanic population: 524.1

In 2018, the age-adjusted death rate for the non-Hispanic

black population was 1.2 times that for the non-Hispanic white

population. The rate for the non-Hispanic white population was

1.4 times that for the Hispanic population (Table C).

From 2017 through 2018, the age-adjusted death rate

decreased for the total (1.1%), male (1.0%), and female (1.4%)

populations (Tables B and 1). The transition to the 1997 race

classifications for data year 2018 should be considered when

estimating change in mortality statistics between 2017 (based

on bridged race) and 2018 (based on single race) and when

evaluating trends that span 2017–2018. Mortality statistics were

estimated for both the bridged- and single-race groups in 2018

to inform these comparisons. When compared to the bridged-

race estimates for 2017, the age-adjusted, single-race death

rate decreased in 2018 for the total (0.8%), male (0.8%), and

female (1.0%) non-Hispanic white population. The bridged-race

estimates for 2018 were very similar to the single-race estimates

for the non-Hispanic white population, so the estimates of

change between 2017 and 2018 using the bridged estimate were

Table B. Percent change in death rates and age-adjusted

death rates in 2018 from 2017, by sex and age: United States

[Based on death rates on an annual basis per 100,000 population and age-

adjusted rates per 100,000 U.S. standard population; see Technical Notes in this

report]

Age group (years) Both sexes Male Female

All ages Percent change

Crude . . . . . . . . . . . . . . . . . . . . . . . 0.5 0.9 0.0

Age adjusted . . . . . . . . . . . . . . . . . –1.1 –1.0 –1.4

Under 1

. . . . . . . . . . . . . . . . . . . . . . –1.6 –0.9 –2.5

1–4. . . . . . . . . . . . . . . . . . . . . . . . . . –1.2 0.7 –3.3

5–14. . . . . . . . . . . . . . . . . . . . . . . . . –2.2 –5.8 3.5

15–24. . . . . . . . . . . . . . . . . . . . . . . . –5.1 –5.7 –4.0

25–34. . . . . . . . . . . . . . . . . . . . . . . . –3.0 –3.9 –1.0

35–44. . . . . . . . . . . . . . . . . . . . . . . . –0.3 0.0 –0.8

45–54. . . . . . . . . . . . . . . . . . . . . . . . –1.4 –0.9 –2.1

55–64. . . . . . . . . . . . . . . . . . . . . . . . 0.1 0.6 –0.7

65–74. . . . . . . . . . . . . . . . . . . . . . . . –0.4 0.3 –1.3

75–84. . . . . . . . . . . . . . . . . . . . . . . . –1.9 –1.9 –2.1

85 and over . . . . . . . . . . . . . . . . . . .

–0.9 –1.3 –0.7

Death rates for “Under 1” (based on population estimates) differ from infant mortality

rates (based on live births); see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Crude

600

800

1,000

1,200

1,400

2018201020001990198019701960

Age adjusted

Rate per 100,000 population

NOTE: Crude death rates are on an annual basis per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Figure 1. Crude and age-adjusted death rates: United States, 1960–2018

6 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

similar to those based on single race for 2018 (1.2% for the total

population and for males and 1.4% for females) (Table 1).

For the non-Hispanic black population, there was more

variability between single- and bridged-race estimates. Based

on the single-race estimates in 2018, the age-adjusted death

rate increased 1.3% for the total, 1.8% for males, and 0.8%

for females from 2017 (when compared with the bridged-race

estimates), while there were no significant changes between 2017

and 2018 when using the bridged estimates for 2018 (Table 1).

Observed changes in age-adjusted rates for the Hispanic total,

male, and female populations were not statistically significant.

Mortality for Hispanic persons may be somewhat

understated because of net underreporting of Hispanic origin on

the death certificate (by an estimated 3%); see Technical Notes.

Misclassification of Hispanic origin on the death certificate is

relatively stable across age groups (28). Although non-Hispanic

white and non-Hispanic black populations are not affected by

problems of underreporting (28,29), rates by race for other non-

Hispanic populations should be interpreted with consideration

that racial misclassification on death certificates exists (28).

Death rates by age and sex

For the total population, age-specific death rates decreased

significantly from 2017 to 2018 for age groups 15–24, 25–34,

45–54, 65–74, 75–84, and 85 and over. Changes in rates for other

age groups were not significant (Tables B, 5, and 7; Figure 2).

The age-adjusted death rate for males was 1.4 times the

rate for females in 2018 (Table C). The male-to-female death rate

ratio was unchanged from the ratio in 2017.

Death rates for males decreased significantly for age groups

5–14, 15–24, 25–34, 45–54, 75–84, and 85 and over. The rate

increased significantly for the age group 55–64. Changes in rates

for males in other age groups were not statistically significant.

Death rates for females decreased significantly for age groups

15–24, 45–54, 65–74, 75–84, and 85 and over. Changes in rates

for females in other age groups were not statistically significant.

Table C. Number of deaths, percentage of total deaths, death rates, and age-adjusted death rates for 2018, percent change in

age-adjusted death rates in 2018 from 2017, and ratio of age-adjusted death rates by sex and by race and Hispanic origin for the

15 leading causes of death for the total population in 2018: United States

[Crude death rates are on an annual basis per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in

this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget (OMB) standards]

Rank

Cause of death (based on International

Classification of Diseases, 10th Revision) Number

Percent of

total deaths,

2018

Crude

death rate,

2018

Age-adjusted death rate

2018

Percent

change Ratio

2017 to

2018

Male to

female

Non-Hispanic

black

non-Hispanic

white

Non-

Hispanic

white

Hispanic

… All causes 2,839,205 100.0 867.8 723.6 –1.1 1.4 1.2 1.4

1 Diseases of heart . . . . . (I00–I09,I11,I13,I20–I51) 655,381 23.1 200.3 163.6 –0.8 1.6 1.3 1.5

2 Malignant neoplasms . . . . . . . . . . . . . . (C00–C97) 599,274 21.1 183.2 149.1 –2.2 1.4 1.1 1.4

3 Accidents (unintentional

injuries) . . . . . . . . . . . . . . . (V01–X59,Y85–Y86) 167,127 5.9 51.1 48.0 –2.8 2.1 0.9 1.7

4 Chronic lower respiratory diseases . . . (J40–J47) 159,486 5.6 48.7 39.7 –2.9 1.2 0.7 2.7

5 Cerebrovascular diseases . . . . . . . . . . . (I60–I69) 147,810 5.2 45.2 37.1 –1.3 1.0 1.5 1.1

6 Alzheimer disease . . . . . . . . . . . . . . . . . . . . (G30) 122,019 4.3 37.3 30.5 –1.6 0.7 0.9 1.3

7 Diabetes mellitus . . . . . . . . . . . . . . . . . (E10–E14) 84,946 3.0 26.0 21.4 –0.5 1.6 2.1 0.8

8 Influenza and pneumonia . . . . . . . . . . . (J09–J18) 59,120 2.1 18.1 14.9 4.2 1.3 1.1 1.3

9 Nephritis, nephrotic syndrome and

nephrosis . . . . . . (N00–N07,N17–N19,N25–N27) 51,386 1.8 15.7 12.9 –0.8 1.5 2.2 1.0

10 Intentional self-harm

(suicide) . . . . . . . . . . . . . (*U03,X60-X84,Y87.0) 48,344 1.7 14.8 14.2 1.4 3.7 0.4 2.4

11 Chronic liver disease and

cirrhosis . . . . . . . . . . . . . . . . . . . (K70,K73–K74) 42,838 1.5 13.1 11.1 1.8 1.9 0.6 0.8

12 Septicemia . . . . . . . . . . . . . . . . . . . . . . (A40–A41) 40,718 1.4 12.4 10.2 –3.8 1.2 1.7 1.3

13 Essential hypertension and

hypertensive renal disease . . . . . . . .(I10,I12,I15) 35,835 1.3 11.0 8.9 –1.1 1.1 2.1 1.0

14 Parkinson disease . . . . . . . . . . . . . . . . (G20–G21) 33,829 1.2 10.3 8.7 3.6 2.3 0.5 1.5

15 Pneumonitis due to solids and liquids . . . . . (J69) 19,239 0.7 5.9 4.8 –5.9 1.8 1.0 1.6

… All other causes . . . . . . . . . . . . . . . . . . . (residual) 571,853 20.1 174.8 … … … … …

… Category not applicable.

Rank based on number of deaths; see Technical Notes in this report.

Includes only one race reported on the death certificate.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 7

Expectation of life at birth and at specified

ages

Life expectancy at birth represents the average number

of years that a group of infants would live if the group was to

experience throughout life the age-specific death rates present

in the year of birth.

Life table data shown in this report for 2010–2018 are based

on a revised methodology first presented with final data reported

for 2008. The life table methodology was revised by changing

the smoothing technique used to estimate the life table functions

at the oldest ages. This revision improves on the methodologies

used previously; see Technical Notes.

The methods used to produce life expectancies by Hispanic

origin are based on death rates adjusted for misclassification

(Technical Notes). In contrast, the age-specific and age-adjusted

death rates shown in this report for the Hispanic population are

not adjusted for misclassification of Hispanic origin. Thus, this

report shows Hispanic deaths and death rates as collected by the

registration areas, and these match the deaths and death rates

produced using the mortality data file.

Life tables were generated for both sexes and by each sex

for the following populations:

• Total U.S. population

• Non-Hispanic white population

• Non-Hispanic black population

• Hispanic population

In 2018, life expectancy at birth for the U.S. population

was 78.7 years, 0.1 year higher than 2017 (Tables 3 and 4). The

general trend in U.S. life expectancy since 1900 has been one of

improvement. The only decreases in life expectancy in the last

20 years occurred in 2015 and 2017. In 2018, life expectancy

for males (76.2 years) was 0.1 year higher than in 2017. Life

expectancy for females (81.2 years) was 0.1 year higher than

in 2017. From 1900 through the late 1970s, the gap in life

expectancy between the sexes widened (3) from 2.0 to 7.8 years.

The gap between sexes has narrowed since its peak in the 1970s

(Figure 3; Table 4). In 2018, the difference in life expectancy

between the sexes was 5.0 years, the same as in 2017.

Life expectancy figures by Hispanic origin have been

available starting with data for 2006 (30). The difference in life

Rate per 100,000 population

Rates are based on population estimates that differ from infant mortality rates (based on live births); see Figure 5 in this report for infant mortality rates and Technical Notes in this report

for further discussion of the difference.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

45–54 years

35–44 years

25–34 years

1–4 years

5–14 years

15–24 years

85 years and over

75–84 years

65–74 years

Under 1 year

Male

55–64 years

1955

100

1,000

10,000

100,000

1960 1970 1980 1990 2000 2010 2018

1955

1960 1970 1980 1990 2000 2010 2018

Female

85 years and over

75–84 years

65–74 years

Under 1 year

55–64 years

45–54 years

35–44 years

25–34 years

1–4 years

5–14 years

15–24 years

Figure 2. Death rates, by age and sex: United States, 1955–2018

8 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

expectancy between the non-Hispanic white and non-Hispanic

black populations was 3.9 years in 2018 (Table 4).

Life expectancy for the Hispanic population was 81.8

years in 2018, unchanged since 2016 (Tables 3 and 4). Life

expectancy was 1.5 years higher in 2018 compared with 2006.

The difference in life expectancy between the Hispanic and non-

Hispanic white population was 3.2 years in 2018 (Table 4). The

transition from bridged-race (1977 OMB standards) to single-

race (1997 OMB standards) classifications for data year 2018

should be considered when estimating change in life expectancy

between 2017 and 2018. Life expectancies were estimated for

both the bridged- and single-race groups in 2018 to inform these

comparisons. The 2018 life expectancy estimates for single race

were 0.1 year lower for the non-Hispanic white population,

0.2 year lower for the non-Hispanic black population and non-

Hispanic black males, and 0.1 year lower for non-Hispanic

black females than life expectancy based on 2018 bridged-race

estimates. Life expectancy for non-Hispanic white males and

non-Hispanic white females were the same for the single race and

bridged race (Table 4). For more information on the differences

in life expectancy for non-Hispanic white and non-Hispanic black

populations based on bridged-race compared with single-race

categories, see “United States Life Tables, 2018” (3).

Among the six Hispanic-origin–race–sex groups in 2018,

Hispanic females had the highest life expectancy at birth (84.3

years), followed by non-Hispanic white females (81.1), Hispanic

males (79.1), non-Hispanic black females (78.0), non-Hispanic

white males (76.2), and non-Hispanic black males (71.3) (Tables

3 and 4).

Life expectancy in 2018 remained unchanged since 2016 for

Hispanic males and since 2015 for Hispanic females.

Life expectancy in 2018 was 2.9 years higher for the

Hispanic male population than for the non-Hispanic white male

population and was 3.2 years higher for the Hispanic female

population than for the non-Hispanic white female population.

Various hypotheses have been proposed to explain favorable

mortality outcomes among Hispanic persons. The most

prevalent hypotheses are the healthy migrant effect, which

argues that Hispanic immigrants are selected for their good

health and robustness; the “salmon bias” effect, which posits

that U.S. residents of Hispanic origin may return to their country

of origin to die or when ill; and the “cultural effect,” which argues

that culturally influenced family structure, lifestyle behaviors,

and social networks may confer a protective barrier against

the negative effects of low socioeconomic and minority status

(31,32).

20182015201020052000199519901985198019751970

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Age (years)

Male

Both sexes

Female

Figure 3. Life expectancy at birth, by sex: United States, 1970–2018

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 9

Life tables shown in this report may be used to compare

life expectancies at selected ages from birth to 100 years. For

example, based on mortality experienced in 2018, a person aged

50 could expect to live an average of 31.7 more years, for a total

of 81.7 years. A person aged 65 could expect to live an average

of 19.5 more years, for a total of 84.5 years, and a person aged

85 could expect to live an average of 6.6 more years, for a total

of 91.6 years (Table 3). Life expectancy increased from 2017 to

2018 (at ages 0–50, 65, and 70) and was unchanged at all other

ages (Table 3) (3).

Leading causes of death

The 15 leading causes of death in 2018 accounted for 79.9%

of all deaths in the United States (Table C). The leading causes

of death in 2018 remained the same as in 2017. Causes of

death are ranked according to the number of deaths; for ranking

procedures, see Technical Notes. By rank, the 15 leading causes

of death in 2018 were:

1. Diseases of heart (heart disease)

2. Malignant neoplasms (cancer)

3. Accidents (unintentional injuries)

4. Chronic lower respiratory diseases

5. Cerebrovascular diseases (stroke)

6. Alzheimer disease

7. Diabetes mellitus (diabetes)

8. Influenza and pneumonia

9. Nephritis, nephrotic syndrome and nephrosis

(kidney disease)

10. Intentional self-harm (suicide)

11. Chronic liver disease and cirrhosis

12. Septicemia

13. Essential hypertension and hypertensive renal

disease (hypertension)

14. Parkinson disease

15. Pneumonitis due to solids and liquids

Death rates vary greatly by age. As a result, the shifting age

distribution of a population can significantly influence changes in

crude death rates over time. Age-adjusted death rates, in contrast,

eliminate the influence of such differences in the population age

structure. Consequently, whereas causes of death are ranked

according to the number of deaths, age-adjusted death rates are

used to depict trends for leading causes of death in this report

because they are better than crude rates for showing changes in

mortality over time and among causes of death (Figure 4; Tables

C and 5).

From 2017 through 2018, age-adjusted death rates

decreased significantly for 8 of the 15 leading causes of death

and increased for 4 of the 15 leading causes (Table C). The rate

for the top leading cause of death, heart disease, decreased 0.8%

in 2018 from 2017 (Figure 4; Tables C and 5) (9). The rate for

the second leading cause of death, cancer, decreased 2.2%,

continuing a gradual but consistent downward trend since 1993.

Deaths from these two diseases combined accounted for 44.2%

of deaths in the United States in 2018 (Table C).

Other leading causes of death that showed significant

decreases in 2018 from 2017 were unintentional injuries (2.8%),

Chronic lower respiratory diseases (2.9%), stroke (1.3%),

Alzheimer disease (1.6%), Septicemia (3.8%), and Pneumonitis

due to solids and liquids (5.9%).

The age-adjusted rate increased significantly in 2018 from

2017 for Influenza and pneumonia (4.2%), suicide (1.4%),

Chronic liver disease and cirrhosis (1.8%), and Parkinson

disease (3.6%).

The observed changes from 2017 to 2018 in the age-adjusted

death rates for diabetes, kidney disease, and hypertension were

not significant.

Assault (homicide), the 16th leading cause of death in 2018,

dropped from among the 15 leading causes of death in 2010. In

2018, the age-adjusted rate for homicide decreased 4.8%, but

homicide remains a major issue for some age groups. Homicide

was among the 15 leading causes of death in 2018 for age

groups under 1 year (13th), 1–4 (3rd), 5–14 (5th), 15–24 (3rd),

25–34 (3rd), 35–44 (5th), and 45–54 (12th) (9).

Although Human immunodeficiency virus (HIV) disease has

not been among the 15 leading causes of death since 1997 (33),

it is still considered a major public health problem for some age

groups. Historically, for all ages combined, HIV disease mortality

reached its highest level in 1995 after a period of increase from

1987 through 1994. Subsequently, the rate for this disease

decreased an average of 33.0% per year from 1995 through

1998, and 6.4% per year from 1999 through 2018 (9,34). In

2018, HIV disease was among the 15 leading causes of death

for age groups 25–34 (9th), 35–44 (11th), 45–54 (14th), and

55–64 (14th).

Enterocolitis due to Clostridium difficile (C. difficile)—A

predominantly antibiotic-associated inflammation of the

intestines caused by C. difficile, a gram-positive, anaerobic,

spore-forming bacillus—has been of growing concern in recent

years. The disease is often acquired in hospitals or other health

care facilities with long-term patients or residents (35,36). The

number of deaths from C. difficile climbed from 793 deaths in

1999 to a high of 8,085 deaths in 2011 (9,34). In 2018, the

number of deaths from C. difficile was 5,249. In 2018, the age-

adjusted death rate for this cause was 1.3 deaths per 100,000

U.S. standard population, a decrease of 18.8% from the rate in

2017 (1.6). In 2018, C. difficile ranked as the 19th leading cause

of death for the population aged 65 and over. Approximately 86%

of deaths from C. difficile occurred among people aged 65 and

over (Table 6).

The relative risk of death in one population group compared

with another can be expressed as a ratio. Ratios based on age-

adjusted death rates show that males have higher rates than

females for 13 of the 15 leading causes of death (Table C), with

rates for males being at least twice as great as those for females

for 3 of these leading causes. The largest ratio was for suicide

(3.7). Other high ratios were evident for Parkinson disease (2.3),

unintentional injuries (2.1), Chronic liver disease and cirrhosis

(1.9), Pneumonitis due to solids and liquids (1.8), heart disease

and diabetes (1.6 each), kidney disease (1.5), cancer (1.4),

Influenza and pneumonia (1.3), Chronic lower respiratory

diseases and Septicemia (1.2 each), and hypertension (1.1).

Age-adjusted rates were lower for males than for females for one

leading cause, Alzheimer disease (0.7).

Circled numbers indicate ranking of conditions as leading causes of death in 2018.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

10 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Age-adjusted death rates for the non-Hispanic black

population were higher than for the non-Hispanic white

population for 8 of the 15 leading causes of death (Table C). The

largest ratios were for kidney disease (2.2) and hypertension

and diabetes (2.1 each). Other causes for which the ratio was

high include Septicemia (1.7), stroke (1.5), heart disease (1.3),

and cancer and Influenza and pneumonia (1.1 each). For six

of the leading causes, age-adjusted rates were lower for the

non-Hispanic black population than for the non-Hispanic white

population. The smallest non-Hispanic black-to-non-Hispanic

white ratio was for suicide (0.4); that is, the risk of dying from

suicide was more than two times greater for the non-Hispanic

white population than for the non-Hispanic black population.

Other conditions with a low non-Hispanic black-to-non-Hispanic

white ratio were Parkinson disease (0.5), Chronic liver disease

and cirrhosis (0.6), Chronic lower respiratory diseases (0.7), and

unintentional injuries and Alzheimer disease (0.9 each).

Leading causes of death in 2018 for the total population and

for specific subpopulations are detailed further in a companion

National Vital Statistics Report on leading causes by age, race,

Hispanic origin, and sex (2).

Age-adjusted death rates for the non-Hispanic white

population were higher than for the Hispanic population for 11 of

the 15 leading causes of death (Table C). The largest ratios were

for Chronic lower respiratory diseases (2.7) and suicide (2.4).

Other causes for which the ratio was high include unintentional

injuries (1.7); Pneumonitis due to solids and liquids (1.6); heart

disease and Parkinson disease (1.5 each); cancer (1.4); Alzheimer

disease, Influenza and pneumonia, and Septicemia (1.3 each);

and stroke (1.1). Age-adjusted rates were lower for the non-

Hispanic white population than for the Hispanic population for

diabetes and Chronic liver disease and cirrhosis (0.8 each).

Other select causes

Dementia-related mortality

In 2018, 266,957 persons died of dementia-related

causes in the United States (Tables 6, 8, and I–1). Deaths from

dementia-related causes are presented for the first time in this

report to provide a more comprehensive estimate of the burden

of mortality from Alzheimer disease and other dementias in the

United States.

2018

Circled numbers indicate ranking of conditions as leading causes of death in 2018.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Rate per 100,000 U.S. standard population

0.1

1.0

10.0

100.0

1,000.0

1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

1958

ICD–7 ICD–8 ICD–9 ICD–10

Diseases of heart

Malignant neoplasms

Cerebrovascular diseases

Accidents (unintentional injuries)

Nephritis, nephrotic syndrome

and nephrosis

Hypertension

Parkinson disease

Alzheimer disease

Figure 4. Age-adjusted death rates for selected leading causes of death: United States, 1958–2018

NOTES: ICD is the International Classification of Diseases.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 11

Dementia-related causes include conditions with similar

physical signs and symptoms that, collectively, are considered

to be a good indicator of dementia mortality (37). Dementia is

characterized by memory impairment and cognitive decline

(38). Causes of death attributable to dementia-related mortality

include ICD–10 codes F01, Vascular dementia; F03, Unspecified

dementia; G30, Alzheimer disease; and G31, Other degenerative

diseases of nervous system, not elsewhere classified. Alzheimer

disease, the sixth leading cause of death, is the most common

cause of dementia, but other dementias, including Lewy body

dementia, frontotemporal degeneration, vascular dementia, and

mixed dementias, are often indistinguishable from Alzheimer

disease in their symptoms and outcomes and may coexist with

Alzheimer disease (37–39).

Certification and coding rule changes can impact data

analysis of component causes of dementia. In 2018, Alzheimer

disease accounted for 45.7% of all dementia deaths; Unspecified

dementia for 37.7%; Other degenerative diseases of nervous

system, not elsewhere classified for 10.4%; and Vascular

dementia for 6.2%. Changes in the percentage of deaths assigned

to individual causes comprising dementia may be the result of

many factors (40). Combining the types of dementia provides a

more comprehensive and stable measure of dementia mortality.

The age-adjusted death rate for dementia-related causes did

not change significantly in 2018 from 2017 for the total, male,

and female populations (Tables 5, 10, and I–1).

Drug-induced mortality

In 2018, a total of 71,147 persons died of drug-induced

causes in the United States (Tables 6, 8, and I– 2). This category

includes deaths from poisoning and medical conditions caused

by use of legal or illegal drugs, as well as deaths from poisoning

due to medically prescribed and other drugs. It excludes deaths

indirectly related to drug use, as well as newborn deaths due to

the mother’s drug use. (For a list of drug-induced causes, see

Technical Notes.)

In 2018, the age-adjusted death rate for drug-induced causes

for the total population decreased significantly, by 4.4%, from

22.8 in 2017 to 21.8 in 2018 (Tables 5, 10, and I–2). For males in

2018, the age-adjusted death rate for drug-induced causes was

2.0 times the rate for females. The rate for drug-induced causes

decreased 3.9% for males and 5.9% for females in 2018 from

2017. The age-adjusted death rate for non-Hispanic white males

was 2.0% higher than for non-Hispanic black males and 101.7%

higher than for Hispanic males. The rate for non-Hispanic white

females was 54.5% higher than for non-Hispanic black females

and 239.3% higher than for Hispanic females.

The age-adjusted death rate for drug-induced causes

increased significantly in 2018 from 2017 for Hispanic males

(4.2%). The rate for Hispanic females did not change significantly.

Alcohol-induced mortality

In 2018, a total of 37,329 persons died of alcohol-induced

causes in the United States (Tables 6, 8, and I–3). This category

includes deaths from dependent and nondependent use of

alcohol, and deaths from accidental poisoning by alcohol. It

excludes unintentional injuries, homicides, and other causes

indirectly related to alcohol use, and deaths due to fetal alcohol

syndrome. For a list of alcohol-induced causes, see Technical

Notes.

The age-adjusted death rate for alcohol-induced causes for

the total population increased significantly, by 3.1%, from 9.6 in

2017 to 9.9 in 2018 (Tables 5, 10, and I–3). The rate for alcohol-

induced causes increased 2.8% for males and 5.7% for females

in 2018 from 2017 (Tables 5, 10, and I–3). For males, the age-

adjusted death rate for alcohol-induced causes in 2018 was 2.6

times the rate for females. The age-adjusted death rate for non-

Hispanic white males was 36.6% higher than for non-Hispanic

black males and 10.5% lower than for Hispanic males. The rate

for non-Hispanic white females was 66.7% higher than for non-

Hispanic black females and 97.0% higher than for Hispanic

females.

The age-adjusted rate for alcohol-induced death did not

change significantly in 2018 from 2017 for Hispanic males and

females.

Firearm-related mortality

In 2018, 39,740 persons died from firearm-related injuries

in the United States (Tables 6, 8, and I–4). The age-adjusted

death rate for firearm-related injuries for the total, male, and

female populations did not change significantly from 2017 to

2018 (Tables 5, 10, and I–4). For males in 2018, the age-adjusted

death rate for firearm-related injuries was 6.1 times the rate for

females. The age-adjusted death rate for non-Hispanic white

males was 53.6% lower than for non-Hispanic black males and

68.1% higher than for Hispanic males. The rate for non-Hispanic

white females was 31.5% lower than for non-Hispanic black

females and 117.6% higher than for Hispanic females.

The age-adjusted death rates for firearm-related injuries did

not change significantly in 2018 from 2017 for Hispanic males

and Hispanic females.

Effect on life expectancy of changes in

mortality by age and cause of death

Changes in mortality by age and cause of death can have

a major effect on life expectancy. In other words, year-to-year

changes in life expectancy may be influenced by changes in age-

specific rates for certain causes, particularly for younger age

groups. Life expectancy at birth for the total population increased

by 0.1 year in 2018 from 2017 primarily because of decreases

in mortality from cancer, unintentional injuries, Chronic lower

respiratory diseases, heart disease, and homicide. The increase

in life expectancy for the total population was slightly offset by

increases in mortality from Influenza and pneumonia, suicide,

Nutritional deficiencies, Chronic liver disease and cirrhosis, and

Parkinson disease. Life expectancy at birth for males increased

0.1 year due to decreases in mortality from unintentional injuries,

cancer, homicide, Chronic lower respiratory diseases, and Viral

hepatitis. These decreases were offset somewhat by increases

in mortality from Influenza and pneumonia, suicide, Chronic

liver disease and cirrhosis, kidney disease, and diabetes. For

the female population, life expectancy at birth increased 0.1 year

12 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

due to decreases in mortality from cancer, unintentional injuries,

heart disease, Chronic lower respiratory diseases, and stroke,

which were offset by increases in mortality from Influenza and

pneumonia, Nutritional deficiencies, suicide, and Parkinson

disease. (For a discussion of the major causes contributing to the

change in life expectancy, see Technical Notes.) The difference in

life expectancy between the male and female populations was

5.0 years in 2018, unchanged from 2017 (Table 4).

Life expectancy for the Hispanic population in 2018 remained

the same (81.8 years) due to decreases in mortality from heart

disease, congenital malformations, diabetes, Viral hepatitis,

and homicide, which were offset somewhat by increases for

suicide, Alzheimer disease, Influenza and pneumonia, kidney

disease, and Chronic liver disease and cirrhosis. Life expectancy

for the Hispanic male population in 2018 remained the same

(79.1 years) due to decreases in mortality from heart disease,

diabetes, Viral hepatitis, homicide, and cancer, which were offset

somewhat by increases for suicide, Alzheimer disease, kidney

disease, Influenza and pneumonia, and Chronic liver disease and

cirrhosis. Life expectancy for the Hispanic female population

in 2018 remained the same (84.3 years) due to decreases in

mortality from heart disease, congenital malformations, Chronic

lower respiratory diseases, cancer, and diabetes, which were

offset somewhat by increases for Influenza and pneumonia,

Alzheimer disease, suicide, Certain conditions originating in the

perinatal period, and Nutritional deficiencies.

Life table partitioning analysis indicates that the difference

in 2018 of 3.2 years in life expectancy between the Hispanic and

non-Hispanic white populations is mostly explained by lower

mortality for the Hispanic population from cancer, heart disease,

unintentional injuries, Chronic lower respiratory diseases, and

suicide. (For a discussion of the major causes contributing to the

difference in life expectancy, see Technical Notes.)

Injury mortality by mechanism and intent

In 2018, a total of 240,583 deaths were classified as injury-

related (Table 11). Injury data are presented using the external

cause-of-injury mortality matrix for ICD–10, as jointly conceived

by the International Collaborative Effort on Injury Statistics and

the Injury Control and Emergency Health Services section of

the American Public Health Association (41,42). The ICD codes

for injuries have two essential dimensions: the mechanism of

the injury and its manner or intent. The mechanism involves the

circumstances of the injury (e.g., fall, motor vehicle traffic, or

poisoning). The manner or intent involves whether the injury

was purposefully inflicted (where it can be determined) and,

when intentional, whether the injury was self-inflicted (suicide)

or inflicted upon another person (assault). In other report tables

showing cause of death, the focus is on manner or intent, with

subcategories showing selected mechanisms.

The matrix has two distinct advantages for the analysis

of injury mortality data: It contains a comprehensive list of

mechanisms, and data can be displayed by mechanism with

subcategories of intent, or vice versa. Four major mechanisms

of injury in 2018—poisoning, motor-vehicle traffic, firearm, and

fall—accounted for 78.5% of all injury deaths (Table 11). A total

of 72,473 deaths occurred as the result of poisonings in 2018,

accounting for 30.1% of all injury deaths (Table 11). The age-

adjusted death rate for poisoning decreased significantly, by

4.3% from 23.2 deaths per 100,000 U.S. standard population

in 2017 to 22.2 in 2018. Most poisoning deaths were either

unintentional (86.1%) or suicides (8.6%). However, 5.1% of

poisoning deaths were of undetermined intent. The age-adjusted

death rate for unintentional poisoning decreased 4.0%, from

20.1 in 2017 to 19.3 in 2018.

Motor vehicle traffic-related injuries in 2018 resulted in

37,991 deaths, accounting for 15.8% of all injury deaths (Table 11).

The age-adjusted death rate for these injuries decreased 2.6%

from 11.5 in 2017 to 11.2 in 2018. In 2018, 39,740 persons died

from firearm injuries in the United States (Table 11), accounting

for 16.5% of all injury deaths that year.

The age-adjusted death rate from firearm injuries (all intents)

did not change significantly between 2017 and 2018. The two

major component causes of firearm injury deaths in 2018 were

suicide (61.5%) and homicide (35.1%). The age-adjusted death

rate for firearm suicide did not change significantly between 2017

and 2018. The age-adjusted rate for firearm homicide decreased

4.3% from 4.6 in 2017 to 4.4 in 2018. A total of 38,707 persons

died as the result of falls in 2018, accounting for 16.1% of all

injury deaths (Table 11).

The age-adjusted death rate for falls in 2018 was 9.8, the

same as in 2017. The overwhelming majority of fall-related

deaths (96.8%) were unintentional.

State of residence

Mortality patterns varied considerably by state (Tables 12

and 15). The state with the highest age-adjusted death rate in

2018 was West Virginia (953.8 per 100,000 U.S. standard

population), with a rate 31.8% above the national rate (723.6).

The state with the lowest age-adjusted death rate was Hawaii

(572.5), with a rate 20.9% below the national rate. The age-

adjusted death rate for West Virginia was 66.6% higher than the

rate for Hawaii.

Variations in mortality by state were associated with

differences in socioeconomic status, racial and ethnic

composition, as well as with differences in risk of specific causes

of death (43).

Infant mortality

In 2018, a total of 21,467 deaths occurred among children

under age 1 year (Tables D, E, 14, and 15). This number

represents 868 fewer infant deaths in 2018 than in 2017. The

ratio of male to female infant mortality rates was 1.2, the same as

in 2017. The infant mortality rate was 5.66 per 1,000 live births,

the neonatal mortality rate (deaths of infants aged 0–27 days per

1,000 live births) was 3.77, and the postneonatal mortality rate

(deaths of infants aged 28 days through 11 months per 1,000

live births) was 1.89 in 2018 (Figure 5; Tables D and 13; see

Technical Notes for information on alternative data sources).

The infant mortality rate decreased 2.2% in 2018 from 2017.

Changes in the neonatal and postneonatal mortality rates from

2017 to 2018 were not significant.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 13

The 10 leading causes of infant death in 2018 accounted for

67.6% of all infant deaths in the United States (Table E). By rank,

the 10 leading causes were:

1. Congenital malformations, deformations

and chromosomal abnormalities (congenital

malformations)

2. Disorders related to short gestation and low

birth weight, not elsewhere classified (low birth

weight)

3. Newborn affected by maternal complications of

pregnancy (maternal complications)

4. Sudden infant death syndrome (SIDS)

5. Accidents (unintentional injuries)

6. Newborn affected by complications of placenta,

cord and membranes (cord and placental

complications)

7. Bacterial sepsis of newborn

8. Diseases of the circulatory system

9. Respiratory distress of newborn

10. Neonatal hemorrhage

In 2018, the 10 leading causes of infant death remained

the same as in 2017 (34). Among the 10 leading causes, rates

decreased in 2018 from 2017 for unintentional injuries (9.9%)

and for Newborn affected by complications of placenta, cord and

membranes (12.8%). Changes in rates among the other leading

causes of infant death were not statistically significant (Table E).

Infant mortality rates by race for non-Hispanic origin that

are based on the mortality file may be somewhat understated and

are better measured using data from the linked file of live births

and infant deaths (44); see Technical Notes. Infant mortality

data presented in this report use the general mortality file, not

the linked file of live births and infant deaths. Infant mortality

rates for the population of Hispanic origin are not adjusted for

misclassification; see Technical Notes. Because these rates are

not adjusted, the misclassification of Hispanic origin should be

considered when interpreting rate disparities between Hispanic

and non-Hispanic populations (28).

In 2018, the infant mortality rate for Hispanic infants was

5.06 deaths per 1,000 live births. By comparison, for non-

Hispanic white infants, the infant mortality rate was 4.55, and for

non-Hispanic black infants, the rate was 11.10 (Table 13).

Maternal mortality

Maternal mortality data are included in this report for the

first time since 2007. In 2018, a total of 658 women died of

maternal causes in the United States (Table 16). The maternal

mortality rate in 2018 was 17.4 deaths per 100,000 live births.

The maternal mortality rate for non-Hispanic black women

(37.3 deaths per 100,000 live births) was 2.5 times the rate for

non-Hispanic white women (14.9), 2.8 times the rate for Asian

women (13.3), and 3.2 times the rate for Hispanic women (11.8).

The maternal mortality rates for AIAN and NHOPI women do not

meet standards of reliability because the death numbers are

too low. Deaths from maternal causes were identified using a

newly revised coding method. The 2018 coding method restricts

application of the pregnancy checkbox to decedents aged 10–44

for coding cause of death to a maternal cause when the certificate

has no mention of a maternal-related condition but has a positive

checkbox entry (45). For women aged 45 and over, the checkbox

is used in coding cause of death only if a positive checkbox entry

is accompanied by a mention of a maternal-related condition

as a cause of death. Maternal deaths include deaths of women

while pregnant or within 42 days of being pregnant, from any

cause related to or aggravated by the pregnancy but exclude

deaths from external causes (i.e., accidents, homicides, and

suicides); for more information, see “Maternal Mortality in the

United States: Changes in Coding, Publication, and Data Release,

2018” (45) and Technical Notes.

Table D. Number of infant, neonatal, and postneonatal deaths and mortality rates, by sex: United States, 2017–2018

[Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group]

Age and sex

2018 2017 Percent

change

from

2017 to 2018Number Rate Number Rate

Infant

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,467 5.66 22,335 5.79 –2.2

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,068 6.23 12,468 6.32 –1.4

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,399 5.07 9,867 5.24 –3.2

Neonatal

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,289 3.77 14,821 3.84 –1.8

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,008 4.13 8,259 4.19 –1.4

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,281 3.39 6,562 3.49 –2.9

Postneonatal

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,178 1.89 7,514 1.95 –3.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,060 2.09 4,209 2.13 –1.9

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,118 1.68 3,305 1.76 –4.5

Based on a comparison of 2018 and 2017 mortality rates.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

NOTE: Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

14 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table E. Number of infant deaths, percentage of total infant deaths, and infant mortality rates for 2018, and percent change in

infant mortality rates from 2017 to 2018 for the 10 leading causes of infant death in 2018: United States

[Rates are infant deaths per 100,000 live births]

Rank

Cause of death (based on International Classification of Diseases, 10th Revision) Number

Percent of

total deaths Rate

Percent

change

from

2017 to 2018

… All causes 21,467 100.0 566.2 –2.3

1 Congenital malformations, deformations and chromosomal abnormalities . . . . . . . (Q00–Q99) 4,473 20.8 118.0 –0.7

2 Disorders related to short gestation and low birth weight, not elsewhere classified . . . . (P07) 3,679 17.1 97.0 –0.2

3 Newborn affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . . . . . . . (P01) 1,358 6.3 35.8 –3.5

4 Sudden infant death syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (R95) 1,334 6.2 35.2 –0.6

5 Accidents (unintentional injuries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V01–X59) 1,168 5.4 30.8 –9.9

6 Newborn affected by complications of placenta, cord and membranes . . . . . . . . . . . . . . (P02) 724 3.4 19.1 –12.8

7 Bacterial sepsis of newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P36) 579 2.7 15.3 –0.6

8 Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I00–I99) 428 2.0 11.3 –2.6

9 Respiratory distress of newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P22) 390 1.8 10.3 –9.6

10 Neonatal hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(P50–P52,P54) 375 1.7 9.9 1.0

… All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (residual) 6,959 32.4 183.5 …

… Category not applicable.

Rank based on number of deaths; see Technical Notes in this report.

Based on a comparison of the 2018 infant mortality rate with the 2017 infant mortality rate.

NOTE: Due to rounding, percent changes based on rates per 100,000 live births may differ from those computed using rates per 1,000 live births.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

NOTE: Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Deaths per 1,000 live births

2018201020001990198019701960

Infant

Neonatal

Postneonatal

Figure 5. Infant, neonatal, and postneonatal mortality rates: United States, 1960–2018

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 15

Additional mortality tables based on 2018 final

data

Trend data on dementia-related causes, drug-induced

causes, alcohol-induced causes, and firearm-related injuries by

race and Hispanic origin are available as supplemental tables

(Tables I–1 through I–4) from the NCHS website: https://www.

cdc.gov/nchs/data/nvsr/nvsr69/nvsr69-13-tables-508.pdf.

Mortality data by specified Hispanic subgroup, marital status,

educational attainment, and injury at work are available in

supplemental Tables I–5 through I–9. Estimated population and

standard errors by specified Hispanic subgroups, marital status,

and educational attainment are available as supplemental tables

(Tables I–17 through I–19). Tables I–20 through I–27 provide

trend data by the bridged-race categories. See List of Internet

Tables for the complete list of supplemental tables.

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List of Detailed Tables

1. Number of deaths, death rates, and age-adjusted death

rates, by race and Hispanic origin and sex: United States,

2010–2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

2. Number of deaths and death rates by age, and age-

adjusted death rates, by race and Hispanic origin and sex:

United States, 2018 ............................... 22

3. Life expectancy at selected ages, by race and Hispanic

origin and sex: United States, 2018 ................... 26

4. Life expectancy at birth, by race and Hispanic origin and

sex: United States, 2010–2018 ...................... 27

5. Death rates by age, and age-adjusted death rates, for the 10

leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by

ﬁrearms: United States, 1999–2018

.................. 28

6. Number of deaths from selected causes, by age:

United States, 2018 ............................... 36

7. Death rates for selected causes, by age: United States,

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

8. Number of deaths from selected causes, by race and

Hispanic origin and sex: United States, 2018 ............ 42

9. Death rates for selected causes, by race and Hispanic origin

and sex: United States, 2018 ........................ 47

10. Age-adjusted death rates for selected causes, by race and

Hispanic origin and sex: United States, 2018 ............ 52

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 19

11. Number of deaths, death rates, and age-adjusted death

rates for injury deaths, by mechanism and intent of death

for all injury death and the leading causes of injury death:

United States, 2018

............................... 57

12. Number of deaths, death rates, and age-adjusted death

rates for major causes of death: United States, each state,

Puerto Rico, U.S. Virgin Islands, Guam, American Samoa,

and Northern Marianas, 2018

....................... 58

13. Infant, neonatal, and postneonatal mortality rates, by race

and Hispanic origin and sex: United States, 2010–2018 ... 61

14. Number of infant deaths and infant mortality rates for

selected causes, by race and Hispanic origin: United States,

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

15. Number of infant deaths and mortality rates, by race and

Hispanic origin for the United States, each state, Puerto

Rico, U.S. Virgin Islands, Guam, American Samoa, and

Northern Marianas, and by sex for the United States, 2018

. 64

16. Number of maternal deaths and maternal mortality rates for

selected causes, by race and Hispanic origin: United States,

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

List of Internet Tables

(Available from https://www.cdc.gov/nchs/data/nvsr/nvsr69/

nvsr69-13-tables-508.pdf)

I–1. Number of deaths, death rates, and age-adjusted death rates for

dementia-related causes, by race and Hispanic origin and sex:

United States, 2010–2018

I–2. Number of deaths, death rates, and age-adjusted death rates

for drug-induced causes, by race and Hispanic origin and sex:

United States, 2010–2018

I–3. Number of deaths, death rates, and age-adjusted death rates for

alcohol-induced causes, by race and Hispanic origin and sex:

United States, 2010–2018

I–4. Number of deaths, death rates, and age-adjusted death rates

for injury by ﬁrearms, by race and Hispanic origin and sex:

United States, 2010–2018

I–5. Number of deaths and death rates by age, and age-adjusted

death rates, by speciﬁed Hispanic origin, and sex: United States,

2018

I–6. Number of deaths, death rates, and age-adjusted death rates for

ages 15 and over, by marital status and sex: United States, 2018

I–7. Number of deaths, death rates, and age-adjusted death rates for

ages 25–64, by educational attainment and sex: United States,

2018

I–8. Number of deaths, death rates, and age-adjusted death rates for

injury at work for ages 15 and over, by race and Hispanic origin

and sex: United States, 2018

I–9. Number of deaths, death rates, and age-adjusted death rates

for injury at work, by race and Hispanic origin and sex:

United States, 2010–2018

I–10. Number of deaths and death rates, by age, race, Hispanic origin,

and sex: United States, 2018

I–11. Number of deaths from 113 selected causes, Enterocolitis due

to Clostridium difﬁcile, drug-induced causes, alcohol-induced

causes, and ﬁrearm-related injuries, by race, Hispanic origin,

and sex: United States, 2018

I–12. Death rates for 113 selected causes, Enterocolitis due to

Clostridium difﬁcile, drug-induced causes, alcohol-induced

causes, and ﬁrearm-related injuries, by race, Hispanic origin,

and sex: United States, 2018

I–13. Age-adjusted death rates for 113 selected causes, Enterocolitis

due to Clostridium difﬁcile, drug-induced causes, alcohol-

induced causes, and ﬁrearm-related injuries, by race, Hispanic

origin, and sex: United States, 2018

I–14. Number of deaths, death rates, and age-adjusted death rates for

injury deaths, by mechanism and intent of death: United States,

2018

I–15. Number of deaths, death rates, and age-adjusted death rates

for major causes of death: United States, each state, Puerto

Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern

Marianas, 2018

I–16. Number of infant deaths and infant mortality rates for 130

selected causes, by race and Hispanic origin: United States,

2018

I–17. Estimated population and standard errors for speciﬁed Hispanic-

origin populations, by 10-year age group and sex: United States,

2018

I–18. Estimated population and standard errors for ages 15 and over

by marital status, 10-year age group, and sex: United States,

2018

I–19. Estimated population and standard errors for ages 25–64, by

educational attainment and sex: United States, 2018

I–20 Number of deaths, death rates, and age-adjusted death rates,

by race and Hispanic origin and sex: United States, 1940, 1950,

1960, 1970, 1980, 1990, 2000, and 2010–2018

I–21. Life expectancy at birth, by race and Hispanic origin and sex:

United States, 1940, 1950, 1960, 1970, 1980, 1990, and

2000–2018

I–22. Infant, neonatal, and postneonatal mortality rates, by race and

Hispanic origin and sex: United States, 1940, 1950, 1960, 1970,

1980, 1990, 2000–2018

I–23. Number of deaths, death rates, and age-adjusted death rates for

dementia-related causes, by race and Hispanic origin and sex:

United States, 1999–2018

I–24. Number of deaths, death rates, and age-adjusted death rates

for drug-induced causes, by race and Hispanic origin and sex:

United States, 1999–2018

I–25. Number of deaths, death rates, and age-adjusted death rates for

alcohol-induced causes, by race and Hispanic origin and sex:

United States, 1999–2018

I–26. Number of deaths, death rates, and age-adjusted death rates

for injury by ﬁrearms, by race and Hispanic origin and sex:

United States, 1999–2018

I–27. Number of deaths, death rates, and age-adjusted death

rates for injury at work, by race and Hispanic origin and sex:

United States, 1997–2018

20 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 1. Number of deaths, death rates, and age-adjusted death rates, by race and Hispanic origin and sex: United States,

2010–2018

[Excludes deaths of nonresidents of the United States]

Race and Hispanic origin and year

Number Crude death rate

Age-adjusted death rate

Both sexes Male Female Both sexes Male Female Both sexes Male Female

All races and origins

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,839,205 1,458,469 1,380,736 867.8 905.2 831.6 723.6 855.5 611.3

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,813,503 1,439,111 1,374,392 863.8 897.2 831.4 731.9 864.5 619.7

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,744,248 1,400,232 1,344,016 849.3 880.2 819.3 728.8 861.0 617.5

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,712,630 1,373,404 1,339,226 844.0 868.0 820.7 733.1 863.2 624.2

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,626,418 1,328,241 1,298,177 823.7 846.4 801.7 724.6 855.1 616.7

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,596,993 1,306,034 1,290,959 821.5 839.1 804.4 731.9 863.6 623.5

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,543,279 1,273,722 1,269,557 810.2 824.5 796.4 732.8 865.1 624.7

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,515,458 1,254,978 1,260,480 807.3 818.7 796.3 741.3 875.3 632.4

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,468,435 1,232,432 1,236,003 799.5 812.0 787.4 747.0 887.1 634.9

Non-Hispanic, single-race white

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,182,552 1,108,848 1,073,704 1,104.8 1,138.2 1,072.3 748.7 878.0 636.5

Non-Hispanic, bridged-race white

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,188,349 1,111,840 1,076,509 1,088.4 1,121.4 1,056.2 745.7 874.3 634.1

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,179,857 1,102,838 1,077,019 1,083.2 1,111.4 1,055.8 755.0 885.1 642.8

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,133,463 1,077,362 1,056,101 1,059.7 1,085.6 1,034.6 749.0 879.5 637.2

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,123,631 1,063,705 1,059,926 1,055.3 1,072.5 1,038.5 753.2 881.3 644.1

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,066,949 1,035,345 1,031,604 1,028.1 1,045.4 1,011.3 742.8 872.3 633.8

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,052,660 1,021,135 1,031,525 1,021.6

1,032.1 1,011.5 747.1 876.8 638.4

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,016,896 998,832 1,018,064 1,004.9 1,011.2 998.8 745.8 876.2 637.6

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,006,319 989,835 1,016,484 1,001.0 1,004.1 998.1 754.3 887.2 644.6

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,969,916 971,604 998,312 984.3 987.5 981.2 755.0 892.5 643.3

Non-Hispanic, single-race black

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341,408 177,958 163,450 834.7 909.8 765.9 892.6 1,102.8 733.7

Non-Hispanic, bridged-race black

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343,393 178,904 164,489 799.8 869.6 735.6 879.5 1,085.2 724.2

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335,667 174,403 161,264 787.5 854.2 726.1 881.0 1,083.3 728.0

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326,810 168,750 158,060 775.5 836.2 719.7 882.8 1,081.2 734.1

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315,254 161,850 153,404 754.6 809.4 704.3 876.1 1,070.1 731.0

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303,844 154,836 149,008 735.4 783.3 691.4 870.7 1,060.3 731.2

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299,227 152,661 146,566 733.4 782.5 688.4 885.2 1,083.3 740.6

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291,179 148,344 142,835 720.9 768.5 677.3 887.1 1,086.4 742.1

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286,797 145,052 141,745 718.0 760.4 679.2 901.6 1,098.3 759.8

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . 283,438 143,824 139,614 718.7 764.5 676.9 920.4 1,131.7 770.8

Non-Hispanic, single-race

American Indian or Alaska Native

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,790 9,678 8,112 735.9 813.5 660.8 790.8 918.7 673.1

Non-Hispanic, bridged-race

American Indian or Alaska Native

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,491 10,875 8,616 709.8 807.7 615.6 780.8 937.4 641.7

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,198 10,502 8,696 703.4 784.4 625.5 800.2 943.9 674.0

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,595 10,280 8,315 685.9 772.8 602.2 800.3 954.0 668.0

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,039 9,869 8,170 670.7 747.4 596.7 805.7 950.2 679.5

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,138 9,338 7,800 642.5 713.4 574.2 796.9 935.0 677.4

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16,219 8,840 7,379 613.7 681.4 548.3 787.5 930.6 666.4

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,705 8,598 7,107 599.3 668.7 532.5 787.8 929.9 666.3

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,181 8,175 7,006 584.2 640.9 529.5 798.1 933.8 684.7

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,846 8,072 6,774 577.8 640.1 517.7 818.8 965.8 696.8

Non-Hispanic, single-race Asian

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,768 35,089 33,679 367.2 393.4 343.3 381.2 454.1 324.1

Non-Hispanic, single-race

Native Hawaiian or Other Pacific Islander

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,277 1,786 1,491 558.9 605.4 511.8 675.7 758.1 597.3

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 21

Table 1. Number of deaths, death rates, and age-adjusted death rates, by race and Hispanic origin and sex: United States,

2010–2018—Con.

[Excludes deaths of nonresidents of the United States]

Race and Hispanic origin and year

Number Crude death rate

Age-adjusted death rate

Both sexes Male Female Both sexes Male Female Both sexes Male Female

Non-Hispanic, bridged-race

Asian or Pacific Islander

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75,266 38,760 36,506 366.3 394.4 340.5 392.2 467.6 332.4

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72,598 37,236 35,362 359.8 386.2 335.6 395.3 470.1 336.4

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,235 34,892 33,343 350.3 374.9 327.8 394.4 466.6 337.4

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65,277 33,306 31,971 341.5 364.9 320.1 396.2 468.9 339.6

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60,424 31,039 29,385 327.7 352.7 305.0 390.5 464.2 333.3

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58,702 30,343 28,359 331.8 359.2 306.7 407.5 490.2 344.8

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55,298 28,214 27,084 322.0 344.1 301.7 409.6 486.3 351.4

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52,346 26,909 25,437 315.7 339.9 293.7 413.2 493.4 352.8

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,018 25,938 24,080 310.0 336.7 285.6 425.6 513.0 360.6

Hispanic

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204,719 113,045 91,674 341.9 373.9 309.3 524.1 633.1 431.7

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,249 108,579 88,670 334.6 364.6 304.0 524.7 631.8 434.2

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188,254 103,532 84,722 327.6 356.8 297.7 525.8 631.8 436.4

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179,457 98,170 81,287 317.1 343.2 290.4 525.3 628.9 438.3

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169,387 92,474 76,913 305.8 330.1 281.0 523.3 626.8 437.5

2013. . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . 163,241 88,880 74,361 301.9 323.7 279.4 535.4 639.8 448.6

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156,419 85,238 71,181 295.0 316.5 272.7 539.1 643.9 452.5

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149,635 81,887 67,748 287.5 309.7 264.6 540.7 647.3 452.8

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144,490 79,622 64,868 286.2 310.8 260.9 558.6 677.7 463.4

Rates are based on populations enumerated as of April 1 for census years and estimated as of July 1 for all other years; see Technical Notes in this report.

Age-adjusted rates are per 100,000 U.S. standard population. For method of computation, see Technical Notes in this report.

Includes races and origin not shown separately; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Multiple-race data reported according to 1997 Office of Management and Budget (OMB) standards were bridged to single-race categories of 1977 OMB standards. For more information on

areas reporting multiple race, see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

22 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 2. Number of deaths and death rates by age, and age-adjusted death rates, by race and Hispanic origin and sex: United States, 2018

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Race and origin categories are consistent

with 1997 Office of Management and Budget standards. Data for specified categories other than non-Hispanic, single-race white and non-Hispanic, single-race black should be interpreted with caution because of

inconsistencies between reporting these items on death certificates and on censuses and surveys; see Technical Notes in this report]

Race, origin, and sex All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Age not

stated

Number

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,839,205 21,467 3,830 5,450 30,154 58,844 80,380 164,837 374,836 543,778 675,205 880,280 144 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,458,469 12,068 2,243 3,081 22,008 40,864 51,376 101,030 228,273 312,911 347,188 337,318 109 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,380,736 9,399 1,587 2,369 8,146 17,980 29,004 63,807 146,563 230,867 328,017 542,962 35 ...

Single race

. . . . . . . . . . . . . . . . . . . . . . . 2,824,647 20,538 3,688 5,261 29,482 57,962 79,458 163,565 372,567 541,197 672,707 878,079 143 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,450,360 11,520 2,159 2,982 21,539 40,260 50,827 100,242 226,918 311,452 345,889 336,463 109 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,374,287 9,018 1,529 2,279 7,943 17,702 28,631 63,323 145,649 229,745 326,818 541,616 34 ...

Two or more races

. . . . . . . . . . . . . . . . . 14,558 929 142 189 672 882 922 1,272 2,269 2,581 2,498 2,201 1 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,109 548 84 99 469 604 549 788 1,355 1,459 1,299 855 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 6,449 381 58 90 203 278 373 484 914 1,122 1,199 1,346 1 ...

Non-Hispanic, single race

. . . . . . . . . . . . . . 2,613,795 16,028 2,910 4,163 23,791 49,331 68,225 144,457 341,123 504,031 630,006 829,666 64 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,333,359 8,997 1,714 2,379 17,245 33,899 43,102 87,610 206,775 289,762 324,229 317,598 49 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,280,436 7,031 1,196 1,784 6,546 15,432 25,123 56,847 134,348 214,269 305,777 512,068 15 ...

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,182,552 8,893 1,767 2,571 15,692 34,729 48,784 107,174 264,392 413,115 542,277 743,111 47 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,108,848 4,991 1,033 1,499 11,084 23,760 31,062 65,593 161,818 239,182 281,466 287,326 34 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,073,704 3,902 734 1,072 4,608 10,969 17,722 41,581 102,574 173,933 260,811 455,785 13 ...

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341,408 6,127 938 1,272 6,823 12,113 15,983 30,882 64,967 74,478 66,907 60,905 13 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 177,958 3,458 555 716 5,260 8,475 9,889 18,127 37,943 41,369 32,058 20,097 11 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 163,450 2,669 383 556 1,563 3,638 6,094 12,755 27,024 33,109 34,849 40,808 2 ...

American Indian or Alaska Native . . . . . . . 17,790 229 58 97 469 1,130 1,325 2,080 3,344 3,635 3,206 2,217 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,678 123 37 43 344 751 835 1,257 1,960 1,959 1,556 813 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 8,112 106 21

54 125 379 490 823 1,384 1,676 1,650 1,404 – ...

Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,768 700 137 207 728 1,219 1,933 3,908 7,763 12,061 17,012 23,096 4 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 35,089 380 82 114 497 823 1,185 2,390 4,673 6,858 8,860 9,223 4 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 33,679 320 55 93 231 396 748 1,518 3,090 5,203 8,152 13,873 – ...

Native Hawaiian or Other

Pacific Islander . . . . . . . . . . . . . . . . . . . . 3,277 79 10 16 79 140 200 413 657 742 604 337 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,786 45 7 7 60 90 131 243 381 394 289 139 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,491 34 3 9 19 50 69 170 276 348 315 198 – ...

Non-Hispanic, two or more races

. . . . . . . . 12,704 733 112 153 557 753 803 1,090 2,012 2,308 2,235 1,948 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,020 434 64 83 381 515 470 665 1,187 1,309 1,160 752 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 5,684 299 48 70 176 238 333 425 825 999 1,075 1,196 – ...

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 23

Table 2. Number of deaths and death rates by age, and age-adjusted death rates, by race and Hispanic origin and sex: United States, 2018—Con.

inconsistencies between reporting these items on death certificates and on censuses and surveys; see Technical Notes in this report]

Race, origin, and sex All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Age not

stated

Number

Hispanic, total

. . . . . . . . . . . . . . . . . . . . . . . 204,719 4,487 794 1,117 5,740 8,611 11,130 18,657 30,007 35,433 41,404 47,327 12 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 113,045 2,502 455 607 4,333 6,356 7,660 12,311 19,083 20,454 20,873 18,403 8 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 91,674 1,985 339 510 1,407 2,255 3,470 6,346 10,924 14,979 20,531 28,924 4 ...

Hispanic, single race

. . . . . . . . . . . . . . . . . . 202,898 4,295 764 1,082 5,626 8,484 11,012 18,483 29,754 35,162 41,146 47,079 11 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 111,977 2,391 435 592 4,246 6,268 7,582 12,192 18,918 20,305 20,738 18,302 8 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 90,921 1,904 329 490 1,380 2,216 3,430 6,291 10,836 14,857 20,408 28,777 3 ...

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,484 3,962 717 1,030 5,373 8,141 10,679 17,982 28,968 34,286 40,229 46,106 11 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 108,970 2,215 407 559 4,061 6,021 7,352 11,872 18,442 19,800 20,279

17,954 8 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 88,514 1,747 310 471 1,312 2,120 3,327 6,110 10,526 14,486 19,950 28,152 3 ...

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,584 262 39 35 171 211 204 312 508 549 618 675 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,015 146 23 23 125 153 145 208 316 325 312 239 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,569 116 16 12 46 58 59 104 192 224 306 436 – ...

American Indian or Alaska Native . . . . . . . 981 31 3 5 48 88 81 103 169 181 146 126 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 561 17 3 3 36 57 51 57 97 102 88 50 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 420 14 – 2 12 31 30 46 72 79 58 76 – ...

Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 31 3 8 17 28 25 48 73 112 126 143 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 9 1 4 11 22 20 32 46 60 46 47 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 316 22 2 4 6 6 5 16 27 52 80 96 – ...

Native Hawaiian or Other

Pacific Islander . . . . . . . . . . . . . . . . .

. . . 235 9 2 4 17 16 23 38 36 34 27 29 – ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 4 1 3 13 15 14 23 17 18 13 12 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 102 5 1 1 4 1 9 15 19 16 14 17 – ...

Hispanic, two or more races

. . . . . . . . . . . . 1,821 192 30 35 114 127 118 174 253 271 258 248 1 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,068 111 20 15 87 88 78 119 165 149 135 101 – ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 753 81 10 20 27 39 40 55 88 122 123 147 1 ...

Not stated or not classifiable origin

. . . . . . 7,987 219 14 17 66 149 222 633 1,694 2,006 1,560 1,339 68 ...

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,045 135 10 12 49 94 144 444 1,228 1,386 926 565 52 ...

Female . . . . . . . . . . . . . . . . . . . . . . . . . 2,942 84 4 5 17 55 78 189 466 620 634 774 16 ...

See footnotes at end of table.

24 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 2. Number of deaths and death rates by age, and age-adjusted death rates, by race and Hispanic origin and sex: United States, 2018—Con.

inconsistencies between reporting these items on death certificates and on censuses and surveys; see Technical Notes in this report]

Race, origin, and sex All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Age not

stated

Rate

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867.8 557.8 24.0 13.3 70.2 128.8 194.7 395.9 886.7 1,783.3 4,386.1 13,450.7 ... 723.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . 905.2 613.1 27.5 14.7 100.1 176.1 249.5 491.8 1,119.0 2,196.5 5,155.0 14,504.0 ... 855.5

Female . . . . . . . . . . . . . . . . . . . . . . . . 831.6 500.0 20.4 11.8 38.8 80.0 140.2 302.5 670.0 1,421.0 3,788.0 12,870.0 ... 611.3

Single race

. . . . . . . . . . . . . . . . . . . . . . . 887.6 568.7 24.6 13.5 71.5 130.4 196.7 399.1 892.4 1,792.5 4,406.4 13,514.0 ... 728.0

Male . . . . . . . . . . . . . . . . . . . . . . . . . 925.6 623.5 28.1 15.0 102.1 178.1 252.0 495.4 1,126.1 2,207.7 5,178.4 14,573.9 ... 860.7

Female . . . . . . . . . . . . . . . . . . . . . . . . 850.8 511.3 20.9 12.0 39.4 81.0 141.5 305.2 674.4 1,428.3 3,806.0 12,929.9 ... 614.9

Two or more races

. . . . . . . . . . . . . . . . . 162.7 392.5 14.8 8.4 38.8 70.7 105.2 195.5 432.4 861.1 1,952.3 4,687.5 ... 320.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . 183.1 453.4 17.2 8.7 53.4 98.8 131.3 255.7 546.6 1,053.1 2,339.4 5,022.9 ... 385.1

Female . . . .

. . . . . . . . . . . . . . . . . . . . 142.7 328.9 12.3 8.2 23.8 43.7 81.3 141.4 330.2 696.1 1,655.6 4,496.7 ... 266.7

Non-Hispanic, single race

. . . . . . . . . . . . . . 1,004.6 604.4 26.4 14.5 74.9 139.8 213.0 423.7 923.1 1,829.1 4,484.7 13,816.8 ... 749.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,046.7 662.8 30.3 16.2 106.2 190.5 271.8 522.7 1,160.6 2,245.6 5,253.2 14,917.1 ... 884.9

Female . . . . . . . . . . . . . . . . . . . . . . . . . 964.2 543.1 22.2 12.7 42.2 88.2 155.4 327.9 702.0 1,462.4 3,882.4 13,212.4 ... 634.7

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,104.8 467.6 22.5 12.5 68.6 137.9 208.6 412.6 892.5 1,799.9 4,529.9 14,287.4 ... 748.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,138.2 512.1 25.6 14.2 94.4 185.6 263.9 506.2 1,118.6 2,193.5 5,280.3 15,400.2 ... 878.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . 1,072.3 420.9 19.2 10.7 41.4 88.6 152.6 319.4 676.7 1,443.7 3,927.5 13,665.0 ... 636.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 834.7 1,159.5 42.7 22.6 112.7 189.5 304.0 596.0 1,327.5 2,515.9 5,105.5 12,180.9 ... 892.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 909.8 1,285.0 49.9 25.1 171.4 267.3 396.7 746.7 1,694.2 3,255.2 6,339.3 13,310.2 ... 1,102.8

Female . . . . . . . . . . . . . . . . . . . . . . . . . 765.9 1,029.2 35.4 20.0 52.4 112.9 220.4 463.2 1,018.2 1,959.7 4,330.2 11,692.3 ... 733.7

American Indian or Alaska Native . . . . . . . 735.9 726.4 44.4 27.8 129.3 304.9 445.4 708.0 1,134.4 1,985.5 4,111.4 8,552.6 ... 790.8

Male . . .

. . . . . . . . . . . . . . . . . . . . . . . . 813.5 763.3 55.5 24.3 186.4 399.4 566.7 880.6 1,415.2 2,306.3 4,515.9 8,534.5 ... 918.7

Female . . . . . . . . . . . . . . . . . . . . . . . . . 660.8 687.8 32.8 31.4 70.1 207.6 326.3 544.9 885.6 1,707.8 3,791.2 8,563.1 ... 673.1

Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367.2 384.0 16.9 9.9 30.5 37.6 64.5 151.8 373.6 847.3 2,526.0 8,476.4 ... 381.2

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 393.4 406.3 19.7 10.8 41.3 52.0 84.5 199.6 496.1 1,095.5 3,007.9 9,149.3 ... 454.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . 343.3 360.5 14.0 9.1 19.5 23.9 46.9 110.3 272.0 652.5 2,151.5 8,081.2 ... 324.1

Native Hawaiian or Other

Pacific Islander . . . . . . . . . . . . . . . . . . . . 558.9 1,005.6 * * 93.2 137.3 229.8 576.1 1,074.8 2,015.8 4,081.9 6,495.8 ... 675.7

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 605.4 1,120.2 * * 137.9 171.4 293.9 682.0 1,284.1 2,222.6 4,252.5 6,850.7 ... 758.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . 511.8 885.6 * * * 101.1 162.5 471.5 877.4 1,823.7 3,937.0 6,267.8 ... 597.3

Non-Hispanic, two or more races

. . . . . . . . 178.6 388.5 14.7 8.6 40.0 77.0 121.0 214.4 468.4 908.6 2,030.3 4,782.2 ... 338.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 199.9 450.3 16.4 9.1 54.1 108.4 150.5 277.7 583.7 1,108.2 2,403.9 5,066.7 ... 403.0

Female . . . . . . . . . . . . . . . . . . . . . . . . . 157.8 323.9 12.8 8.0 25.6 47.3 94.8 158.0 364.8 735.1 1,738.7 4,619.2 ... 283.0

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 25

Table 2. Number of deaths and death rates by age, and age-adjusted death rates, by race and Hispanic origin and sex: United States, 2018—Con.

inconsistencies between reporting these items on death certificates and on censuses and surveys; see Technical Notes in this report]

Race, origin, and sex All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Age not

stated

Rate

Hispanic, total

. . . . . . . . . . . . . . . . . . . . . . . 341.9 445.3 19.1 10.6 58.5 91.3 129.6 265.6 613.6 1,320.8 3,348.8 9,483.8 ... 524.1

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 373.9 486.1 21.4 11.3 86.2 128.7 173.4 347.7 801.9 1,670.5 4,054.5 10,124.4 ... 633.1

Female . . . . . . . . . . . . . . . . . . . . . . . . . 309.3 402.7 16.6 9.9 29.4 50.2 83.2 182.1 435.1 1,027.2 2,845.4 9,116.8 ... 431.7

Hispanic, single race

. . . . . . . . . . . . . . . . . . 349.6 447.6 19.2 10.7 59.4 92.6 131.5 268.5 620.5 1,333.4 3,376.8 9,553.2 ... 528.9

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 381.9 487.8 21.5 11.5 87.5 130.5 175.9 351.2 810.1 1,686.5 4,086.0 10,191.1 ... 638.7

Female . . . . . . . . . . . . . . . . . . . . . . . . . 316.6 405.6 16.9 9.9 29.9 50.9 84.4 184.4 440.5 1,036.8 2,870.5 9,187.5 ... 435.7

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375.5 463.2 20.3 11.4 62.7 98.6 140.6 285.7 659.4 1,407.4 3,539.9 9,943.9 ... 556.0

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 409.9 506.9 22.5 12.1 92.5 138.8 187.6 373.2 861.4 1,780.7 4,284.2

10,600.5 ... 671.7

Female . . . . . . . . . . . . . . . . . . . . . . . . . 340.3 417.7 17.9 10.6 31.4 54.1 90.5 196.2 467.3 1,093.9 3,008.6 9,566.0 ... 457.4

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123.5 458.0 16.4 6.2 35.1 43.8 50.7 105.3 246.4 505.5 1,314.6 3,954.3 ... 216.5

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 141.3 500.4 19.0 8.1 50.1 63.2 75.7 150.0 330.0 676.1 1,627.3 4,139.2 ... 267.8

Female . . . . . . . . . . . . . . . . . . . . . . . . . 106.3 413.9 * * 19.4 24.2 28.0 65.9 173.9 370.0 1,099.2 3,859.8 ... 175.3

American Indian or Alaska Native . . . . . . . 56.7 102.7 * * 16.7 30.9 31.3 50.4 123.0 284.4 622.1 1,547.2 ... 101.6

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 62.4 * * * 24.6 36.8 36.6 52.7 137.5 328.2 856.5 1,630.3 ... 120.9

Female . . . . . . . . . . . . . . . . . . . . . . . . . 50.6 * * * * 23.8 25.2 47.9 107.7 242.6 439.5 1,496.9 ... 84.8

Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102.0 245.7 * * * 28.8 29.4 73.8 165.9 504.4 1,397.2 4,580.4 ... 207.2

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 99.3 * * * * 45.0 47.1 100.3 220.9 609.2 1,243.6 4,376.2 ... 216.6

Female . . . . . . . . . . . . . . . . . . . . . . . . . 104.7 356.9 * * * * * * 116.5 420.8 1,504.0 4,687.5 ... 196.4

Native Hawaiian or Other Pacific Islander . 110.3 * * * * * 69.3 164.0 252.6 532.8 1,058.8 3,584.7 ... 211.4

Male . . . . . . . . . .

. . . . . . . . . . . . . . . . . 120.7 * * * * * * 193.9 * * * * ... 241.3

Female . . . . . . . . . . . . . . . . . . . . . . . . . 99.1 * * * * * * * * * * * ... 185.1

Hispanic, two or more races

. . . . . . . . . . . . 99.4 400.0 15.4 7.7 33.4 47.0 55.3 122.5 265.7 592.8 1,444.1 3,986.5 ... 232.9

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . 116.7 453.4 20.1 * 50.2 64.4 73.7 173.1 370.5 729.4 1,856.2 4,633.0 ... 294.9

Female . . . . . . . . . . . . . . . . . . . . . . . . . 82.2 344.4 * 8.9 16.1 29.2 37.2 75.0 173.6 482.4 1,161.1 3,637.7 ... 184.5

… Category not applicable.

– Quantity zero.

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

Death rates for “Under 1” (based on population estimates) differ from infant mortality rates (based on live births); see Technical Notes in this report.

For method of computation, see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Two or more races were reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Includes origin not stated or not classifiable; see Technical Notes in this report.

Rates are based on populations enumerated as of April 1 for census years and estimated as of July 1 for all other years; see Technical Notes in this report.

NOTE: Figures for age not stated are included in "All ages" but not distributed among age groups.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

26 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 3. Life expectancy at selected ages, by race and Hispanic origin and sex: United States, 2018

[Race and Hispanic-origin categories are consistent with the 1997 Office of Management and Budget standards]

Exact age (years)

Total

Non-Hispanic,

single-race white

2,3

Non-Hispanic,

single-race black

2,3

Hispanic

3,4

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

0. . . . . . . . . . . . . . . . . . . . . . . 78.7 76.2 81.2 78.6 76.2 81.1 74.7 71.3 78.0 81.8 79.1 84.3

1. . . . . . . . . . . . . . . . . . . . . . . 78.2 75.7 80.7 78.0 75.6 80.4 74.5 71.2 77.7 81.2 78.5 83.7

5. . . . . . . . . . . . . . . . . . . . . . . 74.3 71.8 76.7 74.1 71.7 76.5 70.7 67.3 73.8 77.3 74.6 79.8

10. . . . . . . . . . . . . . . . . . . . . . 69.3 66.8 71.8 69.1 66.7 71.5 65.7 62.4 68.9 72.3 69.6 74.8

15. . . . . . . . . . . . . . . . . . . . . . 64.3 61.9 66.8 64.1 61.8 66.6 60.8 57.4 64.0 67.4 64.6 69.9

20. . . . . . . . . . . . . . . . . . . . . . 59.5 57.1 61.9 59.3 57.0 61.6 56.0 52.8 59.1 62.5 59.8 64.9

25. . . . . . . . . . . . . . . . . . . . . . 54.8 52.4 57.0 54.5 52.3 56.8 51.4 48.3 54.3 57.7 55.1 60.1

30. . . . . . . . . . . . . . . . . . . . . . 50.1 47.8 52.2 49.9 47.7 52.0 46.9 43.9 49.5 53.0 50.5 55.2

35. . . . . . . . . . . . . . . . . . . . . . 45.4 43.3 47.5 45.2 43.2 47.3 42.3 39.5 44.8 48.2 45.8 50.3

40. . . . . . . . . . . . . . . . . . . . . . 40.8 38.7 42.7 40.6 38.7 42.6 37.8 35.1 40.2 43.5 41.2 45.5

45. . . . . . . . . . . . . . . . . . . . . . 36.2 34.2 38.1 36.1 34.2 37.9 33.5 30.9 35.7 38.8 36.5 40.7

50. . . . . . . . . . . .

. . . . . . . . . . 31.7 29.9 33.5 31.6 29.8 33.3 29.2 26.7 31.4 34.2 32.0 36.0

55. . . . . . . . . . . . . . . . . . . . . . 27.4 25.7 29.0 27.3 25.7 28.9 25.2 22.9 27.2 29.8 27.7 31.4

60. . . . . . . . . . . . . . . . . . . . . . 23.3 21.8 24.8 23.3 21.7 24.7 21.4 19.3 23.2 25.5 23.6 27.0

65. . . . . . . . . . . . . . . . . . . . . . 19.5 18.1 20.7 19.4 18.1 20.6 18.0 16.1 19.5 21.4 19.7 22.7

70. . . . . . . . . . . . . . . . . . . . . . 15.8 14.6 16.8 15.7 14.5 16.6 14.9 13.3 16.0 17.5 16.0 18.6

75. . . . . . . . . . . . . . . . . . . . . . 12.3 11.3 13.1 12.2 11.3 13.0 11.9 10.5 12.7 13.9 12.6 14.7

80. . . . . . . . . . . . . . . . . . . . . . 9.2 8.4 9.8 9.1 8.4 9.7 9.2 8.1 9.8 10.5 9.4 11.1

85. . . . . . . . . . . . . . . . . . . . . . 6.6 6.0 7.0 6.5 5.9 6.9 6.9 6.1 7.3 7.6 6.7 8.0

90. . . . . . . . . . . . . . . . . . . . . . 4.5 4.1 4.8 4.5 4.0 4.7 5.0 4.5 5.2 5.3 4.6 5.5

95. . . . . . . . . . . . . . . . . . . . . . 3.1 2.8 3.2 3.0 2.7 3.1 3.7 3.3 3.7 3.6 3.1 3.7

100. . . . . . . . . . . . . . . . . . . . . 2.2 2.0 2.2 2.1 1.9 2.2 2.7 2.5 2.7 2.5 2.2 2.5

Includes races and origins not shown separately; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Based on death rates adjusted for misclassification; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 27

Table 4. Life expectancy at birth, by race and Hispanic origin

and sex: United States, 2010–2018

[Life table data are based on revised life table methodology; see Technical Notes

in this report. Race and Hispanic-origin categories are consistent with 1997

Office of Management and Budget (OMB) standards; see Technical Notes in this

report]

Race and Hispanic origin and year Both sexes Male Female

All races and origins

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.2 81.2

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.6 76.1 81.1

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.2 81.1

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.3 81.1

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.9 76.5 81.3

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.8 76.4 81.2

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.8 76.4 81.2

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.3 81.1

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.2 81.0

Non-Hispanic, single-race white

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.6 76.2 81.1

Non-Hispanic, bridged-race white

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.2 81.1

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.5 76.1 81.0

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.6 76.2 81.0

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.3 81.0

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.8 76.5 81.2

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.8 76.5 81.2

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.9 76.5 81.2

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.7 76.4 81.1

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78.8 76.4 81.1

Non-Hispanic, single-race black

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.7 71.3 78.0

Non-Hispanic, bridged-race black

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.9 71.5 78.1

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.9 71.5 78.1

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.9 71.6 78.0

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1 71.9 78.1

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.3 72.2 78.2

2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1 71.9 78.1

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.1 71.9 78.1

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75.0 71.8 77.8

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74.7 71.5 77.7

Hispanic

4–6

2018. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 79.1 84.3

2017. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 79.1 84.3

2016. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 79.1 84.3

2015. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.0 79.3 84.3

2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82.1 79.4 84.5

2013. . . . . . . .

. . . . . . . . . . . . . . . . . . . . . 81.9 79.2 84.2

2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.9 79.3 84.3

2011. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.8 79.2 84.2

2010. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81.7 78.8 84.3

Includes races and origins not shown separately; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Race categories are consistent with 1977 OMB standards.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Based on death rates adjusted for misclassification; see Technical Notes in this report.

Life expectancies by Hispanic origin were revised using updated adjustment factors to

correct for race and Hispanic-origin misclassification; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

28 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

All causes

2018. . . . . . . . . . . . . . . . . . . . 867.8 557.8 24.0 13.3 70.2 128.8 194.7 395.9 886.7 1,783.3 4,386.1 13,450.7 723.6

2017. . . . . . . . . . . . . . . . . . . . 863.8 567.0 24.3 13.6 74.0 132.8 195.2 401.5 885.8 1,790.9 4,472.6 13,573.6 731.9

2016. . . . . . . . . . . . . . . . . . . . 849.3 583.4 25.3 13.4 74.9 129.0 192.2 405.5 883.8 1,788.6 4,474.8 13,392.1 728.8

2015. . . . . . . . . . . . . . . . . . . . 844.0 589.6 24.9 13.2 69.5 116.7 180.1 404.0 875.3 1,796.8 4,579.2 13,673.9 733.1

2014. . . . . . . . . . . . . . . . . . . . 823.7 588.0 24.0 12.7 65.5 108.4 175.2 404.8 870.3 1,786.3 4,564.2 13,407.9 724.6

2013. . . . . . . . . . . . . . . . . . . . 821.5 594.7 25.5 13.0 64.8 106.1 172.0 406.1 860.0 1,802.1 4,648.1 13,660.4 731.9

2012. . . . . . . . . . . . . . . . . . . . 810.2 599.3 26.3 12.6 66.4 105.4 170.7 405.4 854.2 1,802.5 4,674.5 13,678.6 732.8

2011. . . . . . . . . . . . . . . . . . . . 807.3 600.1 26.3 13.2 67.7 104.7 172.0 409.8 849.4 1,846.2 4,753.0 13,779.3 741.3

2010. . . . . . . . . . . . . . . . . . . . 799.5 623.4 26.5 12.9 67.7 102.9 170.5 407.1 851.9 1,875.1 4,790.2 13,934.3 747.0

2009. . . . . . . . . . . . . . . . . . . . 794.5 659.7 27.4 13.8 69.8 104.4 180.0 418.1 856.7 1,888.7 4,820.2 13,660.1 749.6

2008. . . . . . . . . . . . . . . . . . . . 812.9 678.9 29.3 13.9 74.2 105.1 181.0 419.6 867.1 1,958.4 4,998.1 14,332.4 774.9

2007. . . . . . . . . . . . . . . . . . . . 804.6 702.5 29.4 15.2 78.8 107.2 186.0 420.3 866.7 1,976.0 4,987.1 14,160.9 775.3

2006. .

. . . . . . . . . . . . . . . . . . 813.1 705.8 29.1 15.2 81.4 109.0 192.0 427.5 881.3 2,031.4 5,096.1 14,426.7 791.8

2005. . . . . . . . . . . . . . . . . . . . 828.4 710.2 29.9 16.3 80.7 106.8 194.9 431.9 898.5 2,109.7 5,251.8 14,982.4 815.0

2004. . . . . . . . . . . . . . . . . . . . 818.8 695.9 30.3 16.7 79.7 104.1 194.9 426.8 903.2 2,141.0 5,267.4 14,777.6 813.7

2003. . . . . . . . . . . . . . . . . . . . 843.9 704.9 31.8 16.9 81.1 105.2 202.6 433.1 937.3 2,235.0 5,451.3 15,401.4 843.5

2002. . . . . . . . . . . . . . . . . . . . 849.5 709.5 31.4 17.4 80.9 105.1 204.2 431.0 948.7 2,300.3 5,543.8 15,589.5 855.9

2001. . . . . . . . . . . . . . . . . . . . 848.0 687.0 33.4 17.2 80.2 105.6 203.5 426.7 972.5 2,344.2 5,573.7 15,432.6 858.8

2000. . . . . . . . . . . . . . . . . . . . 854.0 736.7 32.4 18.0 79.9 101.4 198.9 425.6 992.2 2,399.1 5,666.5 15,524.4 869.0

1999. . . . . . . . . . . . . . . . . . . . 857.0 736.0 34.2 18.6 79.3 102.2 198.0 418.2 1,005.0 2,457.3 5,714.5 15,554.6 875.6

Diseases of heart

(I00–I09,I11,I13,I20–I51)

2018. . . . . . . . . . . . . . . . . . . . 200.3 7.5 0.7 0.4 2.1 7.8 25.5 77.4 191.7 392.4 1,008.3 3,844.8 163.6

2017. . . . . . . . . . . . . . . . . . . . 198.8 7.7 0.8 0.4 2.1 8.1 25.4 77.1 190.7 392.9 1,028.4 3,882.9 165.0

2016. . . . . . . . . . . . . . . . . . . . 196.6 7.4 0.7 0.5 2.2 7.7 25.9 79.5 189.6 392.5 1,037.1 3,873.4 165.5

2015. . . . . . . . . . . . . . . . . . . . 197.2 7.3 0.9 0.5 2.3 8.0 25.6 79.3 188.1 389.5 1,071.6 3,986.5 168.5

2014. . . . . . . . . . . . . . . . . . . . 192.7 8.0 0.9 0.5 2.2 7.7 25.6 80.1 185.8 385.2 1,070.2 3,920.9 167.0

2013. . . . . . . . . . . . . . . . . . . . 193.3 7.8 1.1 0.4 2.1 7.6 25.6 80.3 184.6 390.3 1,095.1 4,013.9 169.8

2012. . . . . . . . . . . . . . . . . . . . 191.0 8.5 1.0 0.4 2.2 7.6 25.9 79.7 184.6 388.3 1,103.7 4,046.1 170.5

2011. . . . . . . . . . . . . . . . . . . . 191.5 7.7 1.0 0.5 2.3 7.9 26.2 80.7 183.2 399.0 1,134.7 4,111.6 173.7

2010. . . . . . . . . . . . . . . . . . . . 193.6 8.3 1.0 0.5 2.4 7.8 25.8 81.6 186.6 409.2 1,172.0 4,285.2 179.1

2009. . . . . . . . . . . . . . . . . . . . 195.4 9.6 0.9 0.5 2.4 7.8 26.7 82.3 190.0 422.8 1,210.8 4,316.9 182.8

2008. . . . . . . . . . . . . . . . . . . . 202.8 9.6 1.2 0.6 2.5 8.1 26.9 85.2 195.3 441.4 1,271.7 4,598.4 192.1

2007. . . . . . . . . . . . . . . . . . . . 204.5 10.2 1.1 0.6 2.5 8.1 27.7 85.2 197.8

454.8 1,308.6 4,668.1 196.1

2006. . . . . . . . . . . . . . . . . . . . 211.7 8.6 1.0 0.6 2.5 8.4 28.5 88.0 205.1 483.0 1,378.0 4,877.6 205.5

2005. . . . . . . . . . . . . . . . . . . . 220.7 8.9 0.9 0.6 2.6 8.3 29.2 89.7 212.8 512.3 1,458.5 5,188.3 216.8

2004. . . . . . . . . . . . . . . . . . . . 222.8 10.5 1.2 0.6 2.5 8.1 29.5 90.2 217.1 535.7 1,504.1 5,233.8 221.6

2003. . . . . . . . . . . . . . . . . . . . 236.1 11.0 1.2 0.6 2.7 8.3 30.8 92.4 232.3 579.8 1,607.7 5,570.7 236.3

2002. . . . . . . . . . . . . . . . . . . . 242.3 12.7 1.1 0.6 2.5 8.0 30.7 93.9 240.5 612.0 1,673.2 5,726.3 244.6

2001. . . . . . . . . . . . . . . . . . . . 245.7 11.9 1.5 0.7 2.5 8.0 29.6 92.4 248.9 632.6 1,723.0 5,784.1 249.5

2000. . . . . . . . . . . . . . . . . . . . 252.6 13.0 1.2 0.7 2.6 7.4 29.2 94.2 261.2 665.6 1,780.3 5,926.1 257.6

1999. . . . . . . . . . . . . . . . . . . . 259.9 13.8 1.2 0.7 2.8 7.6 30.2 95.7 269.9 701.7 1,849.9 6,063.0 266.5

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 29

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Malignant neoplasms

(C00–C97)

2018. . . . . . . . . . . . . . . . . . . . 183.2 1.3 2.0 2.1 3.2 8.1 25.8 89.6 269.6 554.4 1,031.5 1,577.7 149.1

2017. . . . . . . . . . . . . . . . . . . . 183.9 1.4 2.0 2.1 3.2 8.0 26.7 92.7 273.4 567.5 1,060.2 1,600.3 152.5

2016. . . . . . . . . . . . . . . . . . . . 185.1 1.7 2.4 2.1 3.3 8.5 26.9 96.5 280.6 578.3 1,081.7 1,620.3 155.8

2015. . . . . . . . . . . . . . . . . . . . 185.4 1.3 2.2 2.1 3.4 8.4 26.9 99.7 284.1 594.3 1,100.8 1,628.6 158.5

2014. . . . . . . . . . . . . . . . . . . . 185.6 1.3 2.0 2.1 3.6 8.3 27.8 103.2 287.6 603.1 1,125.9 1,632.9 161.2

2013. . . . . . . . . . . . . . . . . . . . 185.0 1.6 2.1 2.2 3.4 8.6 28.1 105.5 288.2 616.9 1,139.4 1,635.4 163.2

2012. . . . . . . . . . . . . . . . . . . . 185.6 1.6 2.4 2.2 3.6 8.7 28.0 108.5 293.2 632.2 1,161.7 1,658.9 166.5

2011. . . . . . . . . . . . . . . . . . . . 185.1 1.8 2.2 2.1 3.7 8.4 28.8 109.3 295.8 647.6 1,179.1 1,676.2 169.0

2010. . . . . . . . . . . . . . . . . . . . 186.2 1.6 2.1 2.2 3.7 8.8 28.8 111.6 300.1 666.1 1,202.2 1,729.5 172.8

2009. . . . . . . . . . . . . . . . .

. . . 185.0 1.8 2.2 2.2 3.8 9.0 30.2 112.8 301.7 668.2 1,213.0 1,699.3 173.5

2008. . . . . . . . . . . . . . . . . . . . 186.0 1.7 2.4 2.2 3.8 8.8 30.1 113.4 304.7 688.4 1,230.9 1,724.6 176.4

2007. . . . . . . . . . . . . . . . . . . . 186.9 1.7 2.3 2.4 3.8 8.7 31.0 114.2 311.4 702.9 1,250.1 1,739.4 179.3

2006. . . . . . . . . . . . . . . . . . . . 187.6 1.9 2.4 2.2 3.8 9.3 32.2 116.3 317.7 716.3 1,259.2 1,748.3 181.8

2005. . . . . . . . . . . . . . . . . . . . 189.3 1.9 2.4 2.5 4.0 9.2 33.5 118.6 323.9 733.2 1,272.8 1,778.2 185.1

2004. . . . . . . . . . . . . . . . . . . . 189.2 1.8 2.5 2.5 4.1 9.3 33.6 119.0 330.8 746.8 1,278.6 1,767.4 186.8

2003. . . . . . . . . . . . . . . . . . . . 192.0 1.9 2.5 2.6 4.0 9.5 35.1 122.1 341.6 763.5 1,299.7 1,792.3 190.9

2002. . . . . . . . . . . . . . . . . . . . 193.7 1.9 2.6 2.6 4.2 9.8 36.0 124.1 349.7 787.2 1,308.8 1,812.4 194.3

2001. . . . . . . . . . . . . . . . . . . . 194.3 1.6 2.7 2.4 4.2 10.1 36.8 125.8 359.4 799.7 1,313.7 1,802.9 196.5

2000. . . . . . . . . . . . . . . . . . . . 196.5 2.4 2.7 2.5 4.4 9.8 36.6 127.5 366.7 816.3 1,335.6 1,819.4 199.6

1999. . . . . . . . . . . . . . .

. . . . . 197.0 1.8 2.7 2.5 4.5 10.0 37.1 127.6 374.6 827.1 1,331.5 1,805.8 200.8

Accidents (unintentional

injuries) (V01–X59,Y85–Y86)

2018. . . . . . . . . . . . . . . . . . . . 51.1 30.4 7.7 3.5 28.0 53.9 54.9 55.4 56.0 52.3 111.3 368.6 48.0

2017. . . . . . . . . . . . . . . . . . . . 52.2 33.4 7.9 3.8 31.1 56.6 55.8 57.7 55.7 50.7 113.3 374.9 49.4

2016. . . . . . . . . . . . . . . . . . . . 49.9 30.7 7.9 4.0 31.9 53.7 51.8 54.6 52.7 49.1 110.7 365.7 47.4

2015. . . . . . . . . . . . . . . . . . . . 45.6 32.5 7.8 3.7 28.5 44.8 43.9 49.8 47.7 47.0 111.5 364.5 43.2

2014. . . . . . . . . . . . . . . . . . . . 42.6 29.4 7.6 3.6 26.8 39.8 39.6 47.4 44.9 45.1 108.7 349.1 40.5

2013. . . . . . . . . . . . . . . . . . . . 41.3 29.3 8.3 3.7 26.4 37.8 38.0 46.5 43.4 43.5 107.4 340.0 39.4

2012. . . . . . . . . . . . . . . . . . . . 40.7 29.6 8.4 3.8 27.1 37.5 37.1 46.1 41.0 44.0 107.8 336.9 39.1

2011. . . . . . . . . . . . . . . . . . . . 40.6 29.1 8.5 4.0 28.2 37.1 37.5 46.4 39.8 44.5 107.0 333.8 39.1

2010. . . . . . . . . . . . . . . . . . . . 39.1 28.1 8.6 4.0 28.3 35.5 36.0 43.7 38.4 43.3 106.1 328.4 38.0

2009. . . . . . . . . . . . .

. . . . . . . 38.5 29.5 9.0 4.1 28.6 34.5 36.4 44.5 36.5 42.1 103.5 310.9 37.5

2008. . . . . . . . . . . . . . . . . . . . 40.1 31.8 9.1 4.6 32.5 36.3 38.1 45.8 37.4 43.9 105.7 318.3 39.2

2007. . . . . . . . . . . . . . . . . . . . 41.1 31.0 9.9 5.4 36.8 37.7 39.6 46.2 36.8 44.4 105.0 313.6 40.4

2006. . . . . . . . . . . . . . . . . . . . 40.8 28.4 10.1 5.6 37.9 38.0 40.5 45.5 35.8 43.8 104.7 299.2 40.2

2005. . . . . . . . . . . . . . . . . . . . 39.9 27.0 10.5 5.9 37.1 35.7 38.9 43.2 35.4 45.7 106.0 303.5 39.5

2004. . . . . . . . . . . . . . . . . . . . 38.3 26.2 10.4 6.5 36.8 33.2 37.6 40.7 32.9 43.5 103.6 295.8 38.1

2003. . . . . . . . . . . . . . . . . . . . 37.7 23.8 11.0 6.4 36.9 32.0 38.0 38.8 32.7 43.7 101.6 294.3 37.6

2002. . . . . . . . . . . . . . . . . . . . 37.1 23.9 10.6 6.6 37.7 31.9 37.4 36.7 31.3 44.0 101.1 289.6 37.1

2001. . . . . . . . . . . . . . . . . . . . 35.6 24.3 11.2 6.9 35.8 30.0 35.4 33.9 30.5 42.6 100.7 282.2 35.7

2000. . . . . . . . . . . . . . . . . . . . 34.8 23.1 11.9 7.3 36.0 29.5 34.1 32.6 30.9 41.9 95.1 273.5 34.9

1999. . . . . . . . . . .

. . . . . . . . . 35.1 22.3 12.4 7.6 35.3 29.6 33.8 31.8 30.6 44.6 100.5 282.4 35.3

See footnotes at end of table.

30 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Chronic lower respiratory

diseases (J40–J47)

2018. . . . . . . . . . . . . . . . . . . . 48.7 * 0.3 0.3 0.4 0.7 1.6 9.1 44.5 128.6 335.7 682.4 39.7

2017. . . . . . . . . . . . . . . . . . . . 49.2 * 0.2 0.3 0.4 0.7 1.7 9.4 44.4 133.8 347.6 700.6 40.9

2016. . . . . . . . . . . . . . . . . . . . 47.8 0.7 0.3 0.3 0.5 0.8 1.7 10.1 43.0 134.1 347.2 676.9 40.6

2015. . . . . . . . . . . . . . . . . . . . 48.2 0.7 0.3 0.4 0.5 0.7 1.7 10.1 42.7 136.6 357.9 705.1 41.6

2014. . . . . . . . . . . . . . . . . . . . 46.1 * 0.3 0.3 0.4 0.8 1.9 10.1 41.2 134.9 349.0 670.5 40.5

2013. . . . . . . . . . . . . . . . . . . . 47.2 0.6 0.4 0.4 0.4 0.7 1.9 10.6 40.5 141.2 367.0 699.3 42.1

2012. . . . . . . . . . . . . . . . . . . . 45.7 0.5 0.3 0.3 0.3 0.7 1.8 10.2 39.4 140.0 364.0 687.8 41.5

2011. . . . . . . . . . . . . . . . . . . . 45.9 0.8 0.3 0.3 0.4 0.6 1.8 10.4 39.5 144.3 374.9 697.9 42.5

2010. . . . . . . . . . . . . . . . . . . . 44.7 0.9 0.3 0.3 0.3 0.7 1.7 9.9 39.0 146.3 369.9 690.7 42.2

2009. . . . . . . . . . . . . . . . .

. . . 44.8 0.7 0.4 0.3 0.4 0.7 1.8 10.4 40.0 147.5 376.4 684.9 42.7

2008. . . . . . . . . . . . . . . . . . . . 46.4 0.8 0.3 0.3 0.4 0.6 1.9 9.9 41.1 155.9 395.4 722.7 44.7

2007. . . . . . . . . . . . . . . . . . . . 42.5 1.0 0.4 0.3 0.3 0.7 1.9 9.5 38.6 145.5 367.1 652.0 41.4

2006. . . . . . . . . . . . . . . . . . . . 41.8 0.7 0.3 0.3 0.4 0.6 1.9 9.1 38.8 147.0 362.0 641.3 41.0

2005. . . . . . . . . . . . . . . . . . . . 44.3 0.8 0.4 0.3 0.3 0.7 2.0 9.4 41.6 158.4 385.0 691.9 43.9

2004. . . . . . . . . . . . . . . . . . . . 41.7 0.9 0.3 0.3 0.4 0.6 2.0 8.4 40.1 152.1 366.2 643.2 41.6

2003. . . . . . . . . . . . . . . . . . . . 43.6 0.8 0.4 0.3 0.5 0.7 2.2 8.7 43.1 161.7 382.2 670.2 43.7

2002. . . . . . . . . . . . . . . . . . . . 43.4 1.0 0.4 0.3 0.5 0.8 2.3 8.7 42.2 162.0 385.8 670.3 43.9

2001. . . . . . . . . . . . . . . . . . . . 43.2 1.0 0.3 0.3 0.4 0.7 2.2 8.4 44.5 167.3 379.3 658.3 43.9

2000. . . . . . . . . . . . . . . . . . . . 43.4 0.9 0.3 0.3 0.5 0.7 2.1 8.6 44.2 169.4 386.1 648.6 44.2

1999. . . . . . . . . . . . . . .

. . . . . 44.5 0.9 0.4 0.3 0.5 0.8 2.0 8.5 47.5 177.2 397.8 646.0 45.4

Cerebrovascular diseases

(I60–I69)

2018. . . . . . . . . . . . . . . . . . . . 45.2 2.5 0.3 0.2 0.3 1.2 4.1 12.3 30.3 76.8 256.0 984.3 37.1

2017. . . . . . . . . . . . . . . . . . . . 44.9 2.5 0.4 0.2 0.4 1.3 4.4 12.3 30.3 76.4 263.1 993.5 37.6

2016. . . . . . . . . . . . . . . . . . . . 44.0 3.1 0.3 0.2 0.3 1.3 4.6 12.5 29.7 76.0 265.5 972.9 37.3

2015. . . . . . . . . . . . . . . . . . . . 43.7 2.2 0.3 0.2 0.4 1.3 4.4 12.3 29.6 75.5 273.0 975.8 37.6

2014. . . . . . . . . . . . . . . . . . . . 41.7 2.4 0.2 0.2 0.4 1.3 4.3 12.3 29.3 74.5 265.7 929.7 36.5

2013. . . . . . . . . . . . . . . . . . . . 40.8 2.7 0.2 0.2 0.3 1.2 4.2 12.4 28.9 74.2 268.9 906.0 36.2

2012. . . . . . . . . . . . . . . . . . . . 40.9 2.6 0.3 0.2 0.4 1.3 4.3 12.8 28.7 75.7 272.2 931.2 36.9

2011. . . . . . . . . . . . . . . . . . . . 41.4 3.4 0.3 0.2 0.4 1.3 4.2 12.8 29.4 78.2 285.4 943.7 37.9

2010. . . . . . . . . . . . . . . . . . . . 41.9 3.3 0.3 0.2 0.4 1.3 4.6 13.1 29.3 81.7 288.3 993.8 39.1

2009. . . . . . . . . . . . .

. . . . . . . 42.0 3.7 0.3 0.2 0.4 1.3 4.6 13.7 29.7 82.8 294.9 992.2 39.6

2008. . . . . . . . . . . . . . . . . . . . 44.1 3.4 0.4 0.2 0.4 1.3 4.8 13.7 30.6 87.3 313.3 1,071.0 42.1

2007. . . . . . . . . . . . . . . . . . . . 45.1 3.2 0.3 0.2 0.5 1.3 5.0 14.5 31.7 91.4 320.8 1,110.7 43.5

2006. . . . . . . . . . . . . . . . . . . . 46.0 3.5 0.3 0.2 0.5 1.3 5.1 14.6 32.9 94.9 333.9 1,131.7 44.8

2005. . . . . . . . . . . . . . . . . . . . 48.6 3.1 0.4 0.2 0.5 1.4 5.2 15.0 32.7 99.8 358.4 1,239.7 48.0

2004. . . . . . . . . . . . . . . . . . . . 51.3 3.2 0.3 0.2 0.5 1.4 5.4 14.8 34.0 106.6 385.6 1,331.9 51.2

2003. . . . . . . . . . . . . . . . . . . . 54.4 2.5 0.3 0.2 0.5 1.5 5.6 15.0 35.5 111.9 409.8 1,446.0 54.6

2002. . . . . . . . . . . . . . . . . . . . 56.6 3.0 0.3 0.2 0.4 1.4 5.4 15.1 37.1 119.6 430.0 1,520.1 57.2

2001. . . . . . . . . . . . . . . . . . . . 57.4 2.7 0.4 0.2 0.5 1.5 5.5 15.0 38.3 122.9 443.3 1,532.0 58.4

2000. . . . . . . . . . . . . . . . . . . . 59.6 3.3 0.3 0.2 0.5 1.5 5.8 16.0 41.0 128.6 461.3 1,589.2 60.9

1999. . . . . . . . . . .

. . . . . . . . . 60.0 2.7 0.3 0.2 0.5 1.4 5.7 15.2 40.6 130.8 469.8 1,614.8 61.6

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 31

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Alzheimer disease (G30)

2018. . . . . . . . . . . . . . . . . . . . 37.3 * * * * * * 0.3 2.9 24.7 213.9 1,225.3 30.5

2017. . . . . . . . . . . . . . . . . . . . 37.3 * * * * * * 0.2 2.8 24.5 219.7 1,244.7 31.0

2016. . . . . . . . . . . . . . . . . . . . 35.9 * * * * * * 0.2 2.7 23.6 214.1 1,216.9 30.3

2015. . . . . . . . . . . . . . . . . . . . 34.4 * * * * * * 0.2 2.4 22.4 211.9 1,174.2 29.4

2014. . . . . . . . . . . . . . . . . . . . 29.3 * * * * * * 0.2 2.1 19.6 185.6 1,006.8 25.4

2013. . . . . . . . . . . . . . . . . . . . 26.8 * * * * * * 0.2 2.2 18.1 171.6 929.5 23.5

2012. . . . . . . . . . . . . . . . . . . . 26.6 * * * * * * 0.2 2.2 17.9 175.4 936.1 23.8

2011. . . . . . . . . . . . . . . . . . . . 27.3 * * * * * * 0.2 2.2 19.2 183.9 967.1 24.7

2010. . . . . . . . . . . . . . . . . . . . 27.0 * * * * * * 0.3 2.1 19.8 184.5 987.1 25.1

2009. . . . . . . . . . . . . . . . .

. . . 25.8 * * * * * * 0.2 2.0 19.4 179.1 945.3 24.2

2008. . . . . . . . . . . . . . . . . . . . 27.1 * * * * * * 0.2 2.2 21.1 192.5 1,002.2 25.8

2007. . . . . . . . . . . . . . . . . . . . 24.8 * * * * * * 0.2 2.2 20.2 175.8 928.7 23.8

2006. . . . . . . . . . . . . . . . . . . . 24.3 * * * * * * 0.2 2.1 19.9 175.0 923.4 23.7

2005. . . . . . . . . . . . . . . . . . . . 24.2 * * * * * * 0.2 2.1 20.2 177.0 935.5 24.0

2004. . . . . . . . . . . . . . . . . . . . 22.5 * * * * * * 0.2 1.8 19.5 168.5 875.3 22.6

2003. . . . . . . . . . . . . . . . . . . . 21.9 * * * * * * 0.2 2.0 20.7 164.1 846.8 22.1

2002. . . . . . . . . . . . . . . . . . . . 20.5 * * * * * * 0.1 1.9 19.6 157.7 790.9 20.8

2001. . . . . . . . . . . . . . . . . . . . 18.9 * * * * * * 0.2 2.1 18.6 147.2 725.4 19.3

2000. . . . . . . . . . . . . . . . . . . . 17.6 * * * * * * 0.2 2.0 18.7 139.6 667.7 18.1

1999. . . . . . . . . . . . . . .

. . . . . 16.0 * * * * * * 0.2 1.9 17.4 129.5 601.3 16.5

Diabetes mellitus (E10–E14)

2018. . . . . . . . . . . . . . . . . . . . 26.0 * * 0.1 0.6 1.8 5.5 15.4 35.3 72.1 137.5 260.4 21.4

2017. . . . . . . . . . . . . . . . . . . . 25.7 * * 0.1 0.6 1.8 5.2 15.1 35.5 71.9 140.8 262.4 21.5

2016. . . . . . . . . . . . . . . . . . . . 24.8 * * 0.1 0.5 1.8 5.1 14.6 34.4 69.9 137.9 263.6 21.0

2015. . . . . . . . . . . . . . . . . . . . 24.7 * * 0.1 0.4 1.8 4.9 14.4 34.7 70.6 143.0 267.0 21.3

2014. . . . . . . . . . . . . . . . . . . . 24.0 * * 0.1 0.4 1.6 4.9 13.9 33.3 69.0 141.8 268.6 20.9

2013. . . . . . . . . . . . . . . . . . . . 23.9 * * 0.1 0.4 1.6 4.8 13.5 33.2 68.5 145.7 279.5 21.2

2012. . . . . . . . . . . . . . . . . . . . 23.6 * * 0.1 0.4 1.5 4.6 13.0 32.5 69.7 145.8 285.7 21.2

2011. . . . . . . . . . . . . . . . . . . . 23.7 * * 0.1 0.4 1.6 4.5 13.4 33.3 72.0 148.8 289.5 21.6

2010. . . . . . . . . . . . . . . . . . . . 22.4 * * 0.1 0.4 1.5 4.4 12.5 32.0 67.6 144.1 285.5 20.8

2009. . . . . . . . . . . . .

. . . . . . . 22.4 * * 0.1 0.4 1.5 4.5 12.8 32.1 69.6 145.8 282.6 21.0

2008. . . . . . . . . . . . . . . . . . . . 23.2 * * 0.1 0.5 1.4 4.4 12.6 33.3 74.7 153.2 298.9 22.0

2007. . . . . . . . . . . . . . . . . . . . 23.7 * * 0.1 0.4 1.5 4.6 13.1 34.1 76.7 161.9 302.2 22.8

2006. . . . . . . . . . . . . . . . . . . . 24.3 * * 0.1 0.4 1.7 4.8 13.1 35.8 80.6 166.2 310.4 23.6

2005. . . . . . . . . . . . . . . . . . . . 25.4 * * 0.1 0.5 1.6 4.7 13.4 36.9 85.7 177.0 338.8 24.9

2004. . . . . . . . . . . . . . . . . . . . 25.0 * * 0.1 0.4 1.5 4.6 13.4 36.8 86.2 176.6 328.2 24.7

2003. . . . . . . . . . . . . . . . . . . . 25.6 * * 0.1 0.4 1.7 4.6 13.9 38.3 90.0 180.7 335.1 25.5

2002. . . . . . . . . . . . . . . . . . . . 25.5 * * 0.1 0.4 1.6 4.8 13.7 37.5 90.9 182.4 337.0 25.6

2001. . . . . . . . . . . . . . . . . . . . 25.0 * * 0.1 0.4 1.5 4.3 13.6 38.1 91.0 181.1 328.6 25.4

2000. . . . . . . . . . . . . . . . . . . . 24.6 * * 0.1 0.4 1.6 4.3 13.1 37.8 90.7 179.5 319.7 25.0

1999. . . . . . . . . . .

. . . . . . . . . 24.5 * * 0.1 0.4 1.4 4.3 12.9 38.3 91.8 178.0 317.2 25.0

See footnotes at end of table.

32 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Influenza and pneumonia

(J09–J18)

2018. . . . . . . . . . . . . . . . . . . . 18.1 4.6 0.8 0.3 0.5 1.0 2.3 5.6 13.9 31.7 94.2 377.6 14.9

2017. . . . . . . . . . . . . . . . . . . . 17.1 4.0 0.7 0.3 0.4 0.9 1.9 4.8 12.0 29.6 93.8 375.3 14.3

2016. . . . . . . . . . . . . . . . . . . . 15.9 4.2 0.6 0.2 0.4 1.0 2.2 5.0 12.1 28.5 88.5 340.3 13.5

2015. . . . . . . . . . . . . . . . . . . . 17.8 4.4 0.6 0.2 0.4 0.9 1.7 4.7 11.3 29.5 101.6 421.4 15.2

2014. . . . . . . . . . . . . . . . . . . . 17.3 4.7 0.7 0.2 0.5 1.3 2.8 6.3 13.4 29.8 96.4 385.9 15.1

2013. . . . . . . . . . . . . . . . . . . . 18.0 4.5 0.6 0.3 0.4 1.0 2.2 5.1 12.2 29.5 103.7 441.0 15.9

2012. . . . . . . . . . . . . . . . . . . . 16.1 4.0 0.6 0.2 0.3 0.8 1.7 4.1 10.2 26.1 98.2 408.4 14.4

2011. . . . . . . . . . . . . . . . . . . . 17.3 5.2 0.7 0.3 0.5 1.2 2.1 5.0 11.0 28.9 104.0 439.2 15.7

2010. . . . . . . . . . . . . . . . . . . . 16.2 4.9 0.6 0.2 0.4 0.9 1.9 4.3 9.9 27.9 102.4 426.2 15.1

2009. . . . . . . . . . . . . . . . .

. . . 17.5 6.3 0.9 0.6 1.0 2.0 3.2 6.5 11.7 29.5 107.0 433.8 16.5

2008. . . . . . . . . . . . . . . . . . . . 18.5 5.5 0.9 0.2 0.5 0.9 2.1 5.1 10.9 30.5 118.6 512.3 17.6

2007. . . . . . . . . . . . . . . . . . . . 17.5 5.4 0.7 0.3 0.4 0.8 1.8 4.3 9.5 28.2 113.5 506.7 16.8

2006. . . . . . . . . . . . . . . . . . . . 18.9 6.5 0.8 0.2 0.4 0.9 1.9 4.6 9.9 31.6 127.3 547.0 18.4

2005. . . . . . . . . . . . . . . . . . . . 21.3 6.6 0.7 0.3 0.4 0.9 2.1 5.1 11.2 35.1 142.0 644.9 21.0

2004. . . . . . . . . . . . . . . . . . . . 20.4 6.8 0.8 0.2 0.4 0.8 2.0 4.6 10.8 34.2 139.1 622.8 20.4

2003. . . . . . . . . . . . . . . . . . . . 22.5 8.1 1.0 0.4 0.5 1.0 2.2 5.2 11.2 36.9 150.8 703.0 22.6

2002. . . . . . . . . . . . . . . . . . . . 22.8 6.7 0.7 0.2 0.4 0.9 2.2 4.8 11.2 37.2 156.6 732.4 23.2

2001. . . . . . . . . . . . . . . . . . . . 21.8 7.5 0.7 0.2 0.5 0.9 2.2 4.6 10.8 36.2 148.3 700.1 22.2

2000. . . . . . . . . . . . . . . . . . . . 23.2 7.6 0.7 0.2 0.5 0.9 2.4 4.7 11.9 39.1 160.3 744.1 23.7

1999. . . . . . . . . . . . . . .

. . . . . 22.8 8.4 0.8 0.2 0.5 0.8 2.4 4.6 11.0 37.2 157.0 751.8 23.5

Nephritis, nephrotic syndrome

and nephrosis (N00–N07,

N17–N19,N25–N27)

2018. . . . . . . . . . . . . . . . . . . . 15.7 2.0 * * 0.1 0.6 1.8 5.4 13.6 35.6 94.3 257.9 12.9

2017. . . . . . . . . . . . . . . . . . . . 15.5 2.0 * * 0.1 0.6 1.7 5.2 13.5 34.7 95.8 267.1 13.0

2016. . . . . . . . . . . . . . . . . . . . 15.5 1.6 * * 0.1 0.6 1.8 5.0 13.6 34.6 98.1 270.1 13.1

2015. . . . . . . . . . . . . . . . . . . . 15.5 2.1 * * 0.1 0.6 1.7 4.9 13.3 35.1 99.7 281.8 13.4

2014. . . . . . . . . . . . . . . . . . . . 15.1 2.3 * * 0.2 0.5 1.7 4.7 12.6 34.3 98.6 282.4 13.2

2013. . . . . . . . . . . . . . . . . . . . 14.9 2.2 * * 0.1 0.6 1.5 4.6 12.6 33.8 99.0 285.4 13.2

2012. . . . . . . . . . . . . . . . . . . . 14.5 2.1 * * 0.2 0.5 1.6 4.7 12.3 33.3 99.9 280.0 13.1

2011. . . . . . . . . . . . . . . . . . . . 14.6 1.9 * * 0.2 0.5 1.6 4.4 12.5 34.2 101.4 292.1 13.4

2010. . . . . . . . . . . . . . . . . . . . 16.3 2.7 * 0.1 0.2 0.6 1.8 4.9 13.9 39.3 115.7 333.8 15.3

2009. . . . . . . . . . . .

. . . . . . . . 16.0 2.8 * * 0.2 0.7 2.0 5.2 13.5 38.7 115.1 321.4 15.1

2008. . . . . . . . . . . . . . . . . . . . 15.9 3.5 * * 0.2 0.6 1.8 5.0 14.1 39.9 113.3 325.6 15.1

2007. . . . . . . . . . . . . . . . . . . . 15.4 3.5 0.1 0.1 0.2 0.7 1.8 5.1 13.4 39.4 112.4 317.9 14.9

2006. . . . . . . . . . . . . . . . . . . . 15.2 4.0 * * 0.2 0.7 1.8 5.2 13.7 38.8 111.0 316.2 14.8

2005. . . . . . . . . . . . . . . . . . . . 14.9 4.0 * 0.1 0.2 0.7 1.7 4.8 13.5 38.8 110.2 313.1 14.7

2004. . . . . . . . . . . . . . . . . . . . 14.5 4.3 * 0.1 0.2 0.6 1.8 5.0 13.5 38.1 108.2 306.4 14.5

2003. . . . . . . . . . . . . . . . . . . . 14.6 4.6 * 0.1 0.2 0.7 1.8 4.9 13.6 39.7 109.3 309.3 14.7

2002. . . . . . . . . . . . . . . . . . . . 14.2 4.4 * 0.1 0.2 0.7 1.7 4.7 12.9 39.0 108.9 303.4 14.4

2001. . . . . . . . . . . . . . . . . . . . 13.9 3.3 * * 0.2 0.6 1.7 4.6 13.1 40.0 104.0 293.8 14.1

2000. . . . . . . . . . . . . . . . . . . . 13.2 4.3 * 0.1 0.2 0.6 1.6 4.4 12.8 38.0 100.8 277.8 13.5

1999. . . . . . . . . .

. . . . . . . . . . 12.7 4.4 * 0.1 0.2 0.6 1.6 4.0 12.0 37.1 97.6 268.9 13.0

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 33

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Intentional self-harm (suicide)

(*U03,X60–X84,Y87.0)

2018. . . . . . . . . . . . . . . . . . . . 14.8 … … 1.5 14.5 17.6 18.2 20.0 20.2 16.3 18.7 19.1 14.2

2017. . . . . . . . . . . . . . . . . . . . 14.5 … … 1.3 14.5 17.5 17.9 20.2 19.0 15.6 18.0 20.1 14.0

2016. . . . . . . . . . . . . . . . . . . . 13.9 … … 1.1 13.2 16.5 17.4 19.7 18.7 15.4 18.2 19.0 13.5

2015. . . . . . . . . . . . . . . . . . . . 13.7 … … 1.0 12.5 15.7 17.1 20.3 18.9 15.2 17.9 19.4 13.3

2014. . . . . . . . . . . . . . . . . . . . 13.4 … … 1.0 11.6 15.1 16.6 20.2 18.8 15.6 17.5 19.3 13.0

2013. . . . . . . . . . . . . . . . . . . . 13.0 … … 1.0 11.1 14.8 16.2 19.7 18.1 15.0 17.1 18.6 12.6

2012. . . . . . . . . . . . . . . . . . . . 12.9 … … 0.8 11.1 14.7 16.7 20.0 18.0 14.0 16.8 17.8 12.6

2011. . . . . . . . . . . . . . . . . . . . 12.7 … … 0.7 11.0 14.6 16.2 19.8 17.1 14.1 16.5 16.9 12.3

2010. . . . . . . . . . . . . . . . . . . . 12.4 … … 0.7 10.5 14.0 16.0 19.6 17.5 13.7 15.7 17.6 12.1

2009. . . . . . . . . . . . . . . . . . . . 12.0 … … 0.6 10.0 13.1 16.1 19.2 16.4 13.7 15.8 16.4 11.8

2008. . . . . . . . . . . . . . . . . . . . 11.8 … … 0.5 9.9 13.2 15.9 18.6 16.0 13.6 16.1 16.4 11.6

2007. . . . . . . . . . . . . . . . . . . . 11.5 … … 0.5 9.6 13.3 15.7 17.7 15.3 12.4 16.2 17.0 11.3

2006. . . . . . . . . . . . . . . . . . . . 11.2 … … 0.5 9.8 12.7 15.2 17.2 14.4 12.4 15.8 17.3 11.0

2005. . . . . . . . . . . . . . . . . . . . 11.0 … … 0.7 9.9 12.7 15.1 16.5 13.7 12.4 16.8 18.3 10.9

2004. . . .

. . . . . . . . . . . . . . . . 11.1 … … 0.7 10.3 12.9 15.2 16.6 13.7 12.2 16.3 17.6 11.0

2003. . . . . . . . . . . . . . . . . . . . 10.9 … … 0.6 9.6 12.9 15.0 15.9 13.7 12.6 16.4 17.9 10.8

2002. . . . . . . . . . . . . . . . . . . . 11.0 … … 0.6 9.8 12.8 15.3 15.8 13.5 13.4 17.7 18.9 10.9

2001

. . . . . . . . . . . . . . . . . . . 10.7 … … 0.7 9.9 12.8 14.7 15.1 13.2 13.2 17.4 17.8 10.7

2000. . . . . . . . . . . . . . . . . . . . 10.4 … … 0.7 10.2 12.0 14.5 14.4 12.1 12.5 17.6 19.6 10.4

1999. . . . . . . . . . . . . . . . . . . . 10.5 … … 0.6 10.1 12.7 14.3 13.9 12.2 13.4 18.1 19.3 10.5

Dementia-related causes

2018. . . . . . . . . . . . . . . . . . . . 81.6 * * * * 0.1 0.1 0.8 7.8 57.9 447.0 2,700.3 66.6

2017. . . . . . . . . . . . . . . . . . . . 80.4 * * 0.0 * * 0.1 0.7 7.5 56.9 450.9 2,707.3 66.7

2016. . . . . . . . . . . . . . . . . . . . 77.2 * * 0.1 * 0.1 0.1 0.8 7.3 54.7 441.6 2,626.4 64.9

2015. . . . . . . . . . . . . . . . . . . . 76.5 * * 0.1 * * 0.1 0.8 6.8 53.0 447.2 2,637.4 65.2

2014. . . . . . . . . . . . . . . . . . . . 75.2 * 0.1 0.1 * * 0.1 0.8 6.9 52.7 450.6 2,611.3 64.9

2013. . . . . . . . . . . . . . . . . . . . 74.1 * * * * * 0.1 0.9 7.4 52.2 449.7 2,601.8 64.8

2012. . . . . . . . . . . . . . . . . . . . 71.2 * 0.2 * * * 0.1 0.9 6.8 50.3 445.2 2,532.7 63.3

2011. . . . . . . . . . . . . . . . . . . . 68.3 * 0.1 0.1 * * 0.1 0.8 6.5 50.4 436.6 2,458.6 61.8

2010. . . . . . . . . . . . . . . . . . . . 63.6 * * * * * 0.1 0.9 6.3 48.3 412.1 2,352.4 58.8

2009. . . . . . . . . . . . . . . . . . . . 57.9 * 0.1 0.1 * 0.1 0.2 0.8 5.7 45.2 383.3 2,151.3 54.2

2008. . . . . . . . . . . . . . . . . . . . 58.9 * 0.2 0.1 * * 0.1 0.9 6.0 46.4 396.7 2,213.2 55.9

2007. . . . . . . . . . . . . . . . . . . . 51.8 * 0.2 0.1 * * 0.1 0.8 5.5 42.3 350.0 1,976.0 49.8

2006. . . . . . . . . . . . . . . . . . . . 50.8 * 0.1 0.1 * * 0.1 0.8 5.5 42.4 346.2 1,967.0 49.5

2005. . . . . . . . . . . . . . . . . . . .

43.8 * 0.2 * * * 0.1 0.6 4.5 36.3 302.1 1,735.4 43.4

2004. . . . . . . . . . . . . . . . . . . . 39.0 * 0.2 0.1 * * 0.1 0.6 3.9 33.1 275.4 1,556.9 39.1

2003. . . . . . . . . . . . . . . . . . . . 38.1 * 0.2 0.1 * * 0.1 0.6 4.0 34.1 269.5 1,523.1 38.4

2002. . . . . . . . . . . . . . . . . . . . 35.5 * 0.2 0.1 * * 0.1 0.4 3.6 31.9 254.9 1,428.9 36.1

2001. . . . . . . . . . . . . . . . . . . . 32.5 * 0.2 0.0 * 0.1 0.1 0.5 3.8 30.5 234.6 1,299.3 33.1

2000. . . . . . . . . . . . . . . . . . . . 29.7 * 0.2 0.1 0.1 0.1 0.1 0.5 3.6 29.4 218.5 1,180.9 30.5

1999. . . . . . . . . . . . . . . . . . . . 26.7 * 0.2 0.1 * * 0.1 0.4 3.4 27.0 197.9 1,062.5 27.5

See footnotes at end of table.

34 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Drug-induced causes

2018. . . . . . . . . . . . . . . . . . . . 21.7 0.8 0.2 0.1 11.0 36.8 40.0 37.3 30.4 11.4 4.8 5.1 21.8

2017. . . . . . . . . . . . . . . . . . . . 22.7 0.9 0.2 0.2 13.0 39.8 40.6 39.8 30.0 10.5 4.5 5.3 22.8

2016. . . . . . . . . . . . . . . . . . . . 20.8 0.9 0.3 0.1 12.8 35.9 36.6 36.5 27.7 9.2 4.1 5.3 20.8

2015. . . . . . . . . . . . . . . . . . . . 17.2 0.7 0.4 0.1 10.0 28.0 29.6 31.9 23.3 8.1 4.4 5.6 17.2

2014. . . . . . . . . . . . . . . . . . . . 15.6 0.6 0.3 0.1 8.9 24.0 26.2 29.8 21.7 7.6 4.4 5.0 15.5

2013. . . . . . . . . . . . . . . . . . . . 14.7 0.8 0.3 0.1 8.6 21.7 24.1 29.0 20.6 7.1 4.4 5.3 14.6

2012. . . . . . . . . . . . . . . . . . . . 14.0 0.8 0.2 0.1 8.3 20.9 23.1 28.3 17.9 6.5 4.0 5.1 13.8

2011. . . . . . . . . . . . . . . . . . . . 14.0 0.6 0.2 0.1 8.9 20.9 23.4 28.2 17.1 6.0 4.0 4.9 13.9

2010. . . . . . . . . . . . . . . . . . . . 13.1 0.6 0.3 0.2 8.4 19.2 21.7 26.5 16.2 5.2 4.0 5.5 12.9

2009. . . . . . . . . . . . . . . . . . . . 12.8 0.8 0.2 0.1 8.0 17.8 21.5 26.9 14.9 5.4 4.5 5.1 12.6

2008. . . . . . . . . . . . . . . . . . . . 12.7 0.5 0.3 0.1 8.3 17.4 22.2 26.8 14.0 5.2 4.0 5.0 12.6

2007. . . . . . . . . . . . . . . . . . . . 12.7 0.8 0.3 0.2 8.5 17.5 22.6 26.8 13.4 4.6 3.9 5.2 12.6

2006. . .

. . . . . . . . . . . . . . . . . 12.9 1.1 0.2 0.1 8.5 17.2 23.5 26.7 12.1 5.2 6.0 8.8 12.8

2005. . . . . . . . . . . . . . . . . . . . 11.3 0.9 0.2 0.1 7.3 14.6 21.5 23.6 10.6 4.7 5.4 8.3 11.3

2004. . . . . . . . . . . . . . . . . . . . 10.5 0.7 0.2 0.2 6.9 12.9 21.1 21.7 9.0 4.2 4.8 6.7 10.5

2003. . . . . . . . . . . . . . . . . . . . 9.9 0.6 0.2 0.1 6.3 12.3 20.7 20.0 8.0 4.1 4.2 6.3 9.9

2002. . . . . . . . . . . . . . . . . . . . 9.1 0.7 0.2 0.1 5.4 11.3 19.8 18.0 6.8 3.6 3.8 6.0 9.1

2001. . . . . . . . . . . . . . . . . . . . 7.6 0.5 0.2 0.1 4.5 9.5 17.0 14.7 5.4 3.0 3.5 5.2 7.6

2000. . . . . . . . . . . . . . . . . . . . 7.0 * * 0.1 4.0 8.8 16.0 13.2 4.9 2.6 3.5 5.7 7.0

1999. . . . . . . . . . . . . . . . . . . . 6.9 0.6 0.2 0.1 3.5 8.9 15.7 12.6 4.9 3.0 3.8 4.8 6.8

Alcohol-induced causes

2018. . . . . . . . . . . . . . . . . . . . 11.4 * * * 0.3 3.7 10.0 21.6 31.5 22.2 12.4 6.1 9.9

2017. . . . . . . . . . . . . . . . . . . . 11.0 * * * 0.3 3.4 9.4 21.8 30.2 20.9 11.7 6.4 9.6

2016. . . . . . . . . . . . . . . . . . . . 10.8 * * * 0.4 3.6 9.2 21.4 29.7 20.3 11.8 6.3 9.5

2015. . . . . . . . . . . . . . . . . . . . 10.3 * * * 0.4 3.2 8.7 21.6 28.2 19.1 11.2 5.8 9.1

2014. . . . . . . . . . . . . . . . . . . . 9.6 * * * 0.3 2.8 8.0 20.4 26.8 17.6 10.5 5.6 8.5

2013. . . . . . . . . . . . . . . . . . . . 9.2 * * * 0.3 2.5 7.7 20.1 25.3 16.6 10.3 4.9 8.2

2012. . . . . . . . . . . . . . . . . . . . 8.8 * * * 0.4 2.4 7.4 20.0 24.1 15.8 10.3 5.0 8.0

2011. . . . . . . . . . . . . . . . . . . . 8.6 * * * 0.4 2.1 7.6 19.8 22.7 15.2 9.6 5.1 7.7

2010. . . . . . . . . . . . . . . . . . . . 8.3 * * * 0.3 2.2 7.5 19.1 21.9 15.8 9.6 5.3 7.6

2009. . . . . . . . . . . . . . . . . . . . 8.0 * * * 0.4 1.8 7.6 18.7 20.8 15.1 9.2 4.8 7.4

2008. . . . . . . . . . . . . . . . . . . . 8.0 * * * 0.4 2.0 7.6 18.6 20.7 15.3 9.4 5.2 7.4

2007. . . . . . . . . . . . . . . . . . . . 7.7 * * * 0.4 1.9 7.3 18.2 19.9

15.2 9.6 5.0 7.2

2006. . . . . . . . . . . . . . . . . . . . 7.4 * * * 0.3 1.6 7.5 17.5 19.2 14.5 9.7 5.3 7.0

2005. . . . . . . . . . . . . . . . . . . . 7.3 * * * 0.4 1.4 7.5 17.6 19.4 14.9 9.2 5.0 7.0

2004. . . . . . . . . . . . . . . . . . . . 7.2 * * * 0.3 1.6 7.7 17.3 18.6 15.5 9.2 4.6 7.0

2003. . . . . . . . . . . . . . . . . . . . 7.1 * * * 0.3 1.5 8.1 17.3 18.5 15.0 9.2 4.3 7.0

2002. . . . . . . . . . . . . . . . . . . . 7.0 * * * 0.3 1.5 8.1 16.9 18.3 15.4 9.3 4.6 6.9

2001. . . . . . . . . . . . . . . . . . . . 7.1 * * * 0.3 1.6 8.3 17.1 18.3 15.5 9.6 5.1 7.0

2000. . . . . . . . . . . . . . . . . . . . 7.0 * * * 0.2 1.6 8.5 16.3 18.7 15.8 9.9 5.4 7.0

1999. . . . . . . . . . . . . . . . . . . . 7.0 * * * 0.3 1.6 8.5 16.4 18.7 15.9 10.6 5.5 7.1

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 35

Table 5. Death rates by age, and age-adjusted death rates, for the 10 leading causes of death in 2018, dementia-related causes,

drug-induced causes, alcohol-induced causes, and injury by firearms: United States, 1999–2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this

report]

Cause of death

(based on International

Classification of Diseases,

10th Revision) and year All ages

Age group (years)

Age-

adjusted

rate

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Injury by firearms

2018. . . . . . . . . . . . . . . . . . . . 12.1 * 0.6 1.1 17.2 17.7 14.6 12.8 12.7 12.0 15.4 14.7 11.9

2017. . . . . . . . . . . . . . . . . . . . 12.2 * 0.5 1.1 17.7 18.5 14.4 13.1 12.3 11.4 14.8 15.6 12.0

2016. . . . . . . . . . . . . . . . . . . . 12.0 * 0.6 0.9 17.2 18.2 14.5 12.8 11.9 11.4 14.7 14.3 11.8

2015. . . . . . . . . . . . . . . . . . . . 11.3 * 0.5 0.9 15.7 16.8 13.1 12.4 11.7 11.3 14.5 14.5 11.1

2014. . . . . . . . . . . . . . . . . . . . 10.5 * 0.4 0.9 14.0 14.7 12.1 12.2 11.4 11.5 13.9 15.0 10.3

2013. . . . . . . . . . . . . . . . . . . . 10.6 * 0.4 0.8 14.1 15.3 12.3 12.3 11.5 11.3 14.1 13.9 10.4

2012. . . . . . . . . . . . . . . . . . . . 10.7 * 0.4 0.8 14.7 15.3 12.4 12.4 11.6 10.8 14.1 13.6 10.5

2011. . . . . . . . . . . . . . . . . . . . 10.4 * 0.5 0.8 14.4 15.0 11.7 12.2 11.0 10.9 13.7 13.1 10.2

2010. . . . . . . . . . . . . . . . . . . . 10.3 * 0.4 0.7 14.2 15.0 11.7 12.0 11.1 10.7 12.7 13.2 10.1

2009. . . . . . . . . . . . . . . . . . . . 10.2 * 0.4 0.7 14.4 14.5 11.9 11.8 10.8 10.9 13.3 12.5 10.1

2008. . . . . . . . . . . . . . . . . . . . 10.4 * 0.5 0.7 15.4 15.4 11.8 11.5 10.8 10.7 13.2 12.5 10.3

2007. . . . . . . . . . . . . . . . . . . . 10.4 * 0.4 0.8 16.0 15.9 12.0 11.1 10.1 9.8 13.1 12.7 10.3

2006. . .

. . . . . . . . . . . . . . . . . 10.4 * 0.4 0.9 16.7 15.7 11.6 11.2 9.7 9.9 12.9 12.5 10.3

2005. . . . . . . . . . . . . . . . . . . . 10.4 * 0.4 0.8 16.1 16.1 11.7 11.2 9.7 10.2 13.6 13.0 10.3

2004. . . . . . . . . . . . . . . . . . . . 10.1 * 0.3 0.7 15.6 15.3 11.4 11.0 9.8 10.1 13.3 12.7 10.0

2003. . . . . . . . . . . . . . . . . . . . 10.4 * 0.3 0.8 16.5 15.8 11.6 11.1 10.0 10.3 13.4 13.2 10.3

2002. . . . . . . . . . . . . . . . . . . . 10.5 * 0.4 0.8 16.6 15.6 12.2 10.8 10.2 10.8 14.4 13.2 10.5

2001. . . . . . . . . . . . . . . . . . . . 10.4 * 0.5 0.8 16.6 15.5 11.7 10.5 10.1 10.9 14.3 13.1 10.3

2000. . . . . . . . . . . . . . . . . . . . 10.2 * 0.3 0.9 16.8 14.5 11.9 10.5 9.4 10.6 13.9 14.2 10.2

1999. . . . . . . . . . . . . . . . . . . . 10.3 * 0.4 1.0 17.6 14.9 11.6 10.2 9.7 11.0 14.2 13.5 10.3

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

… Category not applicable.

Figures for age not stated included in “All ages” but not distributed among age groups.

Death rates for “Under 1” (based on population estimates) differ from infant mortality rates (based on live births); see Technical Notes in this report.

For method of computation, see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Figures include September 11, 2001-related deaths for which death certificates were filed as of October 24, 2002; see Technical Notes for “Deaths: Final Data for 2001,” National Vital

Statistics Reports vol 52 no 3.

For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

36 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 6. Number of deaths from selected causes, by age: United States, 2018

[Only selected causes of deaths are shown; therefore, subcategories do not add to totals; see Technical Notes in this report]

Cause of death (based on

International Classification of Diseases, 10th Revision)

All

ages

Age group (years)

Age not

statedUnder 1 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,839,205 21,467 3,830 5,450 30,154 58,844 80,380 164,837 374,836 543,778 675,205 880,280 144

Enterocolitis due to Clostridium difficile . . . . . . . . . . . (A04.7) 5,249 2 – 4 10 17 45 156 520 1,040 1,607 1,848 –

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (A40–A41) 40,718 151 54 60 101 399 829 2,380 5,956 9,143 10,687 10,956 2

Viral hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . (B15–B19) 4,842 – – – 3 47 193 703 2,128 1,232 387 148 1

Human immunodeficiency virus (HIV) disease . . (B20–B24) 5,425 – – 1 62 482 753 1,490 1,653 737 214 33 –

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . (C00–C97) 599,274 51 326 843 1,371 3,684 10,640 37,301 113,947 169,056 158,794 103,252 9

Malignant neoplasms of lip, oral cavity and

pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (C00–C14) 10,158 2 – 1 14 62 182 916 2,695 2,997 2,010 1,279 –

Malignant neoplasm of esophagus . . . . . . . . . . . . . . .(C15) 15,419 – – – 2 50 201 1,078 3,763 5,069 3,593 1,663 –

Malignant neoplasm of stomach. . . . . . . . . . . . . . . . .(C16) 11,043 – – – 12 127 439 1,035 2,182 2,811 2,633 1,804 –

Malignant neoplasms of colon,

rectum and anus

. . . . . . . . . . . . . . . . . . . . . . . (C18–C21) 53,094 – – 3 32 372 1,451 4,971 10,256 12,988 12,513 10,508 –

Malignant neoplasms of liver and

intrahepatic bile ducts . . . . . . . . . . . . . . . . . . . . . . .(C22) 27,686 4 12 11 35 104 344 1,621 7,541 9,164 6,005 2,844 1

Malignant neoplasm of pancreas . . . . . . . . . . . . . . . .(C25) 44,915 – – 2 9 57 432 2,460 8,737 13,982 12,409 6,826 1

Malignant neoplasms of trachea,

bronchus and lung . . . . . . . . . . . . . . . . . . . . . (C33–C34) 142,161 – 2 4 18 119 787 6,272 28,972 46,015 41,238 18,733 1

Malignant melanoma of skin. . . . . . . . . . . . . . . . . . . .(C43) 8,199 – – 1 13 118 316 677 1,502 2,014 2,008 1,550 –

Malignant neoplasm of breast . . . . . . . . . . . . . . . . . .(C50) 42,950 – – – 13 397 1,812 4,671 8,945 10,527 9,088 7,496 1

Malignant neoplasm of cervix uteri . . . . . . . . . . . . . . .(C53) 4,138 – – – 2 225 522 873 979 788 487 262 –

Malignant neoplasm of ovary . . . . . . . . . . . . . . . . . . .(C56) 13,748 – 1 2 24 84 290 1,221 2,983 4,015 3,367 1,761 –

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . .(C61) 31,489 – 1 – – – 24 412 2,916 7,420 10,461 10,254 1

Malignant neoplasms of kidney and

renal pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . (C64–C65) 14,134 2 12 27 25 65

229 950 2,726 3,993 3,691 2,414 –

Malignant neoplasm of bladder . . . . . . . . . . . . . . . . .(C67) 16,641 – 1 – – 14 63 440 1,824 3,802 5,289 5,208 –

Malignant neoplasms of meninges, brain and other parts

of central nervous system . . . . . . . . . . . . . . . (C70–C72) 17,127 14 69 326 229 444 849 1,754 4,007 4,796 3,339 1,299 1

Non-Hodgkin lymphoma. . . . . . . . . . . . . . . . . . (C82–C85) 20,287 1 5 23 74 160 318 842 2,726 4,952 6,444 4,742 –

Multiple myeloma and immunoproliferative

neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . (C88,C90) 12,809 – – – – 10 71 521 1,883 3,578 4,169 2,577 –

Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (C91–C95) 23,359 15 106 176 323 371 524 1,039 2,779 5,679 7,123 5,223 1

In situ neoplasms, benign neoplasms and neoplasms of

uncertain or unknown behavior . . . . . . . . . . . . . (D00–D48) 15,640 41 39 49 81 123 213 537 1,468 3,174 4,749 5,166 –

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (D50–D64) 5,262 10 17 23 64 159 173 278 479 832 1,176 2,051 –

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . .(E10–E14) 84,946 2 3 33 246 837 2,282 6,414 14,941 21,971 21,171 17,040 6

Nutritional deficiencies . . . . . . . . . . . . . . . . . . . . . .(E40–E64) 9,619 8 4 3 17 36 73 178 530 1,188 2,298 5,284 –

Obesity .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(E66) 7,916 – – 6 75 379 914 1,484 2,128 1,821 882 226 1

Parkinson disease . . . . . . . . . . . . . . . . . . . . . . . . (G20–G21) 33,829 – – 1 3 4 13 77 743 4,935 14,008 14,045 –

Alzheimer disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . (G30) 122,019 – – – – 2 6 107 1,245 7,543 32,927 80,188 1

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 37

Table 6. Number of deaths from selected causes, by age: United States, 2018—Con.

[Only selected causes of deaths are shown; therefore, subcategories do not add to totals; see Technical Notes in this report]

Cause of death (based on International Classification of

Diseases, 10th Revision)

All

ages

Age group (years)

Age not

statedUnder 1 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Major cardiovascular diseases . . . . . . . . . . . . . . . . .(I00–I78) 863,834 405 161 265 1,118 4,439 13,194 39,963 100,934 154,091 209,425 339,794 45

Diseases of heart . . . . . . . . . . . . (I00–I09,I11,I13,I20–I51) 655,381 288 115 169 905 3,561 10,532 32,220 81,042 119,664 155,219 251,626 40

Essential hypertension and hypertensive

renal disease. . . . . . . . . . . . . . . . . . . . . . . . . (I10,I12,I15) 35,835 1 – – 13 120 476 1,557 4,110 6,164 8,375 15,016 3

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . .(I60–I69) 147,810 98 43 88 148 567 1,704 5,128 12,789 23,414 39,415 64,415 1

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I70) 4,931 8 – 1 – 4 17 78 349 653 1,162 2,659 –

Aortic aneurysm and dissection . . . . . . . . . . . . . . . . . (I71) 9,923 – – 2 30 124 343 627 1,438 2,169 2,633 2,556 1

Influenza and pneumonia . . . . . . . . . . . . . . . . . . . . (J09–J18) 59,120 176 122 122 200 457 956 2,339 5,858 9,676 14,497 24,715 2

Chronic lower respiratory diseases . . . . . . . . . . . . (J40–J47) 159,486 15 50 132 165 300 648 3,807 18,804 39,221 51,677 44,662 5

Pneumonitis due to solids and liquids . . . . . . . . . . . . . . (J69) 19,239 4 7 12 45 86 204 542 1,555 3,007 4,999 8,778 –

Chronic liver disease and cirrhosis . . . . . . . . (K70,K73–K74) 42,838 5 1 2 32 1,008 3,108 8,157 13,945 9,907 5,005 1,667 1

Alcoholic liver disease . . . . . . . . . . .

. . . . . . . . . . . . .(K70) 23,172 – – – 21 832 2,404 5,617 8,526 4,382 1,182 207 1

Cholelithiasis and other disorders of gallbladder . (K80–K82) 3,778 1 – 2 8 17 49 117 333 653 1,008 1,589 1

Nephritis, nephrotic syndrome and

nephrosis . . . . . . . . . . . . . . (N00–N07,N17–N19,N25–N27) 51,386 78 11 17 52 260 753 2,240 5,740 10,841 14,514 16,877 3

Pregnancy, childbirth and the puerperium . . . . . . (O00–O99) 973 … … 1 151 421 387 10 3 – – – –

Certain conditions originating in the perinatal

period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P00–P96) 10,718 10,571 62 34 9 16 6 4 10 3 – 1 2

Congenital malformations, deformations and chromosomal

abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 9,729 4,473 384 373 354 455 428 744 1,178 653 372 313 2

Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified . . . . . . . . . . . (R00–R99) 32,537 2,656 270 124 499 1,142 1,279 1,828 3,252 4,004 5,227 12,233 23

Accidents (unintentional injuries) . . . . . .(V01–X59,Y85–Y86) 167,127 1,168 1,226 1,426 12,044 24,614 22,667 23,056 23,693 15,957 17,134 24,122 20

Motor vehicle accidents . . . . . . . . (V02–V04,V09.0,V09.2,

V12–V14,V19.0–V19.2,V19.4–V19.6,V20–V79,

V80.3–V80.5,V81.0–V81.1,V82.0–V82.1,V83–V86,

V87.0–V87.8,V88.0–V88.8,V89.0,V89.2) 39,404 81 362 765 6,434 7,062 5,219 5,522 5,846 3,996 2,779 1,336 2

Falls . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . (W00–W19) 37,455 4 16 17 152 345 502 1,131 2,766 5,110 9,709 17,703 –

Accidental discharge of firearms . . . . . . . . . . (W32–W34) 458 – 30 24 129 79 46 45 51 34 19 1 –

Accidental drowning and submersion. . . . . . . (W65–W74) 3,710 39 443 216 431 482 414 456 453 413 248 111 4

Accidental hanging, strangulation and

suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . (W75–W84) 6,701 977 112 73 91 185 211 401 858 1,026 1,231 1,536 –

Accidental exposure to smoke, fire and

flames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X00–X09) 2,972 17 121 150 75 161 221 325 557 631 459 255 –

Accidental poisoning and exposure to noxious

substances . . . . . . . . . . . . . . . . . . . . . . . . . . . (X40–X49) 62,399 8 22 36 4,245 15,353 14,978 13,620 10,854 2,620 460 189 14

Intentional self-harm (suicide) . . . . . (*U03,X60–X84,Y87.0)

48,344 … … 605 6,211 8,020 7,521 8,345 8,540 4,974 2,880 1,248 –

Intentional self-harm (suicide) by

poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X60–X69) 6,237 … … 20 454 753 990 1,396 1,491 746 253 134 –

Intentional self-harm (suicide) by hanging,

strangulation and suffocation . . . . . . . . . . . . . . . . . .(X70) 13,840 … … 369 2,237 3,117 2,688 2,481 1,934 649 246 119 –

Intentional self-harm (suicide) by discharge of

firearms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X72–X74) 24,432 … … 203 2,995 3,429 3,222 3,787 4,421 3,237 2,215 923 –

See footnotes at end of table.

38 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 6. Number of deaths from selected causes, by age: United States, 2018—Con.

[Only selected causes of deaths are shown; therefore, subcategories do not add to totals; see Technical Notes in this report]

Cause of death (based on International Classification of

Diseases, 10th Revision)

All

ages

Age group (years)

Age not

statedUnder 1 1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Assault (homicide) . . . . . . . . .(*U01–*U02,X85–Y09,Y87.1)

18,830 269 353 289 4,607 5,234 3,304 2,125 1,501 712 300 134 2

Assault (homicide) by discharge of

firearms . . . . . . . . . . . . . . . . . . . . . . .(*U01.4,X93–X95)

13,958 6 54 191 4,107 4,348 2,569 1,382 802 347 114 37 1

Legal intervention . . . . . . . . . . . . . . . . . . . . . . . (Y35,Y89.0) 618 – – 1 100 179 164 76 70 23 5 – –

Complications of medical and

surgical care . . . . . . . . . . . . . . . . . . . . . . . . (Y40–Y84,Y88) 4,604 18 22 31 44 84 176 363 766 1,259 1,115 726 –

Dementia-related causes

. . . . . . . . . . . . . . . . . . . . . . . . . . . 266,957 10 18 18 13 26 54 340 3,301 17,645 68,806 176,721 5

Drug-induced deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71,147 32 35 54 4,745 16,836 16,499 15,512 12,867 3,480 741 332 14

Drug overdose deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 67,367 32 35 53 4,633 16,200 15,794 14,688 11,946 3,122 603 247 14

Alcohol-induced deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,329 – – 1 128 1,675 4,147 8,992 13,302 6,767 1,914 401 2

Injury by firearms

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,740 7 91 437 7,411 8,100 6,027 5,323 5,353 3,662 2,365 963 1

– Quantity zero.

… Category not applicable.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Included in selected categories above. For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 39

Table 7. Death rates for selected causes, by age: United States, 2018

[Rates are on an annual basis per 100,000 population in specified group; see Technical Notes in this report]

Cause of death (based on International

Classification of Diseases, 10th Revision)

All

ages

Age group (years)

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867.8 557.8 24.0 13.3 70.2 128.8 194.7 395.9 886.7 1,783.3 4,386.1 13,450.7

Enterocolitis due to Clostridium difficile . . . . . . . . . . . (A04.7) 1.6 * * * * * 0.1 0.4 1.2 3.4 10.4 28.2

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(A40–A41) 12.4 3.9 0.3 0.1 0.2 0.9 2.0 5.7 14.1 30.0 69.4 167.4

Viral hepatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B15–B19) 1.5 * * * * 0.1 0.5 1.7 5.0 4.0 2.5 2.3

Human immunodeficiency virus (HIV) disease . . .(B20–B24) 1.7 * * * 0.1 1.1 1.8 3.6 3.9 2.4 1.4 0.5

Malignant neoplasms . . . . . . . . . . . . . . . . . . . . . . .(C00–C97) 183.2 1.3 2.0 2.1 3.2 8.1 25.8 89.6 269.6 554.4 1,031.5 1,577.7

Malignant neoplasms of lip, oral cavity and

pharynx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(C00–C14) 3.1 * * * * 0.1 0.4 2.2 6.4 9.8 13.1 19.5

Malignant neoplasm of esophagus . . . . . . . . . . . . . . .(C15)

4.7 * * * * 0.1 0.5 2.6 8.9 16.6 23.3 25.4

Malignant neoplasm of stomach. . . . . . . . . . . . . . . . .(C16) 3.4 * * * *

0.3 1.1 2.5 5.2 9.2 17.1 27.6

Malignant neoplasms of colon, rectum and

anus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(C18–C21) 16.2 * * * 0.1 0.8 3.5 11.9 24.3 42.6 81.3 160.6

Malignant neoplasms of liver and intrahepatic bile

ducts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(C22) 8.5 * * * 0.1 0.2 0.8 3.9 17.8 30.1 39.0 43.5

Malignant neoplasm of pancreas . . . . . . . . . . . . . . . .(C25) 13.7 * * * * 0.1 1.0 5.9 20.7 45.9 80.6 104.3

Malignant neoplasms of trachea, bronchus and

lung . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . .(C33–C34) 43.5 * * * * 0.3 1.9 15.1 68.5 150.9 267.9 286.2

Malignant melanoma of skin. . . . . . . . . . . . . . . . . . . .(C43) 2.5 * * * * 0.3 0.8 1.6 3.6 6.6 13.0 23.7

Malignant neoplasm of breast . . . . . . . . . . . . . . . . . .(C50) 13.1 * * * * 0.9 4.4 11.2 21.2 34.5 59.0 114.5

Malignant neoplasm of cervix uteri . . . . . . . . . . . . . . .(C53) 1.3 * * * * 0.5 1.3 2.1 2.3 2.6 3.2 4.0

Malignant neoplasm of ovary . . . . . . . . . . . . . . . . . . .(C56) 4.2 * * * 0.1 0.2 0.7 2.9 7.1 13.2 21.9 26.9

Malignant neoplasm of prostate . . . . . . . . . . . . . . . . .(C61) 9.6 * * * * * 0.1 1.0 6.9 24.3 68.0 156.7

Malignant neoplasms of kidney and renal

pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(C64–C65) 4.3 * * 0.1 0.1 0.1 0.6 2.3 6.4 13.1 24.0 36.9

Malignant neoplasm of bladder . . . . . . . . . . . . . . . . .(C67) 5.1 * * * * * 0.2 1.1 4.3 12.5 34.4 79.6

Malignant neoplasms of meninges, brain and other

parts of central nervous system . . . . . . . . . . . .(C70–C72) 5.2 * 0.4 0.8 0.5 1.0 2.1 4.2 9.5 15.7 21.7 19.8

Non-Hodgkin lymphoma. . . . . . . . . . . . . . . . . . .(C82–C85) 6.2 * * 0.1 0.2 0.4 0.8 2.0 6.4 16.2 41.9 72.5

Multiple myeloma and immunoproliferative

neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . .

. (C88,C90) 3.9 * * * * * 0.2 1.3 4.5 11.7 27.1 39.4

Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(C91–C95) 7.1 * 0.7 0.4 0.8 0.8 1.3 2.5 6.6 18.6 46.3 79.8

In situ neoplasms, benign neoplasms and neoplasms of

uncertain or unknown behavior . . . . . . . . . . . . . (D00–D48) 4.8 1.1 0.2 0.1 0.2 0.3 0.5 1.3 3.5 10.4 30.8 78.9

Anemias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (D50–D64) 1.6 * * 0.1 0.1 0.3 0.4 0.7 1.1 2.7 7.6 31.3

Diabetes mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . (E10–E14) 26.0 * * 0.1 0.6 1.8 5.5 15.4 35.3 72.1 137.5 260.4

Nutritional deficiencies . . . . . . . . . . . . . . . . . . . . . . (E40–E64) 2.9 * * * * 0.1 0.2 0.4 1.3 3.9 14.9 80.7

Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (E66) 2.4 * * * 0.2 0.8 2.2 3.6 5.0 6.0 5.7 3.5

Parkinson disease . . . . . . . . . . . . . . . . . . . . . . . . (G20–G21) 10.3 * * * * * * 0.2 1.8 16.2 91.0 214.6

Alzheimer disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(G30) 37.3

* * * * * * 0.3 2.9 24.7 213.9 1,225.3

See footnotes at end of table.

40 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 7. Death rates for selected causes, by age: United States, 2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; see Technical Notes in this report]

Cause of death (based on International

Classification of Diseases, 10th Revision)

All

ages

Age group (years)

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Major cardiovascular diseases . . . . . . . . . . . . . . . . .(I00–I78) 264.0 10.5 1.0 0.6 2.6 9.7 32.0 96.0 238.8 505.3 1,360.4 5,192.1

Diseases of heart . . . . . . . . . . . . (I00–I09,I11,I13,I20–I51) 200.3 7.5 0.7 0.4 2.1 7.8 25.5 77.4 191.7 392.4 1,008.3 3,844.8

Essential hypertension and hypertensive renal

disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I10,I12,I15) 11.0 * * * * 0.3 1.2 3.7 9.7 20.2 54.4 229.4

Cerebrovascular diseases . . . . . . . . . . . . . . . . . . .(I60–I69) 45.2 2.5 0.3 0.2 0.3 1.2 4.1 12.3 30.3 76.8 256.0 984.3

Atherosclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I70) 1.5 * * * * * * 0.2 0.8 2.1 7.5 40.6

Aortic aneurysm and dissection . . . . . . . . . . . . . . . . . (I71) 3.0 * * * 0.1 0.3 0.8 1.5 3.4 7.1 17.1 39.1

Influenza and pneumonia . . . . . . . . . . . . . . . . . . . . (J09–J18) 18.1 4.6 0.8 0.3 0.5 1.0 2.3 5.6 13.9 31.7 94.2 377.6

Chronic lower respiratory diseases . . . . . . . . . . . . (J40–J47) 48.7 * 0.3 0.3 0.4 0.7 1.6 9.1 44.5 128.6 335.7 682.4

Pneumonitis due to solids and liquids . . . . . . . . . . . . . . (J69) 5.9 * * * 0.1 0.2 0.5 1.3 3.7 9.9 32.5 134.1

Chronic liver disease and cirrhosis . . . . . . . . (K70,K73–K74) 13.1 * * * 0.1 2.2 7.5 19.6 33.0 32.5 32.5 25.5

Alcoholic liver disease . . . . . . . . . . . . .

. . . . . . . . . . .(K70) 7.1 * * * 0.0 1.8 5.8 13.5 20.2 14.4 7.7 3.2

Cholelithiasis and other disorders of

gallbladder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(K80–K82) 1.2 * * * * * 0.1 0.3 0.8 2.1 6.5 24.3

Nephritis, nephrotic syndrome and

nephrosis . . . . . . . . . . . . . . (N00–N07,N17–N19,N25–N27) 15.7 2.0 * * 0.1 0.6 1.8 5.4 13.6 35.6 94.3 257.9

Pregnancy, childbirth and the puerperium . . . . . . (O00–O99) 0.3 … … * 0.4 0.9 0.9 * * * * *

Certain conditions originating in the perinatal

period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(P00–P96) 3.3 274.7 0.4 0.1 * * * * * * * *

Congenital malformations, deformations and chromosomal

abnormalities . . . . . . . . . . . . . . . . . . . . . . . . . . . (Q00–Q99) 3.0 116.2 2.4 0.9 0.8 1.0 1.0 1.8 2.8 2.1 2.4 4.8

Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified . . . . . . . . . . . (R00–R99) 9.9 69.0 1.7 0.3 1.2 2.5 3.1 4.4 7.7 13.1 34.0 186.9

Accidents (unintentional

injuries) . . . . . . . . . . . . . . . . . . . . . . . . (V01–X59,Y85–Y86) 51.1 30.4 7.7 3.5 28.0 53.9 54.9 55.4 56.0 52.3 111.3 368.6

Motor vehicle accidents . . . . . . . . . . . . . .(V02–V04,V09.0,

V09.2,V12–V14,V19.0–V19.2,V19.4–V19.6,

V20–V79,V80.3–V80.5,V81.0–V81.1,V82.0–V82.1,

V83–V86,V87.0–V87.8,V88.0–V88.8,V89.0,V89.2) 12.0 2.1 2.3 1.9 15.0 15.5 12.6 13.3 13.8 13.1 18.1 20.4

Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (W00–W19) 11.4 * * *

0.4 0.8 1.2 2.7 6.5 16.8 63.1 270.5

Accidental discharge of firearms . . . . . . . . . . (W32–W34) 0.1 * 0.2 0.1 0.3 0.2 0.1 0.1 0.1 0.1 * *

Accidental drowning and submersion. . . . . . . (W65–W74) 1.1 1.0 2.8 0.5 1.0 1.1 1.0 1.1 1.1 1.4 1.6 1.7

Accidental hanging, strangulation and

suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . (W75–W84) 2.0 25.4 0.7 0.2 0.2 0.4 0.5 1.0 2.0 3.4 8.0 23.5

Accidental exposure to smoke, fire and

flames . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(X00–X09) 0.9 * 0.8 0.4 0.2 0.4 0.5 0.8 1.3 2.1 3.0 3.9

Accidental poisoning and exposure to noxious

substances . . . . . . . . . . . . . . . . . . . . . . . . . . . .(X40–X49) 19.1 * 0.1 0.1 9.9 33.6 36.3 32.7 25.7 8.6 3.0 2.9

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 41

Table 7. Death rates for selected causes, by age: United States, 2018—Con.

[Rates are on an annual basis per 100,000 population in specified group; see Technical Notes in this report]

Cause of death (based on International

Classification of Diseases, 10th Revision)

All

ages

Age group (years)

Under 1

1–4 5–14 15–24 25–34 35–44 45–54 55–64 65–74 75–84

85 and

over

Intentional self-harm (suicide) . . . . . (*U03,X60–X84,Y87.0)

14.8 … … 1.5 14.5 17.6 18.2 20.0 20.2 16.3 18.7 19.1

Intentional self-harm (suicide) by

poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(X60–X69) 1.9 … … 0.0 1.1 1.6 2.4 3.4 3.5 2.4 1.6 2.0

Intentional self-harm (suicide) by hanging, strangulation

and suffocation . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(X70) 4.2 … … 0.9 5.2 6.8 6.5 6.0 4.6 2.1 1.6 1.8

Intentional self-harm (suicide) by discharge of

firearms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(X72–X74) 7.5 … … 0.5 7.0 7.5 7.8 9.1 10.5 10.6 14.4 14.1

Assault (homicide) . . . . . . . . . (*U01–*U02,X85–Y09,Y87.1)

5.8 7.0 2.2 0.7 10.7 11.5 8.0 5.1 3.6 2.3 1.9 2.0

Assault (homicide) by discharge of

firearms . . . . . . . . . . . . . . . . . . . . . . .(*U01.4,X93–X95)

4.3 * 0.3 0.5 9.6 9.5 6.2 3.3 1.9 1.1 0.7 0.6

Legal intervention . . . . . . . . . . . . . . . . . . . . . . . .(Y35,Y89.0) 0.2 * * * 0.2 0.4 0.4 0.2 0.2 0.1 * *

Complications of medical and surgical care . . (Y40–Y84,Y88) 1.4 * 0.1 0.1 0.1 0.2 0.4 0.9 1.8 4.1 7.2 11.1

Dementia-related causes

. . . . . . . . . . . . . . . . . . . . . . . . . . . 81.6 * * * * 0.1 0.1 0.8 7.8 57.9 447.0 2,700.3

Drug-induced deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21.7 0.8 0.2 0.1 11.0 36.8 40.0 37.3 30.4 11.4 4.8 5.1

Drug overdose deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.6 0.8 0.2 0.1 10.8 35.5 38.3 35.3 28.3 10.2 3.9 3.8

Alcohol-induced deaths

. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.4 * * * 0.3 3.7 10.0 21.6 31.5 22.2 12.4 6.1

Injury by firearms

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.1 * 0.6 1.1 17.2 17.7 14.6 12.8 12.7 12.0 15.4 14.7

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

… Category not applicable.

Figures for age not stated included in “All ages” but not distributed among age groups.

Death rates for “Under 1” (based on population estimates) differ from infant mortality rates (based on live births); see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Included in selected categories above. For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

42 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 8. Number of deaths from selected causes, by race and Hispanic origin and sex: United States, 2018

[Includes selected causes of deaths; therefore, subcategories do not add to totals; see Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget

standards. Data for some race or Hispanic-origin categories should be interpreted with caution because of inconsistencies in reporting these items on death certificates and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Hispanic

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

All causes . . . . . . . . . . . . . . . . 2,839,205 1,458,469 1,380,736 2,182,552 1,108,848 1,073,704 341,408 177,958 163,450 17,790 9,678 8,112 68,768 35,089 33,679 3,277 1,786 1,491 204,719 113,045 91,674

Enterocolitis due to

Clostridium

difficile . . . . . . . . . . . (A04.7) 5,249 2,083 3,166 4,193 1,641 2,552 525 223 302 32 8 24 89 37 52 3 2 1 375 156 219

Septicemia . . . . . . .(A40–A41) 40,718 19,820 20,898 29,764 14,571 15,193 6,634 3,064 3,570 243 113 130 762 383 379 42 16 26 3,029 1,541 1,488

Viral hepatitis . . . . .(B15–B19) 4,842 3,138 1,704 3,072 1,979 1,093 728 485 243 65 30 35 201 128 73 11 8 3 696 460 236

Human immunodeficiency

virus (HIV)

disease . . . . . . . . .(B20–B24) 5,425 4,029 1,396 1,775 1,461 314 2,742 1,841 901 38 28 10 57 48 9 6 5 1 728 585 143

Malignant

neoplasms . . . . . .(C00–C97) 599,274 315,553 283,721 462,856 246,008 216,848 69,687 35,071 34,616 2,982 1,534 1,448 17,233 8,673 8,560 717 337 380 42,066 21,892 20,174

Malignant neoplasms of

lip, oral cavity and

pharynx . . . . . .(C00–C14) 10,158 7,221 2,937 7,996 5,635 2,361 1,107 817 290 41 32 9 379 272 107 12 9 3 551 403 148

Malignant neoplasm of

esophagus . . . . . . . . (C15) 15,419 12,297 3,122 12,921 10,441 2,480 1,221 841 380 71 52 19 303 225 78 7 5 2 799 666 133

Malignant neoplasm of

stomach . . . . . . . . . . (C16) 11,043 6,628 4,415 6,145 3,823 2,322 1,955 1,165 790 87 44 43 796 433 363 35 17 18 1,938 1,089 849

Malignant neoplasms of

colon, rectum and

anus . . .

. . . . . .(C18–C21) 53,094 28,296 24,798 39,389 20,840 18,549 7,001 3,682 3,319 314 168 146 1,685 900 785 54 29 25 4,318 2,483 1,835

Malignant neoplasms of

liver and intrahepatic

bile ducts . . . . . . . . .(C22) 27,686 18,594 9,092 18,147 12,231 5,916 3,685 2,496 1,189 247 157 90 1,562 1,030 532 48 33 15 3,766 2,471 1,295

Malignant neoplasm of

pancreas . . . . . . . . . . (C25) 44,915 23,178 21,737 34,240 17,988 16,252 5,489 2,637 2,852 194 99 95 1,386 643 743 40 19 21 3,343 1,671 1,672

Malignant neoplasms of

trachea, bronchus and

lung . . . . . . . . .(C33–C34) 142,161 76,284 65,877 116,432 61,756 54,676 14,974 8,422 6,552 717 359 358 3,471 1,933 1,538 133 76 57 5,552 3,224 2,328

Malignant melanoma of

skin . . . . . . . . . . . . . . (C43) 8,199 5,295 2,904 7,708 5,022 2,686 124 61 63 5 1 4 59 27 32 2 2 – 278 167 111

Malignant neoplasm of

breast . . . . . . . . . . . . (C50) 42,950 484 42,466 31,507 363 31,144 6,501 83 6,418 185 3 182 1,292 5 1,287 71 2 69 3,098 26 3,072

Malignant neoplasm of

cervix uteri . . . .

. . . . (C53) 4,138 … 4,138 2,555 … 2,555 751 … 751 32 … 32 150 … 150 16 … 16 586 … 586

Malignant neoplasm of

ovary . . . . . . . . . . . . (C56) 13,748 … 13,748 10,663 … 10,663 1,365 … 1,365 58 … 58 460 … 460 15 … 15 1,098 … 1,098

Malignant neoplasm of

prostate . . . . . . . . . . (C61) 31,489 31,489 … 23,176 23,176 … 5,197 5,197 … 132 132 … 635 635 … 33 33 … 2,115 2,115 …

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 43

Table 8. Number of deaths from selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Hispanic

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Malignant neoplasms of

kidney and renal

pelvis . . . . . . . .(C64–C65) 14,134 9,188 4,946 11,051 7,212 3,839 1,311 830 481 131 87 44 280 183 97 15 8 7 1,268 810 458

Malignant neoplasm of

bladder . . . . . . . . . . . (C67) 16,641 11,978 4,663 14,129 10,358 3,771 1,283 769 514 47 25 22 281 195 86 13 11 2 801 549 252

Malignant neoplasms of

meninges, brain and other

parts of central nervous

system . . . . . . .(C70–C72) 17,127 9,731 7,396 14,055 8,103 5,952 1,118 570 548 56 28 28 466 281 185 12 6 6 1,309 678 631

Non-Hodgkin

lymphoma . . . .(C82–C85) 20,287 11,678 8,609 16,217 9,411 6,806 1,535 858 677 87 50 37 647 355 292 25 12 13 1,665 935 730

Multiple myeloma and

immunoproliferative

neoplasms . . . . (C88,C90) 12,809 7,045 5,764 9,164 5,202 3,962 2,214 1,099 1,115 82 42 40 292 143 149 18 10 8 974 505 469

Leukemia . . . . . .(C91–C95) 23,359 13,651 9,708 18,700 11,092 7,608 2,031 1,091 940 88 55 33 620 349 271 30 19 11 1,757 972 785

In situ neoplasms, benign

neoplasms and neoplasms of

uncertain or unknown

behavior . . . . . . .

(D00–D48) 15,640 8,377 7,263 12,775 6,953 5,822 1,412 687 725 54 32 22 421 204 217 7 3 4 897 458 439

Anemias . . . . . . . . (D50–D64) 5,262 2,281 2,981 3,682 1,571 2,111 1,104 487 617 24 5 19 115 57 58 7 4 3 303 142 161

Diabetes mellitus . . (E10–E14) 84,946 47,551 37,395 55,597 32,093 23,504 15,211 7,775 7,436 1,005 548 457 2,802 1,480 1,322 239 137 102 9,386 5,115 4,271

Nutritional

deficiencies . . . . . (E40–E64) 9,619 3,620 5,999 7,598 2,775 4,823 1,130 464 666 52 21 31 203 96 107 9 4 5 574 237 337

Obesity . . . . . . . . . . . . . . (E66) 7,916 4,162 3,754 5,640 3,032 2,608 1,414 618 796 79 54 25 38 21 17 20 11 9 649 386 263

Parkinson

disease . . . . . . . . (G20–G21) 33,829 20,523 13,306 29,018 17,703 11,315 1,666 1,004 662 106 61 45 906 496 410 13 7 6 1,988 1,163 825

Alzheimer disease . . . . .(G30) 122,019 37,957 84,062 101,534 31,697 69,837 8,884 2,526 6,358 323 106 217 2,710 818 1,892 61 20 41 8,021 2,619 5,402

Major cardiovascular

diseases . . . . . . . . . (I00–I78) 863,834 446,031 417,803 665,251 341,524

323,727 109,247 56,303 52,944 4,146 2,248 1,898 21,935 11,386 10,549 1,051 593 458 56,217 30,395 25,822

Diseases of

heart . . . . . . . . . . (I00–I09,

I11,I13,I20–I51) 655,381 354,404 300,977 510,960 275,398 235,562 80,483 42,831 37,652 3,210 1,825 1,385 14,677 8,097 6,580 769 463 306 40,537 22,848 17,689

Essential hypertension and

hypertensive renal

disease . . . . . (I10,I12,I15) 35,835 16,141 19,694 24,617 10,748 13,869 6,335 3,061 3,274 188 99 89 1,466 623 843 46 21 25 2,928 1,452 1,476

Cerebrovascular

diseases . . . . . . . (I60–I69) 147,810 62,844 84,966 110,309 45,640 64,669 19,413 8,832 10,581 641 276 365 5,201 2,350 2,851 203 96 107 11,246 5,260 5,986

Atherosclerosis

. . . . . . (I70) 4,931 2,124 2,807 4,029 1,699 2,330 438 218 220 22 9 13 115 51 64 7 1 6 283 126 157

Aortic aneurysm and

dissection . . . . . . . . . (I71) 9,923 5,771 4,152 7,819 4,497 3,322 1,114 631 483 32 19 13 302 186 116 16 8 8 546 373 173

See footnotes at end of table.

44 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 8. Number of deaths from selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Hispanic

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Influenza and

pneumonia . . . . . . (J09–J18) 59,120 28,683 30,437 45,612 21,937 23,675 6,074 2,974 3,100 415 217 198 2,257 1,129 1,128 71 33 38 4,254 2,167 2,087

Chronic lower respiratory

diseases . . . . . . . . (J40–J47) 159,486 75,250 84,236 138,178 64,410 73,768 11,640 5,802 5,838 758 353 405 1,935 1,143 792 98 49 49 5,801 2,924 2,877

Pneumonitis due to solids and

liquids . . . . . . . . . . . . . (J69) 19,239 10,859 8,380 15,495 8,801 6,694 1,925 1,041 884 102 61 41 507 285 222 20 10 10 1,083 586 497

Chronic liver disease and

cirrhosis . . . . (K70,K73–K74) 42,838 27,227 15,611 30,752 19,276 11,476 3,261 2,057 1,204 1,100 594 506 650 403 247 43 26 17 6,628 4,618 2,010

Alcoholic liver

disease . . . . . . . . . . . (K70) 23,172 16,099 7,073 16,438 11,158 5,280 1,711 1,131 580 817 456 361 291 226 65 26 18 8 3,626 2,935 691

Cholelithiasis and other

disorders of

gallbladder . . . . . .(K80–K82) 3,778 1,838 1,940 2,879 1,387 1,492 337 154 183 36 23 13 129 68 61 6 3 3 371 193 178

Nephritis, nephrotic syndrome

and nephrosis . .

.(N00–N07,

N17–N19,N25–N27) 51,386 26,715 24,671 35,275 18,591 16,684 9,722 4,803 4,919 326 145 181 1,452 749 703 71 32 39 4,274 2,255 2,019

Pregnancy, childbirth and the

puerperium . . . . (O00–O99) 973 … 973 451 … 451 297 … 297 16 … 16 39 … 39 7 … 7 149 … 149

Certain conditions originating

in the perinatal

period . . . . . . . . . .(P00–P96) 10,718 6,086 4,632 4,082 2,315 1,767 3,342 1,905 1,437 71 36 35 390 208 182 37 22 15 2,268 1,277 991

Congenital malformations,

deformations and

chromosomal

abnormalities . . . (Q00–Q99) 9,729 5,099 4,630 5,941 3,082 2,859 1,560 813 747 100 56 44 278 145 133 16 10 6 1,606 864 742

Symptoms, signs and

abnormal clinical and

laboratory findings,

not elsewhere

classified

. . . . . . (R00–R99) 32,537 15,297 17,240 24,504 10,940 13,564 4,554 2,378 2,176 244 135 109 553 260 293 49 29 20 2,226 1,296 930

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 45

Table 8. Number of deaths from selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Hispanic

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Accidents (unintentional

injuries) . . . . . . . . (V01–X59,

Y85–Y86) 167,127 107,884 59,243 122,557 76,316 46,241 20,182 14,097 6,085 1,992 1,324 668 2,963 1,857 1,106 211 150 61 17,239 12,778 4,461

Motor vehicle

accidents . . . . . (V02–V04,

V09.0,V09.2,V12–V14,

V19.0–V19.2,V19.4–V19.6,

V20–V79,V80.3–V80.5,

V81.0–V81.1,V82.0–V82.1,

V83–V86,V87.0–V87.8,

V88.0–V88.8,V89.0,V89.2) 39,404 27,953 11,451 25,095 17,584 7,511 6,140 4,475 1,665 686 475 211 837 505 332 76 53 23 6,123 4,559 1,564

Falls . . . . . . . . .(W00–W19) 37,455 18,840 18,615 32,148 15,699 16,449 1,699 1,016 683 206 112 94 996 571 425 33 20 13 2,178 1,300 878

Accidental discharge of

firearms . . . . .(W32–W34) 458 413 45 284 257 27 101 90 11 9 7 2 6 5 1 – – – 49 45 4

Accidental drowning and

submersion . .(W65–W74) 3,710 2,803 907 2,223 1,626 597 631 509 122 64 50 14 182 123 59 13 10 3 528 429 99

Accidental hanging,

strangulation and

suffocation . . .(W75–W84) 6,701 3,873 2,828 4,874 2,811 2,063 1,013 565 448 53 33 20 160 92 68 9 8 1 508 313 195

Accidental exposure to

smoke, fire and

flames . . . . . . . .(X00–X09) 2,972 1,768 1,204 2,069 1,222 847 599 350 249 38

29 9 29 18 11 1 1 – 205 130 75

Accidental poisoning and

exposure to noxious

substances . . . .(X40–X49) 62,399 43,157 19,242 45,315 30,499 14,816 8,372 6,001 2,371 730 470 260 524 398 126 66 48 18 6,374 5,022 1,352

Intentional self-harm

(suicide) . . . . . . . . . . . (*U03,

X60–X84,Y87.0)

48,344 37,761 10,583 38,415 29,997 8,418 3,022 2,406 616 545 409 136 1,315 921 394 73 61 12 4,313 3,469 844

Intentional self-harm

(suicide) by

poisoning . . . . .(X60–X69) 6,237 3,137 3,100 5,274 2,631 2,643 291 145 146 45 22 23 174 90 84 8 7 1 365 193 172

Intentional self-harm

(suicide) by hanging,

strangulation and

suffocation . . . . . . . . (X70) 13,840 10,677 3,163 9,922 7,698 2,224 839 649 190 302 225 77 612 411 201 44 36 8 1,873 1,478 395

Intentional self-harm

(suicide) by discharge of

firearms . . . . . .(X72–X74) 24,432 21,101 3,331 20,585 17,720 2,865 1,492 1,316 176 174 145 29 310 260 50 16 15 1 1,601 1,431 170

See footnotes at end of table.

46 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 8. Number of deaths from selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Hispanic

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Assault

(homicide) . . . .(*U01–*U02,

X85–Y09,Y87.1)

18,830 14,825 4,005 5,460 3,639 1,821 9,469 8,071 1,398 275 218 57 263 171 92 42 35 7 3,045 2,491 554

Assault (homicide) by

discharge of firearms

. . . . . . (*U01.4,X93–X95)

13,958 11,641 2,317 3,303 2,354 949 7,937 6,998 939 153 123 30 162 118 44 32 27 5 2,191 1,880 311

Legal

intervention . . . .(Y35,Y89.0) 618 593 25 301 289 12 136 130 6 14 14 – 11 11 – 2 2 – 141 134 7

Complications of medical

and surgical

care . . . . . . . (Y40–Y84,Y88) 4,604 2,457 2,147 3,423 1,868 1,555 667 310 357 33 18 15 109 67 42 4 1 3 338 183 155

Dementia-related causes

. . . 266,957 87,759 179,198 223,473 73,273 150,200 21,037 6,743 14,294 764 270 494 5,529 1,799 3,730 126 50 76 14,937 5,181 9,756

Drug-induced deaths

. . . . . . 71,147 47,338 23,809 52,322 33,679 18,643 9,632 6,883 2,749 680 407 273 634 441 193 76 56 20 6,663 5,087 1,576

Drug overdose deaths

. . . . 67,367 44,941 22,426 49,637 32,062 17,575 9,027 6,442 2,585 624 381 243 610 425 185 71 52 19 6,332 4,845 1,487

Alcohol-induced deaths

. . . . 37,329 26,820 10,509 26,987 19,001 7,986 3,143 2,234 909 1,312 793 519 456 356 100 34 23 11 4,969 4,109 860

Injury by firearms

. . . . . . . . . 39,740 33,955 5,785 24,643 20,745 3,898 9,713 8,567 1,146 361 298 63 492 396 96 54 48 6 4,018 3,521 497

… Category not applicable.

– Quantity zero.

Includes deaths with origin not stated, origin not classifiable, and two or more races reported; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Included in selected categories above. For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 47

Table 9. Death rates for selected causes, by race and Hispanic origin and sex: United States, 2018

[Rates are on an annual basis per 100,000 population in specified group; see Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards.

Data for some race or Hispanic-origin categories should be interpreted with caution because of inconsistencies in reporting these items on death certificates and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

All causes . . . . . . . . . . . . . . . . 867.8 905.2 831.6 1,104.8 1,138.2 1,072.3 834.7 909.8 765.9 735.9 813.5 660.8 367.2 393.4 343.3 558.9 605.4 511.8 341.9 373.9 309.3

Enterocolitis due to

Clostridium

difficile . . . . . . . . . . . (A04.7) 1.6 1.3 1.9 2.1 1.7 2.5 1.3 1.1 1.4 1.3 * 2.0 0.5 0.4 0.5 * * * 0.6 0.5 0.7

Septicemia . . . . . . .(A40–A41) 12.4 12.3 12.6 15.1 15.0 15.2 16.2 15.7 16.7 10.1 9.5 10.6 4.1 4.3 3.9 7.2 * 8.9 5.1 5.1 5.0

Viral hepatitis . . . . .(B15–B19) 1.5 1.9 1.0 1.6 2.0 1.1 1.8 2.5 1.1 2.7 2.5 2.9 1.1 1.4 0.7 * * * 1.2 1.5 0.8

Human immunodeficiency

virus (HIV)

disease . . . . . . . . .(B20–B24) 1.7 2.5 0.8 0.9 1.5 0.3 6.7 9.4 4.2 1.6 2.4 * 0.3 0.5 * * * * 1.2 1.9 0.5

Malignant

neoplasms . . . . . .(C00–C97) 183.2 195.8 170.9 234.3 252.5 216.6 170.4 179.3 162.2 123.4 128.9 117.9 92.0 97.2 87.3 122.3 114.2 130.4

70.3 72.4 68.1

Malignant neoplasms of

lip, oral cavity and

pharynx . . . . . .(C00–C14) 3.1 4.5 1.8 4.0 5.8 2.4 2.7 4.2 1.4 1.7 2.7 * 2.0 3.0 1.1 * * * 0.9 1.3 0.5

Malignant neoplasm of

esophagus . . . . . . . . (C15) 4.7 7.6 1.9 6.5 10.7 2.5 3.0 4.3 1.8 2.9 4.4 * 1.6 2.5 0.8 * * * 1.3 2.2 0.4

Malignant neoplasm of

stomach . . . . . . . . . . (C16) 3.4 4.1 2.7 3.1 3.9 2.3 4.8 6.0 3.7 3.6 3.7 3.5 4.3 4.9 3.7 6.0 * * 3.2 3.6 2.9

Malignant neoplasms of

colon, rectum and

anus . . . . . . . . .(C18–C21) 16.2 17.6 14.9 19.9 21.4 18.5 17.1 18.8 15.6 13.0 14.1 11.9 9.0 10.1 8.0 9.2 9.8 8.6 7.2 8.2 6.2

Malignant neoplasms of

liver and intrahepatic

bile ducts . . . . . . . . . (C22) 8.5 11.5 5.5 9.2 12.6 5.9 9.0 12.8 5.6 10.2 13.2 7.3 8.3 11.5 5.4 8.2 11.2 * 6.3 8.2 4.4

Malignant neoplasm of

pancreas . . . . . . . . . . (C25) 13.7 14.4 13.1 17.3 18.5 16.2 13.4 13.5 13.4 8.0 8.3 7.7 7.4 7.2 7.6 6.8 * 7.2 5.6 5.5 5.6

Malignant neoplasms of

trachea, bronchus and

lung . . . . . . . . .(C33–C34)

43.5 47.3 39.7 58.9 63.4 54.6 36.6 43.1 30.7 29.7 30.2 29.2 18.5 21.7 15.7 22.7 25.8 19.6 9.3 10.7 7.9

Malignant melanoma of

skin . . . . . . . . . . . . . . (C43) 2.5 3.3 1.7 3.9 5.2 2.7 0.3 0.3 0.3 * * * 0.3 0.3 0.3 * * * 0.5 0.6 0.4

Malignant neoplasm of

breast . . . . . . . . . . . .(C50) 13.1 0.3 25.6 15.9 0.4 31.1 15.9 0.4 30.1 7.7 * 14.8 6.9 * 13.1 12.1 * 23.7 5.2 0.1 10.4

Malignant neoplasm of

cervix uteri . . . . . . . . (C53) 1.3 … 2.5 1.3 … 2.6 1.8 … 3.5 1.3 … 2.6 0.8 … 1.5 * … * 1.0 … 2.0

Malignant neoplasm of

ovary . . . . . . . . . . . . (C56) 4.2 … 8.3 5.4 … 10.6 3.3 … 6.4 2.4 … 4.7 2.5 … 4.7 * … * 1.8 … 3.7

Malignant neoplasm of

prostate . . . . . . . . . . (C61) 9.6 19.5 … 11.7 23.8 … 12.7 26.6 … 5.5 11.1 … 3.4 7.1 … 5.6 11.2 … 3.5 7.0 …

See footnotes at end of table.

48 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 9. Death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Malignant neoplasms of

kidney and renal

pelvis . . . . . . . .(C64–C65) 4.3 5.7 3.0 5.6 7.4 3.8 3.2 4.2 2.3 5.4 7.3 3.6 1.5 2.1 1.0 * * * 2.1 2.7 1.5

Malignant neoplasm of

bladder . . . . . . . . . . .(C67) 5.1 7.4 2.8 7.2 10.6 3.8 3.1 3.9 2.4 1.9 2.1 1.8 1.5 2.2 0.9 * * * 1.3 1.8 0.9

Malignant neoplasms of

meninges, brain and other

parts of central nervous

system . . . . . . .(C70–C72) 5.2 6.0 4.5 7.1 8.3 5.9 2.7 2.9 2.6 2.3 2.4 2.3 2.5 3.2 1.9 * * * 2.2 2.2 2.1

Non-Hodgkin

lymphoma . . . .(C82–C85) 6.2 7.2 5.2 8.2 9.7 6.8 3.8 4.4 3.2 3.6 4.2 3.0 3.5 4.0 3.0 4.3 * * 2.8 3.1 2.5

Multiple myeloma and

immunoproliferative

neoplasms . . . . (C88,C90) 3.9 4.4 3.5 4.6 5.3 4.0 5.4 5.6 5.2 3.4 3.5 3.3 1.6 1.6 1.5 * * * 1.6 1.7 1.6

Leukemia . . . . . .(C91–C95) 7.1 8.5 5.8 9.5 11.4 7.6 5.0 5.6 4.4 3.6 4.6 2.7 3.3 3.9 2.8 5.1 * * 2.9 3.2 2.6

In situ neoplasms, benign

neoplasms and neoplasms of

uncertain or unknown

behavior . . . . . . . (D00–D48) 4.8 5.2 4.4 6.5 7.1

5.8 3.5 3.5 3.4 2.2 2.7 1.8 2.2 2.3 2.2 * * * 1.5 1.5 1.5

Anemias . . . . . . . . (D50–D64) 1.6 1.4 1.8 1.9 1.6 2.1 2.7 2.5 2.9 1.0 * * 0.6 0.6 0.6 * * * 0.5 0.5 0.5

Diabetes mellitus . . (E10–E14) 26.0 29.5 22.5 28.1 32.9 23.5 37.2 39.7 34.8 41.6 46.1 37.2 15.0 16.6 13.5 40.8 46.4 35.0 15.7 16.9 14.4

Nutritional

deficiencies . . . . . (E40–E64) 2.9 2.2 3.6 3.8 2.8 4.8 2.8 2.4 3.1 2.2 1.8 2.5 1.1 1.1 1.1 * * * 1.0 0.8 1.1

Obesity . . . . . . . . . . . . . . (E66) 2.4 2.6 2.3 2.9 3.1 2.6 3.5 3.2 3.7 3.3 4.5 2.0 0.2 0.2 * 3.4 * * 1.1 1.3 0.9

Parkinson

disease . . . . . . . . (G20–G21) 10.3 12.7 8.0 14.7 18.2 11.3 4.1 5.1 3.1 4.4 5.1 3.7 4.8 5.6 4.2 * * * 3.3 3.8 2.8

Alzheimer disease . . . . .(G30) 37.3 23.6 50.6 51.4 32.5 69.7 21.7 12.9 29.8 13.4 8.9 17.7 14.5 9.2 19.3 10.4 6.8 14.1 13.4 8.7 18.2

Major cardiovascular

diseases . . . . . . . . . (I00–I78) 264.0 276.8 251.6 336.8 350.6 323.3 267.1 287.8 248.1 171.5 189.0

154.6 117.1 127.7 107.5 179.2 201.0 157.2 93.9 100.5 87.1

Diseases of

heart . . . . . . . . . . (I00–I09,

I11,I13,I20–I51) 200.3 220.0 181.3 258.7 282.7 235.3 196.8 219.0 176.4 132.8 153.4 112.8 78.4 90.8 67.1 131.2 157.0 105.0 67.7 75.6 59.7

Essential hypertension and

hypertensive renal

disease . . . . . (I10,I12,I15) 11.0 10.0 11.9 12.5 11.0 13.9 15.5 15.6 15.3 7.8 8.3 7.2 7.8 7.0 8.6 7.8 7.1 8.6 4.9 4.8 5.0

Cerebrovascular

diseases . . . . . . . (I60–I69) 45.2 39.0 51.2 55.8 46.8 64.6 47.5 45.2 49.6 26.5 23.2 29.7 27.8 26.3 29.1 34.6 32.5 36.7 18.8 17.4 20.2

Atherosclerosis . . .

. . . (I70) 1.5 1.3 1.7 2.0 1.7 2.3 1.1 1.1 1.0 0.9 * * 0.6 0.6 0.7 * * * 0.5 0.4 0.5

Aortic aneurysm and

dissection . . . . . . . . . (I71) 3.0 3.6 2.5 4.0 4.6 3.3 2.7 3.2 2.3 1.3 * * 1.6 2.1 1.2 * * * 0.9 1.2 0.6

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 49

Table 9. Death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Influenza and

pneumonia . . . . . . (J09–J18) 18.1 17.8 18.3 23.1 22.5 23.6 14.9 15.2 14.5 17.2 18.2 16.1 12.1 12.7 11.5 12.1 11.2 13.0 7.1 7.2 7.0

Chronic lower respiratory

diseases . . . . . . . . (J40–J47) 48.7 46.7 50.7 69.9 66.1 73.7 28.5 29.7 27.4 31.4 29.7 33.0 10.3 12.8 8.1 16.7 16.6 16.8 9.7 9.7 9.7

Pneumonitis due to solids and

liquids . . . . . . . . . . . . . (J69) 5.9 6.7 5.0 7.8 9.0 6.7 4.7 5.3 4.1 4.2 5.1 3.3 2.7 3.2 2.3 3.4 * * 1.8 1.9 1.7

Chronic liver disease and

cirrhosis . . . . (K70,K73–K74) 13.1 16.9 9.4 15.6 19.8 11.5 8.0 10.5 5.6 45.5 49.9 41.2 3.5 4.5 2.5 7.3 8.8 * 11.1 15.3 6.8

Alcoholic liver

disease . . . . . . . . . . .(K70) 7.1 10.0 4.3 8.3 11.5 5.3 4.2 5.8 2.7 33.8 38.3 29.4 1.6 2.5 0.7 4.4 * * 6.1 9.7 2.3

Cholelithiasis and other

disorders of

gallbladder . . . . . .(K80–K82) 1.2 1.1 1.2 1.5 1.4 1.5 0.8 0.8 0.9 1.5 1.9 * 0.7 0.8 0.6 * * * 0.6 0.6 0.6

Nephritis, nephrotic syndrome

and nephrosis . . .(N00–N07,

N17–N19,N25–N27) 15.7 16.6

14.9 17.9 19.1 16.7 23.8 24.6 23.0 13.5 12.2 14.7 7.8 8.4 7.2 12.1 10.8 13.4 7.1 7.5 6.8

Pregnancy, childbirth and the

puerperium . . . . (O00–O99) 0.3 … 0.6 0.2 … 0.5 0.7 … 1.4 * … * 0.2 … 0.4 * … * 0.2 … 0.5

Certain conditions originating

in the perinatal

period . . . . . . . . . .(P00–P96) 3.3 3.8 2.8 2.1 2.4 1.8 8.2 9.7 6.7 2.9 3.0 2.9 2.1 2.3 1.9 6.3 7.5 * 3.8 4.2 3.3

Congenital malformations,

deformations and

chromosomal

abnormalities . . . (Q00–Q99) 3.0 3.2 2.8 3.0 3.2 2.9 3.8 4.2 3.5 4.1 4.7 3.6 1.5 1.6 1.4 * * * 2.7 2.9 2.5

Symptoms, signs and

abnormal clinical and

laboratory findings,

not elsewhere

classified . . . . . . (R00–R99) 9.9 9.5 10.4 12.4 11.2 13.5 11.1 12.2 10.2 10.1 11.3 8.9 3.0 2.9 3.0 8.4 9.8 6.9 3.7 4.3 3.1

See footnotes at end of table.

50 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 9. Death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Accidents (unintentional

injuries) . . . . . . . . (V01–X59,

Y85–Y86) 51.1 67.0 35.7 62.0 78.3 46.2 49.3 72.1 28.5 82.4 111.3 54.4 15.8 20.8 11.3 36.0 50.8 20.9 28.8 42.3 15.1

Motor vehicle

accidents . . . . . (V02–V04,

V09.0,V09.2,V12–V14,

V19.0–V19.2,V19.4–V19.6,

V20–V79,V80.3–V80.5,

V81.0–V81.1,V82.0–V82.1,

V83–V86,V87.0–V87.8,

V88.0–V88.8,V89.0,V89.2) 12.0 17.3 6.9 12.7 18.0 7.5 15.0 22.9 7.8 28.4 39.9 17.2 4.5 5.7 3.4 13.0 18.0 7.9 10.2 15.1 5.3

Falls . . . . . . . . .(W00–W19) 11.4 11.7 11.2 16.3 16.1 16.4 4.2 5.2 3.2 8.5 9.4 7.7 5.3 6.4 4.3 5.6 6.8 * 3.6 4.3 3.0

Accidental discharge of

firearms . . . . .(W32–W34) 0.1 0.3 0.0 0.1 0.3 0.0 0.2 0.5 * * * * * * * * * * 0.1 0.1 *

Accidental drowning and

submersion . .(W65–W74) 1.1 1.7 0.5 1.1 1.7 0.6 1.5 2.6 0.6 2.6 4.2 * 1.0 1.4 0.6 * * * 0.9 1.4 0.3

Accidental hanging,

strangulation and

suffocation . . .(W75–W84) 2.0 2.4 1.7 2.5 2.9 2.1 2.5 2.9 2.1 2.2 2.8 1.6 0.9 1.0 0.7 * * * 0.8 1.0 0.7

Accidental exposure to

smoke, fire and

flames . . . . . . . .(X00–X09) 0.9 1.1 0.7 1.0 1.3 0.8 1.5 1.8 1.2 1.6 2.4 * 0.2 * * *

* * 0.3 0.4 0.3

Accidental poisoning and

exposure to noxious

substances . . . .(X40–X49) 19.1 26.8 11.6 22.9 31.3 14.8 20.5 30.7 11.1 30.2 39.5 21.2 2.8 4.5 1.3 11.3 16.3 * 10.6 16.6 4.6

Intentional self-harm

(suicide) . . . . . . . . . . . (*U03,

X60–X84,Y87.0)

14.8 23.4 6.4 19.4 30.8 8.4 7.4 12.3 2.9 22.5 34.4 11.1 7.0 10.3 4.0 12.4 20.7 * 7.2 11.5 2.8

Intentional self-harm

(suicide) by

poisoning . . . . .(X60–X69) 1.9 1.9 1.9 2.7 2.7 2.6 0.7 0.7 0.7 1.9 1.8 1.9 0.9 1.0 0.9 * * * 0.6 0.6 0.6

Intentional self-harm

(suicide) by hanging,

strangulation and

suffocation . . . . . . . . (X70) 4.2 6.6 1.9 5.0 7.9 2.2 2.1 3.3 0.9 12.5 18.9 6.3 3.3 4.6 2.0 7.5 12.2 * 3.1 4.9 1.3

Intentional self-harm

(suicide) by discharge of

firearms . . . . . .(X72–X74) 7.5 13.1 2.0 10.4 18.2 2.9 3.6 6.7 0.8 7.2 12.2 2.4 1.7 2.9 0.5 * * * 2.7 4.7 0.6

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 51

Table 9. Death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Assault

(homicide) . . . .(*U01–*U02,

X85–Y09,Y87.1)

5.8 9.2 2.4 2.8 3.7 1.8 23.2 41.3 6.6 11.4 18.3 4.6 1.4 1.9 0.9 7.2 11.9 * 5.1 8.2 1.9

Assault (homicide) by

discharge of

firearms . . . . . . . (*U01.4,

X93–X95)

4.3 7.2 1.4 1.7 2.4 0.9 19.4 35.8 4.4 6.3 10.3 2.4 0.9 1.3 0.4 5.5 9.2 * 3.7 6.2 1.0

Legal

intervention . . . .(Y35,Y89.0) 0.2 0.4 0.0 0.2 0.3 * 0.3 0.7 * * * * * * * * * * 0.2 0.4 *

Complications of medical

and surgical

care . . . . . . . (Y40–Y84,Y88) 1.4 1.5 1.3 1.7 1.9 1.6 1.6 1.6 1.7 1.4 * * 0.6 0.8 0.4 * * * 0.6 0.6 0.5

Dementia-related causes

. . . 81.6 54.5 107.9 113.1 75.2 150.0 51.4 34.5 67.0 31.6 22.7 40.2 29.5 20.2 38.0 21.5 16.9 26.1 24.9 17.1 32.9

Drug-induced deaths

. . . . . . 21.7 29.4 14.3 26.5 34.6 18.6 23.5 35.2 12.9 28.1 34.2 22.2 3.4 4.9 2.0 13.0 19.0 6.9 11.1 16.8 5.3

Drug overdose deaths

. . . . 20.6 27.9 13.5 25.1 32.9 17.6 22.1 32.9 12.1 25.8 32.0 19.8 3.3 4.8 1.9 12.1 17.6 * 10.6 16.0 5.0

Alcohol-induced deaths

. . . . 11.4 16.6 6.3 13.7 19.5 8.0 7.7 11.4 4.3 54.3 66.7 42.3 2.4 4.0 1.0 5.8 7.8 * 8.3 13.6 2.9

Injury by firearms

. . . . . . . . . 12.1 21.1 3.5 12.5 21.3 3.9 23.7 43.8 5.4 14.9 25.0 5.1 2.6 4.4 1.0 9.2 16.3 * 6.7 11.6 1.7

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

0.0 Quantity more than zero but less than 0.05.

… Category not applicable.

Includes deaths with origin not stated, origin not classifiable, and two or more races reported; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Included in selected categories above. For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

52 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 10. Age-adjusted death rates for selected causes, by race and Hispanic origin and sex: United States, 2018

[Age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards. Data for

specified categories other than non-Hispanic, single-race white and non-Hispanic, single-race black should be interpreted with caution because of inconsistencies between reporting these items on death certificates and

on censuses and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

All causes . . . . . . . . . . . . . . . . 723.6 855.5 611.3 748.7 878.0 636.5 892.6 1,102.8 733.7 790.8 918.7 673.1 381.2 454.1 324.1 675.7 758.1 597.3 524.1 633.1 431.7

Enterocolitis due to

Clostridium

difficile . . . . . . . . . . . (A04.7) 1.3 1.2 1.4 1.4 1.3 1.4 1.4 1.5 1.4 1.4 * 1.9 0.5 0.5 0.5 * * * 1.0 1.0 1.0

Septicemia . . . . . . .(A40–A41) 10.2 11.5 9.3 10.0 11.2 9.1 17.4 19.8 15.9 10.8 11.0 10.7 4.3 5.1 3.7 8.9 * 10.1 8.0 9.1 7.1

Viral hepatitis . . . . .(B15–B19) 1.2 1.6 0.8 1.1 1.4 0.7 1.6 2.4 1.0 2.5 2.5 2.6 1.0 1.5 0.7 * * * 1.5 2.1 1.0

Human immunodeficiency

virus (HIV)

disease . . . . . . . . .(B20–B24) 1.5 2.3 0.8 0.7 1.2 0.3 6.5 9.3 4.0 1.7 2.5 * 0.3 0.5 * * * * 1.4 2.3 0.6

Malignant

neoplasms . . . . . .(C00–C97) 149.1 176.8 128.6 155.0 183.0 133.8 175.9 217.1 150.4 127.4 144.9 113.7 91.8 107.7 80.2 142.6 145.6 142.8

107.4 128.4 92.5

Malignant neoplasms of

lip, oral cavity and

pharynx . . . . . .(C00–C14) 2.5 3.9 1.3 2.7 4.1 1.4 2.6 4.5 1.2 1.7 2.8 * 2.0 3.2 1.0 * * * 1.4 2.2 0.7

Malignant neoplasm of

esophagus . . . . . . . . (C15) 3.8 6.6 1.4 4.3 7.5 1.5 2.9 4.7 1.6 2.9 4.5 * 1.6 2.6 0.7 * * * 2.0 3.6 0.6

Malignant neoplasm of

stomach . . . . . . . . . . (C16) 2.8 3.7 2.1 2.1 2.9 1.4 5.0 7.3 3.5 3.8 4.3 3.5 4.3 5.5 3.4 7.0 * * 4.7 5.9 3.8

Malignant neoplasms of

colon, rectum and

anus . . . . . . . . .(C18–C21) 13.4 15.9 11.2 13.5 15.9 11.4 17.7 22.3 14.6 13.9 15.9 12.2 8.9 10.8 7.3 9.8 10.6 8.9 10.9 14.0 8.4

Malignant neoplasms of

liver and intrahepatic

bile ducts . . . . . . . . . (C22) 6.7 9.7 4.1 5.9 8.6 3.6 8.6 13.3 5.0 9.9 13.5 6.8 8.2 12.3 5.0 9.5 13.1 * 9.4 13.2 6.2

Malignant neoplasm of

pancreas . . . . . . . . . . (C25) 11.0 12.7 9.6 11.3 13.1 9.7 13.8 15.7 12.4 8.2 8.8 7.6 7.4 8.0 7.0 8.3 * 8.6 8.8 9.6 8.0

Malignant neoplasms of

trachea, bronchus and

lung . . . . . . . . .(C33–C34)

34.8 41.8 29.3 38.2 44.6 33.1 37.4 50.9 28.2 30.2 33.0 27.8 18.7 24.2 14.5 27.8 33.9 22.7 15.1 20.2 11.3

Malignant melanoma of

skin . . . . . . . . . . . . . . (C43) 2.1 3.0 1.4 2.7 3.9 1.8 0.3 0.4 0.3 * * * 0.3 0.3 0.3 * * * 0.7 0.9 0.5

Malignant neoplasm of

breast . . . . . . . . . . . .(C50) 10.9 0.3 19.7 10.9 0.3 19.9 16.3 0.5 28.0 7.9 * 14.2 6.6 * 11.8 14.1 * 26.0 7.4 0.2 13.4

Malignant neoplasm of

cervix uteri . . . . . . . . (C53) 1.1 … 2.2 1.0 … 2.0 1.8 … 3.3 1.3 … 2.4 0.8 … 1.4 * … * 1.2 … 2.4

Malignant neoplasm of

ovary . . . . . . . . . . . . (C56) 3.4 … 6.3 3.6 … 6.7 3.4 … 5.8 2.5 … 4.5 2.3 … 4.2 * … * 2.6 … 4.8

Malignant neoplasm of

prostate . . . . . . . . . . (C61) 7.8 18.8 … 7.5 17.8 … 14.2 37.7 … 6.3 14.9 … 3.6 8.8 … 7.9 17.5 … 6.2 15.1 …

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 53

Table 10. Age-adjusted death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

on censuses and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Malignant neoplasms of

kidney and renal

pelvis . . . . . . . .(C64–C65) 3.5 5.1 2.2 3.7 5.3 2.3 3.3 5.1 2.1 5.5 8.4 3.2 1.5 2.2 0.9 * * * 3.2 4.6 2.1

Malignant neoplasm of

bladder . . . . . . . . . . .(C67) 4.2 7.1 2.0 4.6 7.9 2.2 3.4 5.4 2.3 2.2 2.7 1.9 1.6 2.6 0.8 * * * 2.3 3.8 1.2

Malignant neoplasms of

meninges, brain and other

parts of central nervous

system . . . . . . .(C70–C72) 4.4 5.4 3.5 5.1 6.3 4.1 2.8 3.2 2.4 2.4 2.5 2.3 2.4 3.3 1.8 * * * 3.0 3.2 2.7

Non-Hodgkin

lymphoma . . . .(C82–C85) 5.1 6.8 3.8 5.4 7.2 4.0 3.9 5.2 3.0 3.9 5.1 2.9 3.5 4.5 2.7 4.9 * * 4.5 5.7 3.5

Multiple myeloma and

immunoproliferative

neoplasms . . . . (C88,C90) 3.2 4.0 2.6 3.0 3.9 2.4 5.8 7.2 4.9 3.6 4.2 3.2 1.6 1.9 1.4 * * * 2.6 3.2 2.3

Leukemia . . . . . .(C91–C95) 6.0 8.0 4.4 6.4 8.6 4.7 5.3 6.9 4.3 3.8 5.2 2.6 3.4 4.4 2.6 6.0 * * 4.3 5.3 3.5

In situ neoplasms, benign

neoplasms and neoplasms of

uncertain or unknown

behavior . . . . . . . (D00–D48) 4.0 5.0 3.2 4.3 5.4

3.4 3.8 4.6 3.3 2.5 3.5 1.8 2.4 2.7 2.1 * * * 2.4 2.9 2.1

Anemias . . . . . . . . (D50–D64) 1.3 1.4 1.3 1.2 1.2 1.2 2.9 2.9 2.8 1.1 * * 0.6 0.8 0.6 * * * 0.8 0.8 0.8

Diabetes mellitus . . (E10–E14) 21.4 26.9 16.8 18.9 24.3 14.3 39.3 47.6 33.1 43.7 50.6 37.3 15.4 19.0 12.7 48.1 56.5 40.1 24.6 29.8 20.4

Nutritional

deficiencies . . . . . (E40–E64) 2.4 2.2 2.5 2.4 2.2 2.6 3.3 3.6 3.1 2.8 2.8 2.9 1.2 1.4 1.1 * * * 1.7 1.8 1.7

Obesity . . . . . . . . . . . . . . (E66) 2.1 2.3 1.9 2.2 2.5 1.9 3.5 3.3 3.6 3.2 4.6 1.9 0.2 0.2 * 3.2 * * 1.3 1.5 1.1

Parkinson

disease . . . . . . . . (G20–G21) 8.7 12.9 5.7 9.5 14.1 6.3 5.0 8.2 3.2 5.8 7.9 4.3 5.3 7.1 4.1 * * * 6.3 9.2 4.4

Alzheimer disease . . . . .(G30) 30.5 24.5 34.2 32.3 25.8 36.4 27.6 22.6 29.9 18.2 14.3 20.5 15.8 12.2 18.0 17.0 11.9 20.5 25.5 21.5 27.9

Major cardiovascular

diseases . . . . . . . . . (I00–I78) 215.8 261.9 177.5 218.4 264.6 179.3 290.1 359.9 237.9 188.8 222.9

158.5 122.8 149.7 101.6 225.3 258.5 192.7 156.7 191.6 128.1

Diseases of

heart . . . . . . . . . . (I00–I09,

I11,I13,I20–I51) 163.6 207.5 127.9 168.1 213.1 130.7 212.0 270.6 168.6 144.6 178.6 115.0 82.0 106.0 63.5 161.4 196.2 128.0 112.3 143.0 87.6

Essential hypertension and

hypertensive renal

disease . . . . . (I10,I12,I15) 8.9 9.4 8.3 8.0 8.3 7.5 17.0 20.0 14.7 8.6 10.0 7.4 8.3 8.4 8.1 10.3 9.2 10.9 8.3 9.4 7.4

Cerebrovascular

diseases . . . . . . . (I60–I69) 37.1 37.6 36.1 36.0 35.7 35.6 53.0 59.0 48.0 30.7 29.7 31.1 29.2 31.4 27.4 46.6 47.3 45.7 32.0 34.2 29.9

Atherosclerosis . . .

. . . (I70) 1.2 1.3 1.1 1.3 1.3 1.2 1.2 1.6 1.0 1.0 * * 0.6 0.7 0.6 * * * 0.9 0.9 0.8

Aortic aneurysm and

dissection . . . . . . . . . (I71) 2.5 3.3 1.8 2.7 3.5 1.9 2.9 3.6 2.2 1.5 * * 1.7 2.3 1.1 * * * 1.4 2.0 0.8

See footnotes at end of table.

54 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 10. Age-adjusted death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

on censuses and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Influenza and

pneumonia . . . . . . (J09–J18) 14.9 17.3 13.1 15.1 17.3 13.5 16.4 20.1 14.1 19.3 22.2 16.5 12.9 15.7 10.8 14.9 13.7 15.7 11.7 13.8 10.1

Chronic lower respiratory

diseases . . . . . . . . (J40–J47) 39.7 43.7 36.8 45.2 48.4 42.8 30.8 38.8 25.8 34.9 36.7 33.7 11.1 16.1 7.7 21.9 23.2 20.8 17.0 20.6 14.5

Pneumonitis due to solids and

liquids . . . . . . . . . . . . . (J69) 4.8 6.6 3.6 5.1 6.9 3.7 5.3 7.4 4.0 4.8 6.5 3.6 2.9 4.1 2.1 5.0 * * 3.2 4.1 2.5

Chronic liver disease and

cirrhosis . . . . (K70,K73–K74) 11.1 14.7 7.7 11.5 14.9 8.3 7.4 10.3 5.1 45.2 50.6 40.2 3.4 4.6 2.4 7.9 9.9 * 14.5 20.8 8.8

Alcoholic liver

disease . . . . . . . . . . .(K70) 6.1 8.7 3.7 6.5 8.8 4.3 3.8 5.6 2.5 33.6 38.9 28.9 1.4 2.4 0.6 4.6 * * 7.3 12.4 2.7

Cholelithiasis and other

disorders of

gallbladder . . . . . .(K80–K82) 0.9 1.1 0.8 0.9 1.1 0.8 0.9 1.0 0.8 1.7 2.4 * 0.7 0.9 0.6 * * * 1.1 1.3 0.9

Nephritis, nephrotic syndrome

and nephrosis . . .(N00–N07,

N17–N19,N25–N27) 12.9 15.8

10.8 11.6 14.5 9.6 26.0 31.9 22.1 14.9 14.4 15.1 8.1 10.0 6.8 14.2 13.9 14.8 11.6 13.9 9.8

Pregnancy, childbirth and the

puerperium . . . . (O00–O99) 0.3 … 0.7 0.3 … 0.6 0.8 … 1.5 * … * 0.2 … 0.4 * … * 0.2 … 0.5

Certain conditions originating

in the perinatal

period . . . . . . . . . .(P00–P96) 3.8 4.3 3.4 2.9 3.3 2.6 8.7 9.8 7.6 3.1 3.1 3.2 2.9 3.1 2.8 6.5 7.6 * 3.1 3.4 2.8

Congenital malformations,

deformations and

chromosomal

abnormalities . . . (Q00–Q99) 3.1 3.3 2.9 3.2 3.4 3.1 3.9 4.2 3.8 4.3 4.8 3.8 1.8 1.9 1.8 * * * 2.4 2.6 2.2

Symptoms, signs and

abnormal clinical and

laboratory findings,

not elsewhere

classified . . . . . . (R00–R99) 8.7 9.3 7.9 8.9 9.4 8.3 11.9 14.0 10.1 10.9 12.4 9.3 3.1 3.3 2.9 9.4 10.8 8.0 4.8 5.7 3.9

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 55

Table 10. Age-adjusted death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

on censuses and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Accidents (unintentional

injuries) . . . . . . . . (V01–X59,

Y85–Y86) 48.0 65.9 31.0 54.3 72.6 36.5 49.2 74.1 27.8 85.3 115.3 56.5 16.0 22.2 10.9 37.6 53.1 22.3 32.7 48.4 17.3

Motor vehicle

accidents . . . . . (V02–V04,

V09.0,V09.2,V12–V14,

V19.0–V19.2,V19.4–V19.6,

V20–V79,V80.3–V80.5,

V81.0–V81.1,V82.0–V82.1,

V83–V86,V87.0–V87.8,

V88.0–V88.8,V89.0,V89.2) 11.7 16.9 6.6 11.9 16.9 6.9 14.7 22.6 7.6 28.5 39.7 17.6 4.4 5.6 3.3 12.4 16.9 7.7 10.6 15.8 5.5

Falls . . . . . . . . .(W00–W19) 9.4 11.5 7.8 10.5 12.5 8.9 4.6 6.8 3.1 9.9 11.8 8.2 5.7 7.8 4.1 7.4 9.4 * 5.9 7.8 4.4

Accidental discharge of

firearms . . . . .(W32–W34) 0.1 0.2 0.0 0.2 0.3 0.0 0.2 0.4 * * * * * * * * * * 0.1 0.2 *

Accidental drowning and

submersion . .(W65–W74) 1.1 1.7 0.5 1.1 1.6 0.6 1.5 2.6 0.6 2.7 4.2 * 1.0 1.4 0.6 * * * 0.9 1.4 0.3

Accidental hanging,

strangulation and

suffocation . . .(W75–W84) 1.8 2.4 1.4 1.9 2.4 1.5 2.6 3.3 2.1 2.3 2.9 1.8 0.9 1.3 0.7 * * * 1.1 1.4 0.8

Accidental exposure to

smoke, fire and

flames . . . . . . . .(X00–X09) 0.8 1.0 0.6 0.8 1.0 0.7 1.5 2.0 1.2 1.5 2.3 * 0.2 * * * * * 0.4 0.6 0.3

Accidental poisoning and

exposure to noxious

substances .

. . .(X40–X49) 19.3 26.8 11.7 23.9 32.2 15.4 19.8 30.2 10.7 31.4 41.1 22.2 2.6 4.2 1.2 11.4 16.1 * 11.1 17.2 4.8

Intentional self-harm

(suicide) . . . . . . . . . . . (*U03,

X60–X84,Y87.0)

14.2 22.8 6.2 18.1 28.6 8.0 7.3 12.2 2.9 22.3 33.6 11.1 6.7 10.0 3.8 11.9 19.8 * 7.4 12.1 2.8

Intentional self-harm

(suicide) by

poisoning . . . . .(X60–X69) 1.8 1.9 1.7 2.4 2.4 2.4 0.7 0.7 0.7 1.8 1.8 1.9 0.9 1.0 0.8 * * * 0.6 0.7 0.6

Intentional self-harm

(suicide) by hanging,

strangulation and

suffocation . . . . . . . . (X70) 4.3 6.7 1.9 5.2 8.0 2.4 2.0 3.2 0.9 12.2 18.2 6.3 3.1 4.5 2.0 7.0 11.3 * 3.1 5.0 1.3

Intentional self-harm

(suicide) by discharge of

firearms . . . . . .(X72–X74) 7.0 12.6 1.9 9.3 16.3 2.7 3.6 6.7 0.8 7.2 12.1 2.5 1.6 2.8 0.5 * * * 2.8 5.1 0.6

See footnotes at end of table.

56 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 10. Age-adjusted death rates for selected causes, by race and Hispanic origin and sex: United States, 2018—Con.

on censuses and surveys; see Technical Notes in this report]

Cause of death

(based on International

Classification of Diseases,

10th Revision)

Total

Non-Hispanic, single race

Hispanic

White

Black

American Indian or

Alaska Native

Asian

Native Hawaiian or

Other Pacific Islander

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Both

sexes Male Female

Assault

(homicide) . . . .(*U01–*U02,

X85–Y09,Y87.1)

5.9 9.3 2.5 2.8 3.8 1.8 22.6 39.4 6.6 11.5 18.2 4.9 1.4 1.8 0.9 6.9 11.2 * 4.9 7.9 1.8

Assault (homicide) by

discharge of

firearms . . . . . . . (*U01.4,

X93–X95)

4.4 7.4 1.5 1.8 2.5 1.0 18.9 34.0 4.4 6.4 10.3 2.6 0.8 1.3 0.4 5.1 8.5 * 3.5 5.8 1.0

Legal

intervention . . . .(Y35,Y89.0) 0.2 0.4 0.0 0.2 0.3 * 0.3 0.7 * * * * * * * * * * 0.2 0.4 *

Complications of medical

and surgical

care . . . . . . . (Y40–Y84,Y88) 1.2 1.4 1.0 1.2 1.5 1.0 1.7 1.8 1.6 1.3 * * 0.6 0.8 0.4 * * * 0.8 0.9 0.7

Dementia-related causes

. . . 66.6 56.4 72.5 70.9 59.4 77.8 64.8 59.1 67.0 42.7 36.2 46.5 32.3 26.8 35.6 35.5 31.2 38.3 47.4 42.1 50.3

Drug-induced deaths

. . . . . . 21.8 29.3 14.3 27.2 35.3 19.0 22.7 34.6 12.3 29.2 35.5 23.1 3.1 4.6 1.8 13.1 19.0 7.1 11.6 17.5 5.6

Drug overdose deaths

. . . . 20.7 27.9 13.6 25.9 33.8 18.0 21.3 32.4 11.6 26.8 33.1 20.7 3.0 4.4 1.8 12.3 17.7 * 11.0 16.6 5.2

Alcohol-induced deaths

. . . . 9.9 14.7 5.6 10.7 15.3 6.5 7.1 11.2 3.9 54.5 68.2 42.1 2.2 3.8 0.9 5.9 8.4 * 9.9 17.1 3.3

Injury by firearms

. . . . . . . . . 11.9 20.7 3.4 11.4 19.5 3.7 23.2 42.0 5.4 15.0 24.8 5.4 2.5 4.2 1.0 8.8 15.6 * 6.6 11.6 1.7

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

… Category not applicable.

Includes deaths with origin not stated, origin not classifiable, and two or more races reported; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision (ICD–10); see Technical Notes in this report.

Included in selected categories above. For the list of ICD–10 codes included, see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 57

Table 11. Number of deaths, death rates, and age-adjusted death rates for injury deaths, by mechanism and intent of death for

all injury death and the leading causes of injury death: United States, 2018

[Totals for selected causes of death may differ from those shown in other tables that use standard mortality tabulation lists; see Technical Notes in this report. Rates

are per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Populations used for computing death

rates are postcensal estimates based on the 2010 census estimated as of July 1, 2018; see Technical Notes in this report. Numbers in brackets [ ] apply to the code or

range of codes preceding them. Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision

(ICD–10); see Technical Notes in this report]

Mechanism and intent of death (based on ICD–10) Number Rate Age-adjusted rate

All injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (*U01–*U03,V01–Y36,Y85–Y87,Y89) 240,583 73.5 70.1

Unintentional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(V01–X59,Y85–Y86) 167,127 51.1 48.0

Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (*U03,X60–X84,Y87.0) 48,344 14.8 14.2

Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (*U01–*U02,X85–Y09,Y87.1) 18,830 5.8 5.9

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y10–Y34,Y87.2,Y89.9) 5,653 1.7 1.7

Legal intervention/war . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y35–Y36,Y89[.0,.1]) 629 0.2 0.2

Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . (*U01[.6–.7],X40–X49,X60–X69,X85–X90,Y10–Y19,Y35.2) 72,473 22.2 22.2

Unintentional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X40–X49) 62,399 19.1 19.3

Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X60–X69) 6,237 1.9 1.8

Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (*U01[.6–.7],X85–X90) 124 0.0 0.0

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y10–Y19) 3,712 1.1 1.1

Legal intervention/war . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y35.2) 1 * *

Motor vehicle traffic . . . . . . . . . . (V02–V04[.1,.9],V09.2,V12–V14[.3–.9],V19[.4–.6],V20–V28[.3–.9],

V29–V79[.4–.9],V80[.3–.5],V81.1,V82.1,V83–V86[.0–.3],V87[.0–.8],V89.2)

37,991 11.6 11.2

Occupant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V30–V79[.4–.9],V83–V86[.0–.3])

8,963 2.7 2.7

Motorcyclist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V20–V28[.3–.9],V29[.4–.9])

4,614 1.4 1.4

Pedal cyclist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V12–V14[.3–.9],V19[.4–.6])

682 0.2 0.2

Pedestrian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(V02–V04[.1,.9],V09.2)

6,704 2.0 2.0

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V80[.3–.5],V81.1,V82.1)

9 * *

Unspecified . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V87[.0–.8],V89.2)

17,019 5.2 5.0

Firearm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(*U01.4,W32–W34,X72–X74,X93–X95,Y22–Y24,Y35.0) 39,740 12.1 11.9

Unintentional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (W32–W34) 458 0.1 0.1

Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X72–X74) 24,432 7.5 7.0

Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (*U01.4,X93–X95) 13,958 4.3 4.4

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y22–Y24) 353 0.1 0.1

Legal intervention/war . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y35.0) 539 0.2 0.2

Fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (W00–W19,X80,Y01,Y30) 38,707 11.8 9.8

Unintentional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (W00–W19) 37,455 11.4 9.4

Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (X80) 1,149 0.4 0.4

Homicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y01) 7 * *

Undetermined . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Y30) 96 0.0 0.0

0.0 Quantity more than zero but less than 0.05.

* Estimate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

For method of computation, see Technical Notes in this report.

Intent of death is unintentional.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

58 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 12. Number of deaths, death rates, and age-adjusted death rates for major causes of death: United States, each state,

Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas, 2018

[Rates are per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Codes in parentheses after causes

of death are categories of the International Classification of Diseases, 10th Revision (ICD–10). Asterisks (*) preceding cause-of-death codes indicate they are not part

of ICD–10; see Technical Notes in this report]

Area

All causes

Malignant neoplasms

(C00–C97)

Diseases of heart

(I00–I09,I11,I13,I20–I51)

Cerebrovascular diseases

(I60–I69)

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

United States

. . . . . . . . . . . . 2,839,205 867.8 723.6 599,274 183.2 149.1 655,381 200.3 163.6 147,810 45.2 37.1

Alabama . . . . . . . . . . . . . . . 54,352 1,112.0 918.1 10,632 217.5 170.4 13,473 275.6 224.7 3,088 63.2 51.5

Alaska . . . . . . . . . . . . . . . . . 4,453 603.8 700.3 957 129.8 141.5 815 110.5 129.7 216 29.3 40.0

Arizona . . . . . . . . . . . . . . . . 59,282 826.6 669.2 12,113 168.9 131.9 12,455 173.7 136.4 2,836 39.5 31.0

Arkansas . . . . . . . . . . . . . . . 32,336 1,072.9 876.6 6,491 215.4 168.8 8,171 271.1 217.4 1,551 51.5 41.5

California . . . . . . . . . . . . . . 268,818 679.6 609.0 59,962 151.6 135.0 62,547 158.1 139.7 16,457 41.6 37.0

Colorado . . . . . . . . . . . . . . . 38,526 676.4 651.4 7,812 137.2 127.6 7,370 129.4 124.3 1,996 35.0 34.7

Connecticut . . . . . . . . . . . . 31,230 874.1 644.2 6,472 181.2 134.1 7,205 201.7 142.1 1,388 38.9 27.2

Delaware . . . . . . . . . . . . . . . 9,433 975.3 757.2 2,101 217.2 159.4 2,030 209.9 159.1 605 62.6 46.4

District of Columbia . . . . . . 5,008 712.9 718.8 1,070 152.3 155.6 1,295 184.4 187.0 252 35.9 35.4

Florida . . . . . . . . . . . . . . . . 205,426 964.5 657.9 45,281 212.6 141.7 47,027 220.8 143.1 13,255 62.2 39.6

Georgia . . . . . . . . . . . . . . . . 85,202 809.9 790.2 17,397 165.4 152.4 18,986 180.5 175.8 4,553 43.3 43.4

Hawaii . . . . . . . . . . . . . . . . . 11,415 803.6 572.5 2,405 169.3 123.5 2,570 180.9 125.6 786 55.3 37.4

Idaho . . . . . . . . . . . . . . . . . 14,261 813.0 726.6 3,049 173.8 149.5 3,122 178.0

157.9 718 40.9 36.4

Illinois . . . . . . . . . . . . . . . . . 110,022 863.5 716.9 23,885 187.5 153.5 25,755 202.1 163.9 5,855 46.0 37.3

Indiana . . . . . . . . . . . . . . . . 65,693 981.7 832.7 13,479 201.4 165.7 14,532 217.2 180.7 3,151 47.1 39.3

Iowa . . . . . . . . . . . . . . . . . . 30,367 962.2 723.9 6,427 203.6 155.3 7,185 227.7 165.1 1,440 45.6 33.0

Kansas . . . . . . . . . . . . . . . . 27,537 945.8 771.3 5,607 192.6 156.4 5,823 200.0 158.9 1,296 44.5 35.9

Kentucky . . . . . . . . . . . . . . . 48,707 1,090.0 920.0 10,135 226.8 181.6 10,697 239.4 198.3 2,204 49.3 41.5

Louisiana . . . . . . . . . . . . . . 46,048 988.2 870.9 9,382 201.3 169.0 11,340 243.3 212.2 2,485 53.3 46.7

Maine . . . . . . . . . . . . . . . . . 14,715 1,099.4 753.9 3,275 244.7 162.1 2,965 221.5 147.0 690 51.6 33.7

Maryland . . . . . . . . . . . . . . 50,568 836.8 714.1 10,927 180.8 149.9 11,683 193.3 161.9 2,883 47.7 40.3

Massachusetts . . . . . . . . . . 59,152 857.0 670.6 12,635 183.1 142.8 12,036 174.4 131.5 2,466 35.7 27.1

Michigan . . . . . . . . .

. . . . . . 98,903 989.4 782.3 21,018 210.3 161.1 25,354 253.6 195.0 5,183 51.9 40.0

Minnesota . . . . . . . . . . . . . . 44,745 797.4 648.0 9,910 176.6 143.1 8,408 149.8 119.0 2,270 40.5 32.2

Mississippi . . . . . . . . . . . . . 32,301 1,081.6 934.8 6,510 218.0 179.7 7,758 259.8 222.1 1,805 60.4 51.8

Missouri . . . . . . . . . . . . . . . 63,117 1,030.2 823.2 13,040 212.8 165.3 14,893 243.1 188.4 3,039 49.6 38.5

Montana . . . . . . . . . . . . . . . 9,992 940.6 720.2 2,038 191.8 140.7 2,347 220.9 163.2 418 39.3 30.1

Nebraska . . . . . . . . . . . . . . 16,904 876.2 717.4 3,516 182.2 150.5 3,539 183.4 145.7 758 39.3 31.5

Nevada . . . . . . . . . . . . . . . . 24,715 814.5 741.1 5,195 171.2 146.5 6,393 210.7 190.7 1,190 39.2 36.6

New Hampshire . . . . . . . . . 12,774 941.7 712.7 2,711 199.9 143.7 2,786 205.4 151.0 499 36.8 27.2

New Jersey . . . . . . . . . . . . . 75,765 850.5 672.5 16,011 179.7 141.3 19,047 213.8 163.0 3,444 38.7 29.8

New Mexico . . . . . . . . . . . . 19,007 907.1 748.7 3,672 175.2 136.4 3,935 187.8 148.2 838 40.0 31.8

New York . . . . . . . . . . .

. . . 157,183 804.3 626.7 34,491 176.5 138.2 44,499 227.7 171.9 6,244 32.0 24.4

North Carolina . . . . . . . . . . 93,885 904.2 770.1 19,671 189.4 154.2 19,222 185.1 155.5 5,062 48.7 41.3

North Dakota . . . . . . . . . . . 6,445 847.9 690.3 1,320 173.7 145.2 1,361 179.1 140.0 329 43.3 34.1

Ohio . . . . . . . . . . . . . . . . . . 124,264 1,063.0 838.4 25,164 215.3 165.2 29,220 250.0 191.1 6,525 55.8 42.6

Oklahoma . . . . . . . . . . . . . . 40,933 1,038.1 893.2 8,424 213.6 178.1 10,634 269.7 228.5 1,861 47.2 40.1

Oregon . . . . . . . . . . . . . . . . 36,187 863.5 689.8 8,159 194.7 150.6 6,820 162.7 128.4 2,024 48.3 38.0

Pennsylvania . . . . . . . . . . . 134,702 1,051.8 759.7 28,023 218.8 156.6 32,768 255.9 176.1 6,599 51.5 35.3

Rhode Island . . . . . . . . . . . 10,083 953.6 696.7 2,176 205.8 151.6 2,411 228.0 158.9 424 40.1 28.2

South Carolina . . . . . . . . . . 50,640 996.0 821.6 10,365 203.9 157.3 10,464 205.8 167.0 2,819 55.4 45.5

South Dakota . . . . . . . . . . . 7,971 903.5 715.9 1,632 185.0 145.2 1,796 203.6 156.3 389 44.1 33.6

Tennessee . . . . . . . . . . . . . . 71,078 1,049.9 889.7 14,141 208.9 168.0 16,417 242.5 202.4

3,499 51.7 43.6

Texas . . . . . . . . . . . . . . . . . 202,211 704.5 731.8 40,866 142.4 142.9 46,763 162.9 170.0 10,810 37.7 40.3

Utah . . . . . . . . . . . . . . . . . . 18,354 580.6 691.8 3,264 103.3 120.0 3,749 118.6 146.4 919 29.1 36.3

Vermont . . . . . . . . . . . . . . . 6,027 962.3 706.5 1,388 221.6 156.0 1,338 213.6 150.5 263 42.0 29.5

Virginia . . . . . . . . . . . . . . . . 69,359 814.3 709.5 15,148 177.8 149.3 14,600 171.4 147.9 3,778 44.4 38.9

Washington . . . . . . . . . . . . 56,877 754.8 666.6 12,791 169.7 145.3 11,655 154.7 135.4 2,891 38.4 34.1

West Virginia . . . . . . . . . . . 23,478 1,300.1 953.8 4,682 259.3 179.5 5,007 277.3 196.4 990 54.8 38.6

Wisconsin . . . . . . . . . . . . . . 53,684 923.4 723.3 11,457 197.1 151.5 12,061 207.5 157.8 2,549 43.8 33.4

Wyoming . . . . . . . . . . . . . . 5,070 877.6 749.6 997 172.6 140.6 1,054 182.4 152.7 220 38.1 32.2

Puerto Rico . . . . . . . . . . . . . . 28,958 906.3 619.3 5,035 157.6 105.2 5,288 165.5 106.2 1,159 36.3 23.2

U.S. Virgin Islands . . . . . . . . . --- --- --- --- --- --- ---

--- --- --- --- ---

Guam . . . . . . . . . . . . . . . . . . . 1,035 616.9 869.3 191 113.8 142.4 319 190.1 293.9 84 50.1 79.7

American Samoa . . . . . . . . . . --- --- --- --- --- --- --- --- --- --- --- ---

Northern Marianas . . . . . . . . . 221 425.0 820.5 41 78.9 158.4 58 111.6 201.0 16 * *

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 59

Table 12. Number of deaths, death rates, and age-adjusted death rates for major causes of death: United States, each state,

Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas, 2018—Con.

[Rates are per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Codes in parentheses after causes

of death are categories of the International Classification of Diseases, 10th Revision (ICD–10). Asterisks (*) preceding cause-of-death codes indicate they are not part

of ICD–10; see Technical Notes in this report]

Area

Motor vehicle accidents

Drug overdose (X40–X44,

X60–X64,X85,Y10–Y14)

Intentional self-harm (suicide)

(*U03,X60–X84,Y87.0)

Assault (homicide)

(*U01–*U02,X85–Y09,Y87.1)

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

Number Rate

Age-

adjusted

rate

United States

. . . . . . . . . . . . 39,404 12.0 11.7 67,367 20.6 20.7 48,344 14.8 14.2 18,830 5.8 5.9

Alabama . . . . . . . . . . . . . . . 1,064 21.8 21.4 775 15.9 16.6 823 16.8 16.5 568 11.6 12.2

Alaska . . . . . . . . . . . . . . . . . 95 12.9 12.6 110 14.9 14.6 184 25.0 24.6 56 7.6 7.5

Arizona . . . . . . . . . . . . . . . . 1,041 14.5 14.0 1,670 23.3 23.8 1,438 20.1 19.2 420 5.9 6.1

Arkansas . . . . . . . . . . . . . . . 551 18.3 17.9 444 14.7 15.7 554 18.4 18.3 264 8.8 9.1

California . . . . . . . . . . . . . . 4,150 10.5 10.1 5,348 13.5 12.8 4,491 11.4 10.9 1,890 4.8 4.8

Colorado . . . . . . . . . . . . . . . 671 11.8 11.5 995 17.5 16.8 1,282 22.5 21.9 263 4.6 4.7

Connecticut . . . . . . . . . . . . 302 8.5 8.2 1,069 29.9 30.7 419 11.7 10.6 92 2.6 2.8

Delaware . . . . . . . . . . . . . . . 120 12.4 11.9 401 41.5 43.8 113 11.7 11.4 57 5.9 6.8

District of Columbia . . . . . . 42 6.0 5.8 254 36.2 35.4 54 7.7 7.5 144 20.5 19.4

Florida . . . . . . . . . . . . . . . . 3,243 15.2 14.6 4,698 22.1 22.8 3,567 16.7 15.2 1,315 6.2 6.6

Georgia . . . . . . . . . . . . . . . . 1,529 14.5 14.2 1,404 13.3 13.2 1,569 14.9 14.6 794 7.5 7.7

Hawaii . . . . . . . . . . . . . . . . . 115 8.1 7.9 213 15.0 14.3 176 12.4 11.9 40 2.8 3.1

Idaho . . . . . . . . . . . . . . . . . 250 14.3 14.3 250 14.3 14.6 417 23.8 23.9 41 2.3 2.3

Illinois . . . . . . . . . . . . . . . . 1,195 9.4 9.1 2,722 21.4 21.3 1,488 11.7 11.3 994 7.8 8.0

Indiana . . . . . . . . . . . . . . . . 870 13.0 12.8 1,629 24.3 25.6 1,079 16.1 16.0 473 7.1 7.4

Iowa . . . . . . . . . . . . . . . . . . 361 11.4 10.9 287 9.1 9.6 490 15.5 15.5 81 2.6 2.7

Kansas . . . . . . . . . . . . . . . . 409 14.0 13.9 345 11.8 12.4 556 19.1 19.3 160 5.5 5.9

Kentucky . . . . . . . . . . . . . . . 774 17.3 16.9 1,315 29.4 30.9 800 17.9 17.5 258 5.8 6.1

Louisiana . . . . . . . . . . . . . . 812 17.4 17.2 1,140 24.5 25.4 720 15.5 15.1 598 12.8 13.3

Maine . . . . . . . . . . . . . . . . . 157 11.7 11.0 345 25.8 27.9 270 20.2 18.5 19 * *

Maryland . . . . . . . . . . . . . . 516 8.5 8.4 2,324 38.5 37.2 650 10.8 10.2 541 9.0 9.3

Massachusetts . . . . . . . . . . 400 5.8 5.4 2,241 32.5 32.8 740 10.7 9.9 158 2.3 2.3

Michigan . . . . . . . . . . . . . .

. 1,028 10.3 9.8 2,591 25.9 26.6 1,548 15.5 15.0 613 6.1 6.5

Minnesota . . . . . . . . . . . . . . 489 8.7 8.3 636 11.3 11.5 739 13.2 13.1 122 2.2 2.3

Mississippi . . . . . . . . . . . . . 706 23.6 23.3 310 10.4 10.8 421 14.1 13.8 382 12.8 13.4

Missouri . . . . . . . . . . . . . . . 956 15.6 15.2 1,610 26.3 27.5 1,230 20.1 19.5 658 10.7 11.4

Montana . . . . . . . . . . . . . . . 178 16.8 16.8 125 11.8 12.2 265 24.9 24.9 42 4.0 4.2

Nebraska . . . . . . . . . . . . . . 252 13.1 13.1 138 7.2 7.4 271 14.0 13.4 35 1.8 1.9

Nevada . . . . . . . . . . . . . . . . 367 12.1 11.7 688 22.7 21.2 657 21.7 20.8 225 7.4 7.7

New Hampshire . . . . . . . . . 151 11.1 10.2 452 33.3 35.8 279 20.6 19.4 21 1.5 1.8

New Jersey . . . . . . . . . . . . . 599 6.7 6.4 2,900 32.6 33.1 778 8.7 8.3 311 3.5 3.7

New Mexico . . . . . . . . . . . . 395 18.9 19.0 537 25.6 26.7 536 25.6 25.0 215 10.3 10.8

New York . . . . . . . . . . . . . . 1,065 5.4

5.0 3,697 18.9 18.4 1,723 8.8 8.3 611 3.1 3.2

North Carolina . . . . . . . . . . 1,584 15.3 14.7 2,259 21.8 22.4 1,494 14.4 13.7 647 6.2 6.4

North Dakota . . . . . . . . . . . 106 13.9 13.2 70 9.2 10.2 147 19.3 19.2 20 2.6 2.5

Ohio . . . . . . . . . . . . . . . . . . 1,220 10.4 10.1 3,980 34.0 35.9 1,838 15.7 15.3 760 6.5 6.8

Oklahoma . . . . . . . . . . . . . . 707 17.9 17.6 716 18.2 18.4 790 20.0 20.0 265 6.7 7.0

Oregon . . . . . . . . . . . . . . . . 496 11.8 11.1 547 13.1 12.6 844 20.1 19.0 102 2.4 2.5

Pennsylvania . . . . . . . . . . . 1,294 10.1 9.4 4,415 34.5 36.1 2,014 15.7 14.9 781 6.1 6.4

Rhode Island . . . . . . . . . . . 69 6.5 6.4 317 30.0 30.1 106 10.0 9.5 16 * *

South Carolina . . . . . . . . . . 1,033 20.3 20.0 1,125 22.1 22.6 811 16.0 15.4 481 9.5 10.2

South Dakota . . . . . . . . . . . 156 17.7 17.3 57 6.5 6.9 167 18.9 19.3 32 3.6 3.9

Tennessee . . . . . . . . . . . . . . 1,113 16.4 15.9 1,823 26.9 27.5 1,161 17.1 16.6 604 8.9 9.2

Texas .

. . . . . . . . . . . . . . . . 3,788 13.2 13.2 3,005 10.5 10.4 3,930 13.7 13.7 1,557 5.4 5.4

Utah . . . . . . . . . . . . . . . . . . 258 8.2 8.5 624 19.7 21.2 665 21.0 22.2 67 2.1 2.2

Vermont . . . . . . . . . . . . . . . 75 12.0 11.4 153 24.4 26.6 125 20.0 18.8 14 * *

Virginia . . . . . . . . . . . . . . . . 914 10.7 10.3 1,448 17.0 17.1 1,243 14.6 14.0 425 5.0 5.1

Washington . . . . . . . . . . . . 672 8.9 8.6 1,164 15.4 14.8 1,252 16.6 15.9 275 3.6 3.7

West Virginia . . . . . . . . . . . 333 18.4 17.4 856 47.4 51.5 395 21.9 21.2 97 5.4 5.8

Wisconsin . . . . . . . . . . . . . . 637 11.0 10.2 1,079 18.6 19.2 888 15.3 14.8 204 3.5 3.9

Wyoming . . . . . . . . . . . . . . 96 16.6 16.5 66 11.4 11.1 147 25.4 25.2 22 3.8 4.1

Puerto Rico . . . . . . . . . . . . . . 339 10.6 9.8 58 1.8 1.8 239 7.5 6.9 623 19.5 21.3

U.S. Virgin Islands . . . . . . . . . --- --- --- --- --- --- --- --- --- --- --- ---

Guam . . . . . . . . . . . . . . . . . . . 24 14.3 15.9 – * * 45 26.8 28.9 6 * *

American Samoa . . . . . . . . . . --- --- --- --- --- --- --- --- --- --- --- ---

Northern Marianas 3 * * – * * 8 * * – * *

See footnotes at end of table.

60 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 12. Number of deaths, death rates, and age-adjusted death rates for major causes of death: United States, each state,

Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas, 2018—Con.

[Rates are per 100,000 population; age-adjusted rates are per 100,000 U.S. standard population; see Technical Notes in this report. Codes in parentheses after causes

of death are categories of the International Classification of Diseases, 10th Revision (ICD–10). Asterisks (*) preceding cause-of-death codes indicate they are not part

of ICD–10; see Technical Notes in this report]

--- Data not available.

* Rate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

– Quantity zero.

Death rates are affected by the population composition of the area. Age-adjusted death rates should be used for comparisons between areas; for method of computation, see Technical Notes

in this report.

Excludes data for Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas.

ICD–10 codes for Motor vehicle accidents are V02–V04, V09.0, V09.2, V12–V14, V19.0–V19.2, V19.4–V19.6, V20–V79, V80.3–V80.5, V81.0–V81.1, V82.0–V82.1, V83–V86, V87.0–V87.8,

V88.0–V88.8, V89.0, and V89.2; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 61

Table 13. Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin and sex: United States, 2010–2018

[Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days–11 months) deaths per 1,000 live births in specified group]

Race and Hispanic

origin and year

Infant mortality rate Neonatal mortality rate Postneonatal mortality rate

Both sexes Male Female Both sexes Male Female Both sexes Male Female

All races and origins

2018. . . . . . . . . . . . . . . . . . . . . . . . 5.66 6.23 5.07 3.77 4.13 3.39 1.89 2.09 1.68

2017. . . . . . . . . . . . . . . . . . . . . . . . 5.79 6.32 5.24 3.84 4.19 3.49 1.95 2.13 1.76

2016. . . . . . . . . . . . . . . . . . . . . . . . 5.87 6.38 5.34 3.87 4.19 3.54 2.00 2.19 1.80

2015. . . . . . . . . . . . . . . . . . . . . . . . 5.90 6.39 5.38 3.93 4.22 3.64 1.96 2.17 1.74

2014. . . . . . . . . . . . . . . . . . . . . . . . 5.82 6.31 5.30 3.94 4.25 3.62 1.88 2.07 1.68

2013. . . . . . . . . . . . . . . . . . . . . . . . 5.96 6.52 5.38 4.04 4.37 3.68 1.93 2.15 1.70

2012. . . . . . . . . . . . . . . . . . . . . . . . 5.98 6.50 5.43 4.01 4.34 3.67 1.97 2.16 1.76

2011. . . . . . . . . . . . . . . . . . . . . . . . 6.07 6.58 5.52 4.06 4.36 3.73 2.01 2.22 1.79

2010. . . . . . . . . . . . . . . . . . . . . . . . 6.15 6.69 5.57 4.05 4.37 3.71 2.10 2.32 1.87

Non-Hispanic,

single-race white

2,3

2018. . . . . . . . . . . . . . . . . . . . . . . . 4.55 4.98 4.09 3.02 3.27 2.76 1.53 1.71 1.34

Non-Hispanic,

bridged-race white

2018. . . . . . . . . . . . . . . . . . . . . . . . 4.63 5.08 4.16 3.08 3.34 2.80 1.56 1.74 1.36

2017. . . . . . . . . . . . . . . . . . . . . . . . 4.61 5.07 4.12 3.05 3.34 2.74 1.56 1.73 1.38

2016. . . . . . . . . . . . . . . . . . . . . . . . 4.80 5.24 4.34 3.10 3.33 2.86 1.70 1.90 1.48

2015. . . . . . . . . . . . . . . . . . . . . . . . 4.82 5.27 4.36 3.16 3.37 2.92 1.67 1.89 1.43

2014. . . . . . . . . . . . . . . . . . . . . . . . 4.81 5.26 4.34 3.23 3.48 2.97 1.58 1.78 1.37

2013. . . . . . . . . . . . . . . . . . . . . . . . 4.96 5.53 4.36 3.33 3.67 2.97 1.63 1.86 1.38

2012. . . . . . . . . . . . . . . . . . . . . . . . 4.97 5.38 4.54 3.31 3.54 3.06 1.66 1.84 1.47

2011. . . . . . . . . . . . . . . . . . . . . . . . 5.05 5.52 4.56 3.34 3.62 3.06 1.71 1.90 1.50

2010. . . . . . . . . . . . . . . . . . . . . . . . 5.10 5.54 4.64 3.34 3.58 3.07 1.76 1.96 1.56

Non-Hispanic,

single-race black

2,3

2018. . . . . . . . . . . . . . . . . . . . . . . . 11.10 12.35 9.81 7.13 7.93 6.31 3.97 4.42 3.50

Non-Hispanic,

bridged-race black

2018. . . . . . . . . . . . . . . . . . . . . . . . 10.97 12.19 9.73 7.02 7.78 6.23 3.96 4.40 3.50

2017. . . . . . . . . . . . . . . . . . . . . . . . 11.46 12.59 10.29 7.28 8.04 6.51 4.17 4.55 3.78

2016. . . . . . . . . . . . . . . . . . . . . . . . 11.76 12.67 10.82 7.64 8.32 6.95 4.11 4.35 3.87

2015. . . . . . . . . . . . . . . . . . . . . . . . 11.73 12.75 10.67 7.60 8.16 7.02 4.13 4.59 3.65

2014. . . . . . . . . . . . . . . . . . . . . . . . 11.37 12.33 10.39 7.51 8.13 6.87 3.86 4.21 3.51

2013. . . . . . . . . . . . . . . . . . . . . . . . 11.61 12.48 10.73 7.66 8.16 7.14 3.96 4.31 3.59

2012. . . . . . . . . . . . . . . . . . . . . . . . 11.59 12.80 10.35 7.58 8.30 6.83 4.02 4.49 3.52

2011. . . . . . . . . . . . . . . . . . . . . . . . 11.98 13.13 10.80 7.85 8.53 7.14 4.14 4.60 3.67

2010. . . . . . . . . . . . . . . . . . . . . . . . 11.99 13.08 10.85 7.71 8.32 7.09 4.28 4.77 3.77

Hispanic

3,5

2018. . . . . . . . . . . . . . . . . . . . . . . . 5.06 5.55 4.56 3.54 3.88 3.18 1.52 1.67 1.38

2017. . . . . . . . . . . . . . . . . . . . . . . . 5.35 5.76 4.93 3.73 4.00 3.46 1.62 1.76 1.47

2016. . . . . . . . . . . . . . . . . . . . . . . . 5.24 5.72 4.75 3.63 3.94 3.30 1.62 1.78 1.45

2015. . . . . . . . . . . . . . . . . . . . . . . . 5.20 5.56 4.83 3.73 4.02 3.42 1.47 1.54 1.41

2014. . . . . . . . . . . . . . . . . . . . . . . . 5.22 5.63 4.79 3.67 3.98 3.34 1.55 1.66 1.45

2013. . . . . . . . . . . . . . . . . . . . . . . . 5.27 5.65 4.88 3.73 3.99 3.45 1.54 1.66 1.43

2012. . . . . . . . . . . . . . . . . . . . . . . . 5.30 5.76 4.83 3.71 4.05 3.35 1.60 1.71 1.47

2011. . . . . . . . . . . . . . . . . . . . . . . . 5.25 5.59 4.90 3.67 3.87 3.46 1.58 1.72 1.44

2010. . . . . . . . . . . . . . . . . . . . . . . . 5.47 5.96 4.96 3.73 4.07 3.37 1.74 1.89 1.59

Includes race and origin groups not shown separately; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Infant deaths are based on race or Hispanic origin of child as stated on the death certificate; live births are based on race or Hispanic origin of mother as stated on the birth certificate; see

Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget (OMB) standards.

Multiple-race data reported according to 1997 OMB standards were bridged to single-race categories of 1977 OMB standards. For more information on areas reporting multiple race, see

Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

62 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 14. Number of infant deaths and infant mortality rates for selected causes, by race and Hispanic origin: United States,

2018

[Rates are infant deaths (under 1 year) per 100,000 live births in specified group. Infant deaths are based on race or Hispanic origin of decedent; live births are based

on race or Hispanic origin of mother. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards]

Cause of death (based on International

Classification of Diseases, 10th Revision)

Number

Rate

Total

Non-

Hispanic,

single-race

white

Non-

Hispanic,

single-race

black

Hispanic

Total

Non-

Hispanic,

single-race

white

Non-

Hispanic,

single-race

black

Hispanic

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,467 8,893 6,127 4,487 566.2 454.6 1,109.9 506.3

Certain intestinal infectious diseases . . . . . . . .(A00–A08) 10 4 1 3 * * * *

Diarrhea and gastroenteritis of infectious

origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(A09) 151 58 43 37 4.0 3.0 7.8 4.2

Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . .(A16–A19) – – – – * * * *

Tetanus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (A33,A35) – – – – * * * *

Diphtheria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(A36) – – – – * * * *

Whooping cough . . . . . . . . . . . . . . . . . . . . . . . . . . .(A37) 4 1 – 2 * * * *

Meningococcal infection . . . . . . . . . . . . . . . . . . . . .(A39) 5 4 1 – * * * *

Septicemia . . . . . . . . . . . . . . . . . . . . . . . . . . . .(A40–A41) 151 53 46 30 4.0 2.7 8.3 3.4

Congenital syphilis . . . . . . . . . . . . . . . . . . . . . . . . . .(A50) – – – – * * * *

Gonococcal infection . . . . . . . . . . . . . . . . . . . . . . . .(A54) – – – – * * * *

Acute poliomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . .(A80) – – – – * * * *

Varicella (chickenpox) . . . . . . . . . . . . . . . . . . . . . . .(B01) – – – – * * * *

Measles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B05) – – – – * * * *

Human immunodeficiency virus (HIV)

disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B20–B24) – – – – * * * *

Mumps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B26) – – – – * * * *

Candidiasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B37) 3 – 3 – * * * *

Malaria . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . .(B50–B54) – – – – * * * *

Pneumocystosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .(B59) 1 – 1 – * * * *

Malignant neoplasms . . . . . . . . . . . . . . . . . . . .(C00–C97) 51 23 5 15 1.3 1.2 * *

In situ neoplasms, benign neoplasms and neoplasms of

uncertain or unknown behavior . . . . . . . . . . (D00–D48) 41 18 11 10 1.1 * * *

Diseases of the blood and blood-forming organs and

certain disorders involving the immune

mechanism . . . . . . . . . . . . . . . . . . . . . . . . . (D50–D89) 75 42 21 12 2.0 2.1 3.8 *

Short stature, not elsewhere classified . . . . . . . . (E34.3) – – – – * * * *

Nutritional deficiencies . . . . . . . . . . . . . . . . . . . (E40–E64) 8 2 3 1 * * * *

Cystic fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (E84) 3 1 1 1 * * * *

Volume depletion, disorders of fluid, electrolyte and acid-

base balance . . . . . . . . . . . . . . . . . . . . . . . . . (E86–E87) 37 18 12 7 1.0 * * *

Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . (G00,G03) 64 28 14 10 1.7 1.4 * *

Infantile spinal muscular atrophy, type I

(Werdnig-Hoffman) . . . . . . . . . . . . . . . . . . . . . . (G12.0) 3 1 2 – * * * *

Infantile cerebral palsy . . . . . . . . . . . . . . . . . . . . . . .(G80) 5 1 3 1 * * * *

Anoxic brain damage, not elsewhere

classified . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . (G93.1) 19 7 5 5 * * * *

Diseases of the ear and mastoid process . . . . (H60–H93) – – – – * * * *

Diseases of the circulatory system . . . . . . . . . . .(I00–I99) 428 185 116 89 11.3 9.5 21.0 10.0

Acute upper respiratory infections . . . . . . . . . . (J00–J06) 8 4 2 1 * * * *

Influenza and pneumonia . . . . . . . . . . . . . . . . . (J09–J18) 176 69 58 33 4.6 3.5 10.5 3.7

Acute bronchitis and acute bronchiolitis . . . . . (J20–J21) 34 9 15 8 0.9 * * *

Bronchitis, chronic and unspecified . . . . . . . . . (J40–J42) 10 4 4 2 * * * *

Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (J45–J46) 1 1 – – * * * *

Pneumonitis due to solids and liquids . . . . . . . . . . . (J69) 4 3 1 – * * * *

Gastritis, duodenitis, and noninfective

enteritis and colitis . . . . . . . . . . . . . . . . . (K29,K50–K55) 27 11 11 2 0.7 * * *

Hernia of abdominal cavity and intestinal obstruction

without hernia . . . . . . . . . . . . . . . . . . . . (K40–K46,K56) 41 19 7 10 1.1 * * *

Renal failure and other disorders of

kidney . . . . . . . . . . . . . . . . . . . . . . (N17–N19,N25,N27) 69 26 22 17 1.8 1.3 4.0 *

Newborn affected by maternal hypertensive

disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P00.0) 63 24 21 14 1.7 1.2 3.8 *

Newborn affected by other maternal conditions

which may be unrelated to present

pregnancy . . . . . . . . . . . . . . . . . . . . . . . .(P00.1–P00.9) 86 41 20 21 2.3 2.1 3.6 2.4

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 63

Table 14. Number of infant deaths and infant mortality rates for selected causes, by race and Hispanic origin: United States,

2018—Con.

[Rates are infant deaths (under 1 year) per 100,000 live births in specified group. Infant deaths are based on race or Hispanic origin of decedent; live births are based

on race or Hispanic origin of mother. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards]

Cause of death (based on International

Classification of Diseases, 10th Revision)

Number

Rate

Total

Non-

Hispanic,

single-race

white

Non-

Hispanic,

single-race

black

Hispanic

Total

Non-

Hispanic,

single-race

white

Non-

Hispanic,

single-race

black

Hispanic

Newborn affected by maternal complications of

pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(P01) 1,358 469 416 331 35.8 24.0 75.4 37.4

Newborn affected by complications of placenta,

cord and membranes . . . . . . . . . . . . . . . . . . . . . . .(P02) 724 308 193 158 19.1 15.7 35.0 17.8

Newborn affected by other complications of

labor and delivery . . . . . . . . . . . . . . . . . . . . . . . . .(P03) 86 41 19 19 2.3 2.1 * *

Newborn affected by noxious influences

transmitted via placenta or breast milk . . . . . . . . .(P04) 71 34 10 16 1.9 1.7 * *

Slow fetal growth and fetal malnutrition . . . . . . . . .(P05) 116 51 40 17 3.1 2.6 7.2 *

Disorders related to short gestation and

low birth weight, not elsewhere classified . . . . . . .(P07) 3,679 1,213 1,371 735 97.0 62.0 248.4 82.9

Disorders related to long gestation and

high birth weight . . . . . . . . . . . . . . . . . . . . . . . . . .(P08) – – – – * * * *

Birth trauma . . . . . . . . . . . . . . . . . . . . . . . . . . .(P10–P15) 12 7 3 1 * * * *

Intrauterine hypoxia and birth asphyxia . . . . . .(P20–P21) 309 137 93 57 8.1 7.0 16.8 6.4

Respiratory distress of newborn . . . . . . . . . . . . . . .(P22) 390 164 121 79 10.3 8.4 21.9 8.9

Other respiratory conditions originating in the

perinatal period . . . . . . . . . . . . . . . . . . . . . . .(P23–P28) 748 305 219 158 19.7 15.6 39.7 17.8

Congenital pneumonia . . . . . . . . . . . . . . . . . . . . .(P23) 48 24 11 10 1.3 1.2 * *

Neonatal aspiration syndromes . . . . . . . . . . . . . .(P24) 50 27 7 11 1.3 1.4 * *

Interstitial emphysema and related conditions

originating in the perinatal period . . . . . . . . . . . .(P25) 68 26 22 16 1.8 1.3 4.0 *

Pulmonary hemorrhage originating in the

perinatal period. . . . . . . . . . . .

. . . . . . . . . . . . . .(P26) 149 49 53 37 3.9 2.5 9.6 4.2

Chronic respiratory disease originating in the

perinatal period. . . . . . . . . . . . . . . . . . . . . . . . . .(P27) 157 65 57 23 4.1 3.3 10.3 2.6

Atelectasis . . . . . . . . . . . . . . . . . . . . . . .(P28.0–P28.1) 214 86 55 48 5.6 4.4 10.0 5.4

Bacterial sepsis of newborn . . . . . . . . . . . . . . . . . . .(P36) 579 205 186 127 15.3 10.5 33.7 14.3

Omphalitis of newborn with or without mild

hemorrhage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(P38) – – – – * * * *

Neonatal hemorrhage . . . . . . . . . . . . . . . . (P50–P52,P54) 375 178 85 78 9.9 9.1 15.4 8.8

Hemorrhagic disease of newborn . . . . . . . . . . . . . .(P53) 1 – – 1 * * * *

Hemolytic disease of newborn due to isoimmunization

and other perinatal jaundice . . . . . . . . . . . . . .(P55–P59) 10 4 2 1 * * * *

Hematological disorders . . . . . . . . . . . . . . . . .(P60–P61) 91 50 14 16 2.4 2.6 * *

Syndrome of infant of a diabetic mother and neonatal

diabetes mellitus . . . . . . . . . . . . . . . . . . .(P70.0–P70.2) 5 2 1 1 * * * *

Necrotizing enterocolitis of newborn . . . . . . . . . . . .(P77) 298 104 101 63 7.9 5.3 18.3 7.1

Hydrops fetalis not due to hemolytic

disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P83.2) 187 98 27 40 4.9 5.0 4.9 4.5

Congenital malformations, deformations and

chromosomal abnormalities . . . . . . . . . . . . (Q00–Q99) 4,473 2,139 881 1,088 118.0 109.3 159.6 122.8

Symptoms, signs and abnormal clinical and laboratory

findings, not elsewhere classified . . . . . . . . (R00–R99) 2,656 1,105 898 429 70.0 56.5 162.7 48.4

Sudden infant death syndrome . . . . . . . . . . . . . .

. .(R95) 1,334 585 429 216 35.2 29.9 77.7 24.4

Accidents (unintentional injuries) . . . . . . . . . . .(V01–X59) 1,168 526 354 186 30.8 26.9 64.1 21.0

Assault (homicide) . . . . . . . . . . . . . . . . (*U01,X85–Y09)

269 117 72 59 7.1 6.0 13.0 6.7

Complications of medical and

surgical care . . . . . . . . . . . . . . . . . . . . . . . . .(Y40–Y84) 18 8 7 3 * * * *

* Rate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

– Quantity zero.

Only selected causes of death are shown; therefore, subcategories do not add to totals; see Technical Notes in this report.

Includes race and origin groups not shown separately; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Asterisks (*) preceding cause-of-death codes indicate they are not part of the International Classification of Diseases, 10th Revision; see Technical Notes in this report.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

64 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 15. Number of infant deaths and mortality rates, by race and Hispanic origin for the United States, each state, Puerto Rico,

U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas, and by sex for the United States, 2018

[Rates are infant (under 1 year) deaths per 1,000 live births in specified group. Infant deaths are based on race or Hispanic origin of decedent; live births are based on

race or Hispanic origin of mother; see Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget

standards; see Technical Notes in this report]

Area and sex

Total

Non-Hispanic,

single-race white

Non-Hispanic,

single-race black

Hispanic

Number Rate Number Rate Number Rate Number Rate

United States

. . . . . . . . . . . . . . . . . . . . . . . . 21,467 5.66 8,893 4.55 6,127 11.10 4,487 5.06

Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,068 6.23 4,991 4.98 3,458 12.35 2,502 5.55

Female . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,399 5.07 3,902 4.09 2,669 9.81 1,985 4.56

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405 7.01 182 5.39 192 10.91 13 *

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 5.95 20 3.95 2 * 8 *

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 451 5.59 129 3.93 33 7.67 213 6.25

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 7.54 158 6.69 85 12.20 24 5.86

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,909 4.20 421 3.42 189 8.45 957 4.53

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298 4.74 150 4.11 22 7.26 111 6.23

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . 147 4.23 61 3.30 34 7.69 47 5.36

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 5.84 21 4.06 33 11.90 7 *

District of Columbia . . . . . . . . . . . . . . . . . . . . 64 6.95 3 * 53 12.46 5 *

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,332 6.01 392 4.09 523 10.86 345 5.13

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 888 7.04 271 4.87 513 11.73 76 4.36

Hawaii . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . 116 6.83 9 * 8 * 25 9.69

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 5.09 78 4.71 1 * 20 5.64

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 942 6.50 382 4.95 336 13.72 160 5.27

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556 6.81 346 5.81 134 13.08 48 6.10

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 5.05 124 4.23 31 11.85 20 5.41

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236 6.51 126 4.98 28 10.87 55 9.20

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 5.84 239 5.52 47 9.49 15 *

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . 454 7.62 170 5.58 253 11.44 25 5.30

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.44 59 5.35 3 * 1 *

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432 6.08 109 3.68 224 10.23 47 3.77

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . 290 4.20 143 3.61 62 9.08 63 4.56

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . 684 6.22 302 4.04 277 13.47 56 7.84

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 5.08 172 3.74 76 9.26 35 7.01

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . 306 8.27 117 6.29 175 11.08 7 *

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460 6.28 292 5.44 110 10.39 34 7.71

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.78 40 4.34 1 * 1 *

Nebraska . . . . . . . . . . . . . .

. . . . . . . . . . . . . . 149 5.85 94 5.33 19 * 24 5.78

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 6.08 83 6.37 37 8.11 65 4.88

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . 43 3.58 35 3.39 2 * 2 *

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . 390 3.85 121 2.66 123 8.86 121 4.38

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . 131 5.69 34 5.27 2 * 76 5.95

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . 974 4.31 392 3.54 266 8.03 182 3.52

North Carolina . . . . . . . . . . . . . . . . . . . . . . . . 797 6.70 316 4.98 333 12.03 88 4.79

North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.55 40 5.12 3 * 2 *

Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 938 6.94 528 5.42 324 14.59 45 6.05

Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 7.09 154 5.41 58 14.02 55 7.29

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 4.17 102 3.61 10 * 44 5.50

Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . 805 5.93 413 4.55 222 12.49 115 7.27

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . 53 5.04 24 3.99 9 * 14 *

South Carolina . . . . . . . . . . . . . . . . . . . . . . . . 406 7.16 156 4.89 210 12.59 29 5.52

South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . 70 5.89 44 5.19 2 * 4 *

Tennessee . . . . . . . . . . . . . . . .

. . . . . . . . . . . 560 6.93 291 5.46 194 12.19 48 6.13

Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,083 5.50 577 4.60 519 10.78 890 4.97

Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 5.53 163 4.75 5 * 59 7.25

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 6.44 32 6.49 1 * 1 *

Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 558 5.59 247 4.51 185 8.87 72 5.00

Washington . . . . . . . . . . . . . . . . . . . . . . . . . . 401 4.66 190 3.88 40 10.20 78 4.85

West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . 130 7.12 109 6.56 13 * 2 *

Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . 393 6.13 208 4.56 103 15.55 45 7.07

Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 5.33 24 4.73 2 * 8 *

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 65

Table 15. Number of infant deaths and mortality rates, by race and Hispanic origin for the United States, each state, Puerto Rico,

U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas, and by sex for the United States, 2018—Con.

[Rates are infant (under 1 year) deaths per 1,000 live births in specified group. Infant deaths are based on race or Hispanic origin of decedent; live births are based on

race or Hispanic origin of mother; see Technical Notes in this report. Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget

standards; see Technical Notes in this report]

Area and sex

Total

Non-Hispanic,

single-race white

Non-Hispanic,

single-race black

Hispanic

Number Rate Number Rate Number Rate Number Rate

Puerto Rico . . . . . . . . . . . . . . . . . . . . . . . . . . 141 6.58 – * – * 141 6.77

U.S. Virgin Islands . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- --- --- ---

Guam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 11.37 – * – * – *

American Samoa . . . . . . . . . . . . . . . . . . . . . . --- --- --- --- --- --- --- ---

Northern Marianas . . . . . . . . . . . . . . . . . . . . . 6 * – * – * – *

* Rate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

– Quantity zero.

--- Data not available.

Includes race and origin groups not shown separately; see Technical Notes in this report.

Includes only one race reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Excludes data for Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and Northern Marianas.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

66 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table 16. Number of maternal deaths and maternal mortality rates for selected causes, by race and Hispanic origin:

United States, 2018

[Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards. Data for specified categories other than non-Hispanic,

single-race white and non-Hispanic, single-race black should be interpreted with caution because of inconsistencies between reporting these items on death certificates

and on censuses and surveys; see Technical Notes in this report]

Cause of death (based on International

Classification of Diseases, 10th Revision) Total

Non-Hispanic, single race

Hispanic

White

Black

American

Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Number

Maternal causes . . . . . . . . . . . . . . . . (A34,O00–O95,O98–O99) 658 291 206 9 32 4 105

Direct obstetric causes . . . . . . . . . . . . . . . . . (A34,O00–O95) 509 215 164 5 27 4 86

Pregnancy with abortive outcome . . . . . . . . . . (O00–O07) 29 9 16 – – – 4

Ectopic pregnancy . . . . . . . . . . . . . . . . . . . . . . . . .(O00) 24 9 12 – – – 3

Spontaneous abortion . . . . . . . . . . . . . . . . . . . . . .(O03) 2 – 2 – – – –

Medical abortion . . . . . . . . . . . . . . . . . . . . . . . . . .(O04) – – – – – – –

Other abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . .(O05) 1 – – – – – 1

Other and unspecified pregnancy with abortive

outcome . . . . . . . . . . . . . . . . . . (O01–O02,O06–O07) 2 – 2 – – – –

Other direct obstetric causes . . . . . . . . . . (A34,O10–O92) 459 197 141 5 27 4 77

Eclampsia and pre-eclampsia . . . . . . . .(O11,O13–O16) 35 15 14 – 2 – 4

Hemorrhage of pregnancy and childbirth and

placenta previa . . . . . . . . . . (O20,O44–O46,O67,O72) 30 12 7 – 1 – 10

Complications predominantly related to

the puerperium . . . . . . . . . . . . . . . . . . (A34,O85–O92) 71 27 26 – 6 1 11

Obstetrical tetanus . . . . . . . . . . . . . . . . . . . . . . .(A34) – – – – – – –

Obstetric embolism . . . . . . . . . . . . . . . . . . . . . .(O88) 43 17 14 – 4 1 7

Other complications predominantly related to the

puerperium . . . . . . . . . . . . . . (O85–O87,O89–O92) 28 10 12 – 2 – 4

All other direct obstetric causes . . (O10,O12,O21–O43,

O47–O66,O68–O71,O73–O75) 323 143 94 5 18 3 52

Obstetric death of unspecified cause . . . . . . . . . . . .(O95) 21 9 7 – – – 5

Indirect obstetric causes . . . . . . . . . . . . . . . . . . (O98–O99) 149 76 42 4 5 – 19

Death from any obstetric cause occurring more than

42 days but less than 1 year after delivery . . . . . . . . . (O96)

277 142 77 6 7 2 40

See footnotes at end of table.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 67

Table 16. Number of maternal deaths and maternal mortality rates for selected causes, by race and Hispanic origin:

United States, 2018—Con.

[Race and Hispanic-origin categories are consistent with 1997 Office of Management and Budget standards. Data for specified categories other than non-Hispanic,

single-race white and non-Hispanic, single-race black should be interpreted with caution because of inconsistencies between reporting these items on death certificates

and on censuses and surveys; see Technical Notes in this report]

Cause of death (based on International

Classification of Diseases, 10th Revision) Total

Non-Hispanic, single race

Hispanic

White

Black

American

Indian or

Alaska Native

Asian

Native Hawaiian

or Other Pacific

Islander

Rate per 100,000 live births

Maternal causes . . . . . . . . . . . . . . . . (A34,O00–O95,O98–O99) 17.4 14.9 37.3 * 13.3 * 11.8

Direct obstetric causes . . . . . . . . . . . . . . . . . (A34,O00–O95) 13.4 11.0 29.7 * 11.2 * 9.7

Pregnancy with abortive outcome . . . . . . . . . . (O00–O07) 0.8 * * * * * *

Ectopic pregnancy . . . . . . . . . . . . . . . . . . . . . . . . .(O00) 0.6 * * * * * *

Spontaneous abortion . . . . . . . . . . . . . . . . . . . . . .(O03) * * * * * * *

Medical abortion . . . . . . . . . . . . . . . . . . . . . . . . . .(O04) * * * * * * *

Other abortion . . . . . . . . . . . . . . . . . . . . . . . . . . . .(O05) * * * * * * *

Other and unspecified pregnancy with abortive

outcome . . . . . . . . . . . . . . . . . . (O01–O02,O06–O07) * * * * * * *

Other direct obstetric causes . . . . . . . . . . (A34,O10–O92) 12.1 10.1 25.5 * 11.2 * 8.7

Eclampsia and pre-eclampsia . . . . . . . .(O11,O13–O16) 0.9 * * * * * *

Hemorrhage of pregnancy and childbirth and

placenta previa . . . . . . . . . . (O20,O44–O46,O67,O72) 0.8 * * * * * *

Complications predominantly related to

the puerperium . . . . . . . . . . . . . . . . . . (A34,O85–O92) 1.9 1.4 4.7 * * * *

Obstetrical tetanus . . . . . . . . . . . . . . . . . . . . . . .(A34) * * * * * * *

Obstetric embolism . . . . . . . . . . . . . . . . . . . . . .(O88) 1.1 * * * * * *

Other complications predominantly related to the

puerperium . . . . . . . . . . . . . . (O85–O87,O89–O92) 0.7 * * * * * *

All other direct obstetric causes . . (O10,O12,O21–O43,

O47–O66,O68–O71,O73–O75) 8.5 7.3 17.0 * * * 5.9

Obstetric death of unspecified cause . . . . . . . . . . . .(O95) 0.6 * * * * * *

Indirect obstetric causes . . . . . . . . . . . . . . . . . . (O98–O99) 3.9 3.9 7.6 * * * *

Death from any obstetric cause occurring more than

42 days but less than 1 year after delivery . . . . . . . . . (O96)

7.3 7.3 13.9 * * * 4.5

– Quantity zero.

* Rate does not meet National Center for Health Statistics standards of reliability; see Technical Notes in this report.

Includes deaths with origin not stated, origin not classifiable, and two or more races reported; see Technical Notes in this report.

Only one race was reported on the death certificate; see Technical Notes in this report.

Includes persons of Hispanic origin of any race; see Technical Notes in this report.

Late maternal death.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

68 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Technical Notes

Nature and sources of data

Data in this report are based on information from all death

certificates filed in the 50 states and the District of Columbia

and are processed by the National Center for Health Statistics

(NCHS). Death certificates are completed by funeral directors,

attending physicians, medical examiners, coroners, or other

persons legally authorized to certify deaths. Data for 2018 are

based on records of deaths that occurred during 2018 and

were received as of July 16, 2019. Data for earlier years can be

obtained via CDC WONDER (9).

The U.S. Standard Certificate of Death, which the states use

as a model, was revised in 2003 (4). Prior to 2003, the certificate

had not been revised since 1989 (14). Beginning in 2018, all 50

states and the District of Columbia used the 2003 revision of

the U.S. Standard Certificate of Death for the entire year. During

2003–2017, both the 1989 and the 2003 certificates were used.

For this transitional period, the race and Hispanic ethnicity of

decedents was reported using the 1977 Office of Management

and Budget (OMB) guidelines (1989 certificate), which allowed

the reporting of only one race and provided four choices. The

1997 OMB guidelines (2003 certificate) allowed the reporting of

more than one race and provided five categories (34).

Data for Guam, Commonwealth of the Northern Mariana

Islands (Northern Marianas), and Puerto Rico are included in

tables showing data by state but are not included in U.S. totals.

Data for American Samoa and U.S. Virgin Islands for the 2018

data year were not available at the time of file closing and, so, are

not included in this report. In 2018, Guam, Northern Marianas,

and Puerto Rico collected and reported death data using the

2003 revision of the U.S. Standard Certificate of Death. Mortality

statistics are based on information submitted by the jurisdictions

and coded by the National Center for Health Statistics (NCHS)

through the Vital Statistics Cooperative Program. For the 2018

data year, all states, the District of Columbia, New York City, and

Puerto Rico submitted mortality medical data and demographic

data in electronic data files to NCHS. Guam and Northern

Marianas submitted copies of death certificates from which

NCHS entered and coded all medical and demographic data.

Data for the entire United States refer to events occurring

within the United States. Data shown for geographic areas are by

place of residence. Beginning with 1970, mortality statistics for

the United States exclude deaths of nonresidents of the United

States. All data exclude fetal deaths.

Mortality statistics for Northern Marianas and Puerto

Rico exclude deaths of nonresidents for each area. For Guam,

however, mortality statistics exclude deaths that occurred to a

nonresident of Guam or the United States (50 states and the

District of Columbia).

Cause-of-death classification

The mortality statistics presented in this report were

compiled according to World Health Organization (WHO)

regulations, which specify that member countries classify and

code causes of death according to the current revision of the

International Classification of Diseases (ICD). ICD provides the

basic guidance used in virtually all countries to code and classify

causes of death. Effective with deaths occurring in 1999, the

United States began using the 10th revision of this classification

(ICD–10) (46). For earlier years, causes of death were classified

according to the revisions then in use: 1979–1998, Ninth

Revision; 1968–1978, Eighth Revision; 1958–1967, Seventh

Revision; and 1949–1957, Sixth Revision.

Changes in the classification of causes of death due to these

revisions may result in discontinuities in cause-of-death trends.

Consequently, cause-of-death comparisons among revisions

require consideration of comparability ratios and, where

available, estimates of their standard errors. Comparability

ratios between the Ninth and 10th revisions, Eighth and Ninth

revisions, Seventh and Eighth revisions, and Sixth and Seventh

revisions may be found in other NCHS reports and independent

tabulations (47–52).

ICD not only details disease classification but also provides

definitions, tabulation lists, the format of the death certificate, and

rules for coding cause of death. Cause-of-death data presented

in this publication were coded by procedures outlined in annual

issues of the NCHS Instruction Manual (12,53,54). ICD includes

rules for selecting the underlying cause of death and regulations

on the use of ICD.

Prior to data year 1968, mortality medical data were based

on manual coding of an underlying cause of death for each

certificate, in accordance with WHO rules. Effective with data

year 1968, NCHS converted to computerized coding of the

underlying cause and manual coding of all causes (multiple

causes) on the death certificate. In this system, called Automated

Classification of Medical Entities (ACME) (55), multiple-cause

codes are inputted in computer software that uses WHO rules to

select the underlying cause. All cause-of-death data in this report

are coded using ACME.

The ACME system is used to select the underlying cause

of death for all death certificates in the United States. In

addition, NCHS developed two computer systems as inputs

to ACME. Beginning with 1990 data, the Mortality Medical

Indexing, Classification, and Retrieval system (MICAR) (56,57)

was introduced to automate the coding of multiple causes of

death. In addition, MICAR provides more detailed information

on the conditions reported on death certificates than is available

through ICD code structure. Beginning with data year 1993,

SuperMICAR (58), an enhancement of the MICAR system, was

introduced, allowing for literal entry of the multiple cause-of-

death text as reported by the certifier. This information is then

processed automatically by the MICAR and ACME computer

systems. Records that cannot be automatically processed by

MICAR are manually coded for multiple cause and then further

processed through ACME to determine the underlying cause

of death. In 2018, SuperMICAR was used to process all of the

country’s death records.

In this report, tabulations of cause-of-death statistics are

based solely on the underlying cause of death. The underlying

cause is defined by WHO as “the disease or injury which

initiated the train of morbid events leading directly to death, or

the circumstances of the accident or violence which produced

the fatal injury” (11). The underlying cause is selected from

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 69

the conditions entered by the medical certifier in the cause-of-

death section of the death certificate. When more than one cause

or condition is entered by the medical certifier, the underlying

cause is determined by the sequence of conditions on the

certificate, provisions of ICD, and associated selection rules and

modifications. Generally, more medical information is reported

on death certificates than is directly reflected in the underlying

cause of death. This is captured in NCHS multiple cause-of-death

statistics (59–61).

Tabulation lists and cause-of-death ranking

Tabulation lists for ICD–10 are published in NCHS Instruction

Manual, “ICD–10 Cause-of-Death Lists for Tabulating Mortality

Statistics” (updated September 2018 to include WHO updates to

ICD–10 for data year 2017) (62). Beginning with data year 2017,

cause-of-death titles previously appearing in the possessive form

were changed to the nonpossessive form (e.g., “Alzheimer’s

disease” was changed to “Alzheimer disease”). Tabulation

lists, a) “List of 113 Selected Causes of Death and Enterocolitis

due to Clostridium difficile” (the title of which was modified in

2009 to include Enterocolitis due to Clostridium difficile), used

for deaths of all ages; and b) “List of 130 Selected Causes of

Infant Death,” used for infants, are used to rank leading causes

of death for the two population groups (62). Prior to the 2015

data year, annual reports of final data presented cause-of-death

data based on these two tabulation lists. To streamline cause-of-

death information shown in this report, beginning with the 2015

data year, cause-of-death data are presented for select causes of

death only. The select causes include all rankable causes as well

as other select causes based on public health impact and future

planning. Data for all causes on the “List of 113 Selected Causes

of Death” and “List of 130 Selected Causes of Infant Death” are

available from the NCHS website (https://www.cdc.gov/nchs/

data/nvsr/nvsr69/nvsr69-13-tables-508.pdf) and through CDC

WONDER (https://wonder.cdc.gov/). In the list of 113 causes,

the group titles of Major cardiovascular diseases (ICD–10

codes I00–I78) and Symptoms, signs and abnormal clinical and

laboratory findings, not elsewhere classified (R00–R99) are not

ranked. In addition, category titles that begin with the words

“other” and “all other” are not ranked to determine the leading

causes of death. When one of the titles that represents a subtotal

is ranked, for example, Tuberculosis (A16–A19), its component

parts are not ranked, as in this case, Respiratory tuberculosis

(A16) and Other tuberculosis (A17–A19). For the list of 130

causes of infant death, the same ranking procedures are used

except that the category of Major cardiovascular diseases is not

on the list. More detail regarding ranking procedures can be

found in “Deaths: Leading Causes for 2018” (2).

Leading cause-of-death trends discussed in this report

are based on cause-of-death data according to ICD–10 for

1999–2018 and ICD–9 for the most comparable cause-of-death

titles for 1979–1998. Although, in some cases, categories from

the “List of 113 Selected Causes of Death” are identical to those

in the earlier “List of 72 Selected Causes of Death” used with

ICD–9, caution must be used because many of these categories

are not comparable even though the cause-of-death titles may be

the same. Tables showing ICD–9 categories that are comparable

with ICD–10 titles in the “List of 113 Selected Causes of Death”

may be found in the reports, “Comparability of Cause of Death

Between ICD–9 and ICD–10: Preliminary Estimates” (49) and

“Deaths: Final Data for 1999” (63).

Trend data for 1979–1998 that are classified by ICD–9 but

sorted into the “List of 113 Selected Causes of Death” developed

for ICD–10 are available from the NCHS website: https://www.

cdc.gov/nchs/data/statab/hist001r.pdf.

Revision of ICD and resulting changes in classification and

rules for selecting the underlying cause of death have important

implications for the analysis of mortality trends by cause of

death. For some causes of death, the discontinuity in trend can

be substantial (47,49). Therefore, considerable caution should

be used in analyzing cause-of-death trends for periods of time

that extend across more than one revision of ICD.

Codes added or deleted in 2018

No ICD–10 codes were added or deleted in data year 2018.

Information on categories added or deleted in previous years is

available from the NCHS Instruction Manual, Part 9: https://www.

cdc.gov/nchs/data/dvs/Part9InstructionManual2017.pdf (62).

Codes for terrorism

Beginning with data for 2001, NCHS introduced categories

*U01–*U03 for classifying and coding deaths due to acts of

terrorism. The asterisks before the category codes indicate that

they are not part of ICD–10. Deaths classified to the terrorism

categories are included in the 113 causes of death list in the

categories for Assault (homicide) and Intentional self-harm

(suicide), and in the 130 causes of death list for infants in the

category for Assault (homicide). Additional information on these

new categories is available from: https://www.cdc.gov/nchs/icd/

terrorism_code.htm. This report includes one death coded to

Sequelae of terrorism.

In any given year, it is possible that deaths resulting from

acts of terrorism may not be identified as such if: a) information

identifying an incident as an act of terrorism is not available to

the certifier at the time of certification; b) the certificate is not

updated with the information if it later becomes available; or c)

official results of the investigation declaring the incident to be an

act of terrorism have not yet been made public. A death coded

to Sequelae of terrorism is one in which an act of terrorism was

the underlying cause of death, but the incident occurred a year

or more before death.

Enterocolitis due to Clostridium difficile

The number of deaths from Enterocolitis due to Clostridium

difficile (C. difficile) (ICD–10 code A04.7) was 5,249 in 2018.

Deaths from this cause increased dramatically from 793 deaths

in 1999 to a high of 8,085 deaths in 2011 (9). Because of the

increasing importance of this cause of death (35,36), beginning

with data year 2006, C. difficile was added to the list of rankable

causes.

70 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Quality of reporting and processing cause of

death

The quality of mortality data is largely dependent on proper

and thorough completion of death certificates by certifiers.

Accuracy and completeness of information entered on death

certificates can vary by state from year to year.

One index of the quality of reporting causes of death is

the proportion of death certificates coded to Chapter XVIII—

Symptoms, signs and abnormal clinical and laboratory findings,

not elsewhere classified (ICD–10 codes R00–R99). Although

which deaths occur for which underlying causes are impossible

to determine, the proportion coded to R00–R99 indicates the

consideration given to the cause-of-death statement by the

medical certifier. This proportion also may be used as a rough

measure of the specificity of medical diagnoses made by the

certifier in various areas. The percentage of all reported deaths

in the United States assigned to Symptoms, signs and abnormal

clinical and laboratory findings, not elsewhere classified,

decreased from 1.16% in 2017 to 1.15% in 2018.

Rules for coding a cause or causes of death may sometimes

require modification when evidence suggests it will improve the

quality of cause-of-death data. Prior to 1999, such modifications

were made only when a new ICD revision was implemented.

A process for updating ICD was introduced with ICD–10 that

allows for midrevision changes. These changes, however, may

affect comparability of data between years for selected causes

of death.

Detail on coding and classification rule changes can be found

in “ICD–10 ACME Decision Tables for Classifying Underlying

Causes of Death, 2016,” available from: https://www.cdc.gov/

nchs/data/dvs/2c_2016.pdf (55). No new coding or classification

rule changes occurred in 2018. Trend data for causes of death

affected by coding rule changes in previous years should be

interpreted with caution.

Rare causes of death

Selected causes of death considered to be of public health

concern are supposed to be routinely confirmed by states

according to agreed-upon procedures between state vital

statistics programs and NCHS. These causes, termed “infrequent

and rare causes of death,” are listed in the NCHS Instruction

Manuals, Parts 2a, 11, and 20 (53,64,65). In 2018, some states

did not confirm some or all deaths from rare causes.

Codes for dementia-related causes

Causes of death attributable to dementia-related mortality

include ICD–10 codes F01, Vascular dementia; F03, Unspecified

dementia; G30, Alzheimer disease; and G31, Other degenerative

diseases of nervous system, not elsewhere classified.

Codes for drug-induced deaths

Causes of death attributable to drug-induced mortality

include ICD–10 codes D52.1, Drug-induced folate deficiency

anemia; D59.0, Drug-induced hemolytic anemia; D59.2, Drug-

induced nonautoimmune hemolytic anemia; D61.1, Drug-induced

aplastic anemia; D64.2, Secondary sideroblastic anemia due to

drugs and toxins; E06.4, Drug-induced thyroiditis; E16.0,

Drug-induced hypoglycemia without coma; E23.1, Drug-induced

hypopituitarism; E24.2, Drug-induced Cushing syndrome; E27.3,

Drug-induced adrenocortical insufficiency; E66.1, Drug-induced

obesity; selected codes from the ICD–10 title of Mental and

behavioral disorders due to psychoactive substance use, F11.1–

F11.5, F11.7–F11.9, F12.1–F12.5, F12.7–F12.9, F13.1–F13.5,

F13.7–F13.9, F14.1–F14.5, F14.7–F14.9, F15.1–F15.5, F15.7–

F15.9, F16.1–F16.5, F16.7–F16.9, F17.3–F17.5, F17.7–F17.9,

F18.1–F18.5, F18.7–F18.9, F19.1–F19.5, and F19.7–F19.9;

G21.1, Other drug-induced secondary parkinsonism; G24.0,

Drug-induced dystonia; G25.1, Drug-induced tremor; G25.4,

Drug-induced chorea; G25.6, Drug-induced tics and other tics of

organic origin; G44.4, Drug-induced headache, not elsewhere

classified; G62.0, Drug-induced polyneuropathy; G72.0, Drug-

induced myopathy; I95.2, Hypotension due to drugs; J70.2,

Acute drug-induced interstitial lung disorders; J70.3, Chronic

drug-induced interstitial lung disorders; J70.4, Drug-induced

interstitial lung disorder, unspecified; K85.3, Drug-induced acute

pancreatitis; L10.5, Drug-induced pemphigus; L27.0, Generalized

skin eruption due to drugs and medicaments; L27.1, Localized

skin eruption due to drugs and medicaments; M10.2, Drug-

induced gout; M32.0, Drug-induced systemic lupus

erythematosus; M80.4, Drug-induced osteoporosis with

pathological fracture; M81.4, Drug-induced osteoporosis;

M83.5, Other drug-induced osteomalacia in adults; M87.1,

Osteonecrosis due to drugs; R50.2, Drug-induced fever; R78.1,

Finding of opiate drug in blood; R78.2, Finding of cocaine in

blood; R78.3, Finding of hallucinogen in blood; R78.4, Finding of

other drugs of addictive potential in blood; R78.5, Finding of

psychotropic drug in blood; X40–X44, Accidental poisoning by

and exposure to drugs, medicaments and biological substances;

X59–X64, Intentional self-poisoning (suicide) by and exposure

to drugs, medicaments and biological substances; X85, Assault

(homicide) by drugs, medicaments and biological substances;

and Y10–Y14, Poisoning by and exposure to drugs, medicaments

and biological substances, undetermined intent. Drug-induced

causes exclude unintentional injuries, homicide, and other

causes indirectly related to drug use, as well as newborn deaths

associated with the mother’s drug use.

Codes for alcohol-induced deaths

Causes of death attributable to alcohol-induced mortality

include ICD–10 codes E24.4, Alcohol-induced pseudo-Cushing

syndrome; F10, Mental and behavioral disorders due to alcohol

use; G31.2, Degeneration of nervous system due to alcohol;

G62.1, Alcoholic polyneuropathy; G72.1, Alcoholic myopathy;

I42.6, Alcoholic cardiomyopathy; K29.2, Alcoholic gastritis;

K70, Alcoholic liver disease; K85.2, Alcohol-induced acute

pancreatitis; K86.0, Alcohol-induced chronic pancreatitis; R78.0,

Finding of alcohol in blood; X45, Accidental poisoning by and

exposure to alcohol; X65, Intentional self-poisoning by and

exposure to alcohol; and Y15, Poisoning by and exposure to

alcohol, undetermined intent. Alcohol-induced causes exclude

unintentional injuries, homicides, and other causes indirectly

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 71

related to alcohol use, as well as newborn deaths associated with

maternal alcohol use.

Codes for firearm-related deaths

Causes of death attributable to firearm-related injuries

include ICD–10 codes *U01.4, Terrorism involving firearms

(homicide); W32–W34, Accidental discharge of firearms;

X72–X74, Intentional self-harm (suicide) by discharge of

firearms; X93–X95, Assault (homicide) by discharge of firearms;

Y22–Y24, Discharge of firearms, undetermined intent; and

Y35.0, Legal intervention involving firearm discharge. Deaths

from firearm-related injuries exclude deaths due to explosives

and other causes indirectly related to firearms.

Race and Hispanic origin

The 2003 revision of the U.S. Standard Certificate of Death

allows the reporting of more than one race (multiple races)

(4). This change was implemented to reflect the increasing

diversity of the U.S. population and to be consistent with the

decennial census and the 1997 “Revisions to the Standards for

the Classification of Federal Data on Race and Ethnicity,” issued

by OMB (5). This revision replaced standards that were issued

in 1977 (15). The new standards mandate the collection of more

than one race, where applicable, for federal data (5) and require

the collection of information on a minimum set of five races

(more than the minimum number of race categories are reported

on death certificates) (4). Multiple race includes any combination

of white, black or African American, American Indian or Alaska

Native (AIAN), Asian, and Native Hawaiian or Other Pacific

Islander (NHOPI). If two or more specific subgroups, such as

Korean and Chinese, are reported, these count as a single race of

Asian rather than as multiple races.

The number of states reporting multiple race has increased

from 7 states in 2003 to all 50 states and the District of Columbia

in 2018 (Table I). In 2018, more than one race was reported

for 0.5% of decedents of non-Hispanic origin and for 0.9% of

Hispanic origin (Table II). Although still uncommon, multiple

races were reported more often for younger decedents than for

older decedents (3.3% of decedents under age 25 compared

with 0.8% of decedents aged 25–64 and 0.3% of decedents aged

65 and over). In 2018, only one decedent reported five races.

During 2003–2017, both the 1989 and the 2003 standard

death certificates were used. For this transitional period, states

using the 1989 certificate reported the race and Hispanic

ethnicity of decedents based on the 1977 OMB guidelines, which

allowed the reporting of only one race and provided four choices:

white, black or African American, AIAN, and Asian or Pacific

Islander (API). Under these standards, data for API persons

were collected as a single group; that is, data for Asian persons

were not reported separately from NHOPI persons (15). States

using the 2003 death certificate reported the race and Hispanic

ethnicity of decedents based on the 1997 OMB guidelines, which

allowed the reporting of more than one race and provided five

categories (14,15,5). These guidelines provide for the reporting

of Asian persons separately from NHOPI persons (14).

Beginning with data year 2018, multiple race data were

collected and reported for the entire year by all 50 states and the

District of Columbia. Previously, data by race for death certificates

collecting only one race—the source of the numerators for death

rates—were incompatible with the reporting in other states

that had adopted the new standards and with population data

collected in the 2000 and 2010 censuses, intercensal estimates

for 1991–1999 and 2001–2009, and postcensal estimates

for 2011–2017—the denominators for the rates. To produce

death rates by race, the reported multiple-race data from death

certificates and population data for multiple-race persons

had to be “bridged” to single-race categories. The bridging

procedures used for the mortality records, and the multiple-

race population estimates were similar (26,27). Multiracial

decedents were imputed to a single race (white, black, AIAN, or

API) according to their combination of races, Hispanic origin,

and geographic area indicated on the death certificate. The

imputation procedure is described in detail in “NCHS Procedures

for Multiple-Race and Hispanic Origin Data: Collection, Coding,

Editing, and Transmitting,” available from: https://www.cdc.

gov/nchs/data/dvs/Multiple_race_documentation_5-10-04.pdf.

Similarly, when calculating infant mortality rates, multiracial

infants were bridged to a single race. The bridging procedure for

multiple-race mothers and fathers was based on the procedure

used to bridge the multiple-race population estimates (44). In

2018, use of the bridged-race process was no longer needed

because all states collected data on race according to 1997 OMB

guidelines for the entire year, however, bridged estimates will be

calculated through 2020 to inform the reporting of trends over

time.

Race and Hispanic origin are two distinct attributes and

are reported separately on the death certificate. Therefore, data

shown by Hispanic origin and race are based on a combination of

the two attributes for the non-Hispanic population. Data shown

for the Hispanic population include persons of any race.

Changing from bridged-race to unbridged data had a

relatively minor impact on age-adjusted death rates in 2018.

Table A presents age-adjusted rates for 2018 based on 1977

bridged-race categories and 1997 race categories. Age-adjusted

rates based on unbridged data were higher than rates based on

bridged data for the non-Hispanic white population by 0.4% and

for the non-Hispanic black population by 1.5%. The difference

between rates for the non-Hispanic AIAN population was not

significant.

Quality of race and Hispanic-origin data—Death rates

for Hispanic, non-Hispanic Asian, non-Hispanic NHOPI, and

non-Hispanic API populations are affected by inconsistencies

in reporting Hispanic origin or race on the death certificate

compared with censuses, surveys, and birth certificates. Studies

have shown underreporting on death certificates of non-Hispanic

and Hispanic decedents, as well as undercounts of these groups

in censuses (28,29,66,67).

A number of studies have been conducted on the reliability

of race and Hispanic origin reported on the death certificate

by comparing them with race and Hispanic origin reported on

another data collection instrument, such as the census or a

survey (28,29,66,67). Inconsistencies may arise because of

72 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

differences in who provides race and ethnicity information on

the compared records. Race and Hispanic-origin information

on the death certificate is reported by a funeral director as

provided by an informant or, in the absence of an informant, on

the basis of observation. In contrast, race and Hispanic origin in

the census or the U.S. Census Bureau’s American Community

Survey is obtained while the person is alive; in these cases, race

and ethnicity is self-reported or reported by another member

of the household familiar with the person and, so, may be

considered more valid. A high level of agreement between the

death certificate and the census or survey report is essential to

assure unbiased death rates by race and ethnicity.

Using the National Longitudinal Mortality Study, Arias et al.

examined the reliability of race and Hispanic origin reported on

about 559,007 death certificates compared with that reported on

a total of 38 Current Population Surveys (CPS) conducted by

the Census Bureau for 1979–2011 (28,29). Agreement between

the two sources was found to be excellent for the non-Hispanic

white and non-Hispanic black populations, both exhibiting CPS-

to-death-certificate ratios of 1.00. On the other hand, substantial

differences were found for other race and ethnicity groups. The

ratio of CPS to death certificates was found to be 1.33 for the

non-Hispanic AIAN population and 1.03 for the non-Hispanic API

population, indicating net underreporting on death certificates of

33% for non-Hispanic AIAN and 3% for non-Hispanic API. Using

the new race standard, Asian and Pacific Islander are separate

categories. The ratio of deaths for CPS to death certificates

for Hispanic persons was found to be 1.03, indicating a net

underreporting on death certificates for the Hispanic population

of 3%. The net effect of misclassification is an underestimation

of deaths and death rates for some race-ethnicity populations.

In addition, undercoverage of minority groups in the census

and resultant population estimates introduces biases into death

rates by race and Hispanic origin (28,29,66–69). Unlike the

1990 census, coverage error in the 2000 census was found

to be statistically significant only for the non-Hispanic white

Table I. Year state started reporting multiple race and year state began using the revised standard certificate of death: Each

state, 2003–2018

Area

Year

state

began reporting

multiple race

Year state

began using the

2003 standard

certificate Area

Year

state

began reporting

multiple race

Year state

began using the

2003 standard

certificate

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . 2016 2016 Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . 2003 2003

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2014 2014 Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . 2005 2005

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2010 2010 Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2008 2008

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . 2008 2008 New Hampshire . . . . . . . . . . . . . . . . . . . . .

2004

California . . . . . . . . . . . . . . . . . . . . . . . . . . 2003 2003 New Jersey . . . . . . . . . . . . . . . . . . . . . . . . 2004 2004

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . 2015 2015 New Mexico . . . . . . . . . . . . . . . . . . . . . . . . 2006 2006

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . 2005 2005 New York . . . . . . . . . . . . . . . . . . . . . . . . . . 2003 2003

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . 2007 2007 North Carolina . . . . . . . . . . . . . . . . . . . . . . 2014 2014

District of Columbia . . . . . . . . . . . . . . . . . .

2005

2005 North Dakota . . . . . . . . . . . . . . . . . . . . . . . 2008 2008

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2005 2005 Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2007 2007

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . 2008 2008 Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . 2004 2004

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2003 2014 Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006 2006

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2003 2003 Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . 2012 2012

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2008 2008 Rhode Island . . . . . . . . . . . . . . . . . . . . . . . 2006 2006

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2008 2008 South Carolina . . . . . . . . . . . . . . . . . . . . . . 2005 2005

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2011 2011 South Dakota . . . . . . . . . . . . . . . . . . . . . . . 2004 2004

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2005 2005 Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . 2012 2012

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . .

2010

2010 Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2006 2006

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . .

2012

2012 Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2005 2005

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2003

2010 Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . .

2008

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . 2015 2015 Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2014

Massachusetts . . . . . . . . . . . . . . . . . . . . . .

2014

2014 Washington . . . . . . . . . . . . . . . . . . . . . . . . 2004 2004

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . 2004 2004 West Virginia . . . . . . . . . . . . . . . . . . . . . . .

2017

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . 2004

2011 Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . 2003

2013

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . 2012 2012 Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . 2004 2004

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . 2010 2010

Indicates year in which the National Center for Health Statistics first received multiple-race data from each state, although the state may have begun collecting such data at an earlier date.

Began reporting multiple race in March.

Began implementing revised certificate in March.

Began reporting multiple race in July.

Began implementing revised certificate in July.

Began implementing revised certificate in June.

Began implementing revised certificate in September.

Began reporting multiple race in September.

Began reporting multiple race in mid-April.

Began implementing revised certificate in mid-April.

Began reporting multiple race in November.

Began implementing revised certificate in November.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

73 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

Table II. Deaths, by origin and race: United States, 2018

[By state of occurrence. Data exclude deaths with origin not stated or not classifiable. Records with race not stated or not classifiable are imputed; see Technical Notes]

Origin and race Deaths

Percent of

non-Hispanic

deaths Origin and race Deaths

Percent of

Hispanic deaths

Non-Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,626,499 100.0 Hispanic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204,719 100.0

One race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,613,795 99.5 One race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202,898 99.1

White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,182,552 83.1 White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197,484 96.5

Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341,408 13.0 Black . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,584 1.8

AIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17,790 0.7 AIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 981 0.5

Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68,768 2.6 Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 614 0.3

NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,277 0.1 NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235 0.1

Two or more races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,704 0.5 Two or more races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,821 0.9

Two races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,930 0.5 Two races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,660 0.8

Black and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,876 0.1 Black and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398 0.2

Black and AIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755 0.0 Black and AIAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 0.0

Black and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280 0.0 Black and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 0.0

Black and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 0.0 Black and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 0.0

AIAN and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,697 0.2 AIAN and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677 0.3

AIAN and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 0.0 AIAN and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 0.0

AIAN and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 0.0 AIAN and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0.0

Asian and White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,289 0.1 Asian and White. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370 0.2

Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 964 0.0 Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0.0

NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 802 0.0 NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 0.1

Three races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 756 0.0 Three races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 0.1

Black, AIAN and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 0.0 Black, AIAN and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 0.0

Black, AIAN and Asian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 0.0 Black, AIAN and Asian . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . – 0.0

Black, AIAN and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 0.0 Black, AIAN and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 0.0

Black, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 0.0 Black, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 0.0

Black, Asian and NHOPI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0.0 Black, Asian and NHOPI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

Black, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 0.0 Black, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0.0

AIAN, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 0.0 AIAN, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 0.0

AIAN, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 0.0 AIAN, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0.0

AIAN, Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 0.0 AIAN, Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471 0.0 Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 0.0

Four races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 0.0 Four races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0.0

Black, AIAN, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . 6 0.0 Black, AIAN, Asian and White . . . . . . . . . . . . . . . . . . . . . . . . . 2 0.0

Black, AIAN, Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . 1 0.0 Black, AIAN, Asian and NHOPI . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

Black, AIAN, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . 2 0.0 Black, AIAN, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

Black, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . – 0.0 Black, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

AIAN, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . 8 0.0 AIAN, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . . . . . . 2 0.0

Five races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0.0 Five races . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . – 0.0

Black, AIAN, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . 1 0.0 Black, AIAN, Asian, NHOPI and White . . . . . . . . . . . . . . . . . . . – 0.0

0.0 Quantity more than zero but less than 0.05.

– Quantity zero.

NOTE: AIAN is American Indian or Alaska Native, and NHOPI is Native Hawaiian or Other Pacific Islander.

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 74

population (overcounted by approximately 1.13%) and non-

Hispanic black population (undercounted by approximately

1.84%) (68). Overall, the 2010 census coverage error was

minor, with a net overcount of 0.01%. The net undercounts were

statistically different from zero for the following groups: non-

Hispanic black (2.07%), non-Hispanic white (–0.84%), Hispanic

(1.54%), and on-reservation AIAN (4.88%) populations. The

net undercounts were not statistically different from zero for the

non-Hispanic Asian (0.08%), non-Hispanic NHOPI (1.34%), and

off-reservation AIAN (–1.95%) populations (70).

Data year 1997 was the first year in which mortality data by

Hispanic origin were available for the entire United States.

Race not stated or not classifiable and Hispanic origin not

stated or not classifiable—In 2018, death records with race not

stated or not classifiable (1.1% of all records) were imputed to

one of the five single-race categories by assigning the record a

single-race value based on the last single-race record processed.

Records with Hispanic origin not stated or not classifiable were

not imputed and accounted for 0.3% of all records.

Infant and maternal mortality rates—Infant and maternal

deaths in this report are tabulated by the race and Hispanic

origin of the decedent. Live births, the denominators of infant

and maternal mortality rates, are tabulated by race and Hispanic

origin of mother.

In 2018, multiple race was reported on the revised birth

certificates of all 50 states, the District of Columbia, Puerto Rico,

Guam, and Northern Marianas using the 2003 revision of the

U.S. Standard Certificate of Birth (71).

Infant mortality rates by race and origin are based on

numbers of resident infant deaths by race and origin and numbers

of resident live births by race and origin of mother for the United

States. In computing infant mortality rates, deaths and live births

of unknown or not classifiable origin are not distributed among

the specified Hispanic and non-Hispanic groups. In the United

States in 2018, the percentage of infant deaths of unknown

origin was 1.0%, and the percentage of live births to mothers of

unknown origin was 0.9%.

Small numbers of infant deaths for specific Hispanic-origin

groups result in infant mortality rates subject to relatively large

random variation (see “Random variation”).

Infant mortality rates calculated from the general mortality

file for specified race and Hispanic origin contain errors because

of reporting problems that affect the classification of race and

Hispanic origin on the birth and death certificates for the same

infant. Infant mortality rates by specified race and Hispanic

origin are more accurate when based on the linked file of infant

deaths and live births (44). The linked file computes infant

mortality rates using the race and Hispanic origin of the mother

from the birth certificate in both the numerator and denominator

of the rate. In addition, the mother’s race and Hispanic origin

from the birth certificate are considered to be more accurately

reported than the infant’s race and Hispanic origin from the death

certificate. On the birth certificate, race and Hispanic origin are

generally reported by the mother at the time of delivery, whereas

on the death certificate, the infant’s race and Hispanic origin are

reported by an informant, usually the mother but sometimes the

funeral director. Estimates of reporting errors have been made by

comparing rates based on the linked files with those in which the

infant’s race and Hispanic origin are based on information from

the death certificate (44,66).

Life tables

The life table provides a comprehensive measure of the

effect of mortality on life expectancy. It is composed of sets

of values showing the mortality experience of a hypothetical

group of infants born at the same time and subject throughout

their lifetime to the age-specific death rates of a particular time

period, usually a given year. Prior to data year 1997, U.S. life

tables were abridged and constructed by reference to a standard

table (72). In addition, the age range for these life tables was

limited to 5-year age groups ending with age group 85 and over.

Beginning with final data reported for 1997, complete life tables

were constructed by single years of age extending to age 100

(73), using a methodology similar to that of the 1989–1991

decennial life tables (74). The methodology was again revised

for data years 2000–2007 using a methodology similar to that of

the 1999–2001 decennial life tables (75).

Research into the methodology used for the 1999–2001

decennial life tables, which was applied to the 2000–2007

annual life tables, revealed that it is not necessary to model

(or “smooth”) the probabilities of death beginning at age 66.

The observed blended vital statistics and Medicare data for

ages 66–85 are robust enough and do not require additional

smoothing. Beginning with final data reported for 2008 (76), the

life table methodology was refined by changing the smoothing

technique used to estimate the life table functions at the oldest

ages. Beginning with the 2008 data year, the methodology used

to produce the life tables does not model the probabilities of

death beginning at age 66, but rather at ages above 85 or so. See

“United States Life Tables, 2008” for a detailed description of the

new methodology (77). Life table data shown in this report for

data years 2001–2018 are based on the new methodology.

Because life table values presented in this report for

2001–2009 were re-estimated using the new methodology and

revised 2001–2009 intercensal population estimates based on

the 2010 decennial census (25), the values may differ from

those previously published in annual final mortality and life

table reports. Historically, NCHS has produced annual life tables

by race, including the white and black populations, but did not

produce life tables for other racial or ethnic groups. Beginning

with data year 2006 (originally published elsewhere) (30), NCHS

began producing life tables by Hispanic origin, after conducting

research into the quality of race and ethnicity reporting on

death certificates and developing methodologies to correct

for misclassification of these populations on death certificates

(28,29). These methods that adjust for misclassification are

applied to the production of the life tables, but not to the death

rates shown throughout this report.

Race-specific life tables for 2018 presented in this report

are based on the new standard and show estimates for single

race groups. These estimates may not be comparable to those

of previous years that are based on bridged-race groups. To

document the impact of changing to the 1997 standards, trend

life expectancy estimates for bridged-race categories are included

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 75

in this report for years 2006–2018 (Table I–21). Estimates for

bridged-race categories will continue to be calculated through

data year 2020. The category “Hispanic” is consistent with

previous reports, so trend data for the Hispanic population are

presented. Life tables by race and ethnicity are shown in this

report for 2018 with trend data shown from 2010 through 2018

for the total population and the Hispanic population (Table 4).

Although the life table methodology used produces complete

life tables (by single years of age), the life table data shown in

this report are summarized in 5-year age groupings.

Causes of death contributing to changes in life

expectancy

A life table partitioning technique was used to estimate

causes of death contributing to changes in life expectancy in this

report. The method partitions changes into component additive

parts and identifies the causes of death having the greatest

influence, positive or negative, on changes in life expectancy

(78–80).

Injury mortality by mechanism and intent

Injury mortality data are presented using the external

cause-of-injury mortality matrix for ICD–10 (Table 11). In this

framework, cause-of-injury deaths are organized principally

by mechanism (e.g., firearm or poisoning), and secondarily

by manner or intent of death (e.g., unintentional, suicide, or

homicide).

The number of deaths for selected causes in this framework

may differ from those shown in tables that use the standard

mortality tabulation lists. Following WHO conventions, standard

mortality tabulations (Table 8) present external causes of death

(ICD–10 codes *U01–*U03 and V01–Y89); in contrast, the

matrix (Table 11) excludes deaths classified as Complications

of medical and surgical care (Y40–Y84 and Y88). For additional

information on injury data presented in this framework, see

“Deaths: Injuries, 2002,” available from: https://www.cdc.gov/

nchs/data/nvsr/nvsr54/nvsr54_10.pdf (81). Data for later years

are available through CDC WONDER (https://wonder.cdc.gov/)

and CDC WISQARS (https://www.cdc.gov/injury/wisqars/index.

html). Implementation of changes to ICD–10 may affect the

matrix, requiring modification of codes in selected categories. No

changes were made to the matrix in 2018. For more information

on the latest ICD–10 external cause-of-injury codes included in

the matrix, see https://www.cdc.gov/nchs/injury/injury_tools.

htm.

Infant mortality

Infant mortality rates are the most commonly used index for

measuring the risk of dying during the first year of life. The rates

presented in this report are calculated by dividing the number

of infant deaths in a calendar year by the number of live births

registered for the same period, and are presented as rates per

1,000 or per 100,000 live births. For final birth figures used in the

denominator for infant mortality rates, see: “Births: Final Data

for 2018” (71). In contrast to infant mortality rates based on live

births, infant death rates are based on the estimated population

under age 1 year. Infant death rates that appear in tabulations of

age-specific death rates in this report are calculated by dividing

the number of infant deaths by the July 1, 2018, population

estimate of persons under age 1, based on 2010 census

populations. These rates are presented per 100,000 population

in this age group. Because of differences in the denominators,

infant death rates may differ from infant mortality rates.

There are two sources of infant mortality data: a) the general

mortality file and b) the linked file of live births and infant deaths.

Data from the linked file differ from the infant mortality data

presented in this report because the linked file includes only

those events in which both the birth and the death occur in the

United States, and late-filed births. Processing of the linked file

allows for further exclusion of infant records due to duplicates

and records with additional information that raise questions

about an infant’s age. Although the differences are usually very

small, infant mortality rates based on the linked file tend to be

somewhat smaller than those based on data from the general

mortality file as presented in this report. The linked file is the

preferred source for infant mortality by race because it uses the

mother’s self-reported race from the child’s birth certificate (44),

which is more reliable than the infant’s race listed on the death

certificate, and because the numerator and denominator are

referring to the same person’s race.

Maternal mortality

Maternal mortality rates are computed based on the

number of live births. The maternal mortality rate indicates the

likelihood of a pregnant woman dying of maternal causes. The

rates are calculated by dividing the number of maternal deaths

in a calendar year by the number of live births registered for the

same period, and are presented as rates per 100,000 live births.

Because the population of pregnant women who are at risk of a

maternal death is unknown, the number of live births is used as

the denominator.

Maternal deaths are defined by WHO as “the death of a woman

while pregnant or within 42 days of termination of pregnancy,

irrespective of the duration and the site of the pregnancy, from

any cause related to or aggravated by the pregnancy or its

management but not from accidental or incidental causes” (11).

Included in these deaths are ICD–10 codes A34, O00–O95, and

O98–O99.

The 2003 revision of the U.S. Standard Certificate of Death

introduced a pregnancy-related checkbox question to help

identify pregnancy-related deaths. Adopting a pregnancy status

question consistent with the standard death certificate increased

the identification of maternal deaths. Because maternal mortality

was not comparable between states using a pregnancy checkbox

and those not using a checkbox, NCHS suspended publishing

maternal mortality data in 2007 until all states adopted use of the

revised certificate (45).

In 2018, all 50 states and the District of Columbia used the

revised certificate for the entire year, including its pregnancy

checkbox (California implemented a different checkbox from

that on the U.S. Standard Certificate of Death that specifies if

pregnant within the last year but does not indicate detail on

76 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

whether pregnant at the time of death, pregnant 42 days before

death, or pregnant 2 days to 1 year before death) (45).

Because maternal mortality data among states are now

comparable, NCHS is resuming publication of maternal mortality

statistics. Maternal mortality data are included in this report for

the first time since 2007.

NCHS recently adopted a new method (called the 2018

method) for coding maternal deaths, which was developed

to improve the quality of maternal mortality data after studies

concluded that implementation of the checkbox had resulted

in overreporting of maternal deaths, particularly among older

women (45). The 2018 method further restricts application of

the pregnancy checkbox to decedents aged 10–44 (previously

application of the checkbox was restricted to age group 10–54).

In addition, if the checkbox is the only indication of pregnancy

on the death certificate and no other pregnancy information

is provided in the cause-of-death section, the 2018 method

restricts assignment of maternal codes solely to the underlying

cause of death.

Other variables available online

Hispanic subgroup

Mortality data by Hispanic subgroup no longer appear in

the printed version of this report but are available in Table I–5

from the NCHS website at: https://www.cdc.gov/nchs/data/nvsr/

nvsr69/nvsr69-13-tables-508.pdf.

Marital status

Mortality data by marital status no longer appear in the

printed version of this report but are available in Table I–6 from

the NCHS website at: https://www.cdc.gov/nchs/data/nvsr/

nvsr69/nvsr69-13-tables-508.pdf.

Educational attainment

Mortality data by educational attainment no longer appear

in the printed version of this report but are available in Table I–7

from the NCHS website at: https://www.cdc.gov/nchs/data/nvsr/

nvsr69/nvsr69-13-tables-508.pdf.

Injury at work

Mortality data by injury at work no longer appear in the

printed version of this report but are available in Tables I–8 and

I–9 from the NCHS website at: https://www.cdc.gov/nchs/data/

nvsr/nvsr69/nvsr69-13-tables-508.pdf.

Population bases for computing rates

Populations used for computing death rates and life tables

shown in this report represent the population residing in the

United States, enumerated as of April 1 for census years and

estimated as of July 1 for all other years. Population estimates

used to compute death rates for the United States for 2018 are

shown for 5-year age groups by race and Hispanic origin in

Table III (16).

Populations used for computing death rates by state, shown

in Table IV, represent state postcensal population estimates

based on the 2010 census, estimated as of July 1, 2018 (16).

Rates for Puerto Rico also are based on population estimates

from the 2010 census as of July 1, 2018, and are provided by the

Census Bureau (82). Rates for Guam and Northern Marianas are

based on population estimates provided by the Census Bureau’s

International Data Base (83). Population estimates for each state

and territory are not subject to sampling variation because the

sources used in demographic analysis are complete counts.

Rates for 2011–2018 are based on postcensal population

estimates consistent with the 2010 census, estimated as of

July 1 (16,18–24). Rates for 2010 are based on populations

enumerated as of April 1, 2010 (17). Rates for 2001–2009

shown in this report were revised using revised intercensal

population estimates based on the 2010 census, estimated as

of July 1 (25). Death rates for 2000 are based on populations

enumerated as of April 1, 2000 (84). Rates for 1991–1999 are

based on intercensal population estimates consistent with the

2000 census levels (85).

Prior to 2018, population estimates were produced under a

collaborative arrangement with the Census Bureau, based on the

2000 census counts by age, race, and sex, and were modified

for consistency with 1977 OMB race categories and historical

categories for death data (15,86). The modification procedures

are described in detail elsewhere (26,27).

Beginning with 2018, death rates are based on unbridged,

multiple-race data collected on death certificates according to the

1997 OMB standards. The denominator of the rates is unbridged,

multiple-race population data collected according to the same

standards by the U.S. Census Bureau. Overall, changing from

bridged-race to unbridged data had a relatively minor impact on

mortality rates in 2018 (6).

Computing rates

Except for infant and maternal mortality rates, rates are on

an annual basis per 100,000 estimated population residing in the

specified area. Infant and maternal mortality rates are per 1,000

or per 100,000 live births. Comparisons made in the text among

rates, unless otherwise specified, are statistically significant at

the 0.05 level of significance. Lack of comment in this report

about any two rates does not mean that the difference was tested

and found not to be significant at this level.

Age-adjusted rates (R

) are used to compare relative

mortality risks among groups and over time. However, they

should be viewed as relative indexes rather than as actual

measures of mortality risk. They were computed by the direct

method—that is, by applying age-specific death rates (R

) to the

U.S. standard population age distribution (Table V), as in

where P

is the standard population for age group i and P

is the

total U.S. standard population (all ages combined).

Beginning with the 1999 data year, NCHS adopted a new

population standard for use in age adjusting death rates. Based

on the projected year 2000 population of the United States, the







National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 77

Table III. Estimated population by 5-year age groups, according to race and Hispanic origin and sex: United States, 2018

[Populations are postcensal estimates based on 2010 census estimated as of July 1, 2018; see Technical Notes in this report]

Race, Hispanic origin, and sex Total

Age group (years)

Under

1 year 1–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39

All origins

. . . . . . . . . . . . . . . . . . 327,167,434 3,848,208 15,962,067 20,195,642 20,879,527 21,097,221 21,873,579 23,561,756 22,136,018 21,563,587

Male . . . . . . . . . . . . . . . . . . . 161,128,679 1,968,505 8,163,697 10,315,990 10,658,840 10,774,908 11,201,547 12,018,838 11,191,871 10,790,190

Female . . . . . . . . . . . . . . . . . 166,038,755 1,879,703 7,798,370 9,879,652 10,220,687 10,322,313 10,672,032 11,542,918 10,944,147 10,773,397

Non-Hispanic, single race

White . . . . . . . . . . . . . . . . . . . . 197,546,407 1,901,862 7,864,666 9,993,820 10,614,714 11,142,697 11,730,085 12,793,828 12,392,215 12,184,509

Male . . . . . . . . . . . . . . . . . . . 97,418,608 974,706 4,037,757 5,123,491 5,442,265 5,718,583 6,025,174 6,530,723 6,271,679 6,137,490

Female . . . . . . . . . . . . . . . . . 100,127,799 927,156 3,826,909 4,870,329 5,172,449 5,424,114 5,704,911 6,263,105 6,120,536 6,047,019

Black . . . . . . . . . . . . . . . . . . . . . 40,902,223 528,430 2,195,577 2,781,726 2,846,100 2,927,001 3,127,543 3,477,092 2,915,530 2,767,220

Male . . . . . . . . . . . . . . . . . . . 19,560,023 269,097 1,112,581 1,409,935 1,441,436 1,484,024 1,585,198 1,746,680 1,423,424 1,320,630

Female . . . . . . . . . . . . . . . . . 21,342,200 259,333 1,082,996 1,371,791 1,404,664 1,442,977 1,542,345 1,730,412 1,492,106 1,446,590

American Indian or

Alaska Native . . . . . . . . . . . . . 2,417,371 31,525 130,716 171,054 177,641 178,610 184,162 200,130 170,496 156,743

Male . . . . . . . . . . . . . . . . . . . 1,189,703 16,114 66,670 86,906 89,958 90,979 93,539 102,205 85,824 77,933

Female . . . . . . . . . . . . . . . . . 1,227,668 15,411 64,046 84,148 87,683 87,631 90,623 97,925 84,672 78,810

Asian . . . . . . . . . . . . . . . . . . . . 18,728,675 182,275 810,104 1,024,398 1,061,466 1,097,417 1,292,983 1,605,360 1,634,132 1,562,088

Male . . . . . . . . . . . . . . . .

. . . 8,918,924 93,516 416,108 524,051 536,298 549,970 653,178 793,743 788,445 733,443

Female . . . . . . . . . . . . . . . . . 9,809,751 88,759 393,996 500,347 525,168 547,447 639,805 811,617 845,687 828,645

Native Hawaiian or

Other Pacific Islander . . . . . . . 586,346 7,856 32,818 40,354 41,889 40,969 43,835 51,313 50,670 47,615

Male . . . . . . . . . . . . . . . . . . . 294,994 4,017 16,729 20,547 21,229 21,018 22,506 26,492 26,031 24,467

Female . . . . . . . . . . . . . . . . . 291,352 3,839 16,089 19,807 20,660 19,951 21,329 24,821 24,639 23,148

Hispanic

. . . . . . . . . . . . . . . . . . . 59,871,746 1,007,577 4,164,396 5,256,407 5,278,748 4,975,084 4,839,172 4,877,375 4,551,791 4,478,782

Male . . . . . . . . . . . . . . . . . . . 30,234,185 514,677 2,123,725 2,677,320 2,691,359 2,537,685 2,490,343 2,544,442 2,396,015 2,323,263

Female . . . . . . . . . . . . . . . . . 29,637,561 492,900 2,040,671 2,579,087 2,587,389 2,437,399 2,348,829 2,332,933 2,155,776 2,155,519

Age group (years)

40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84

and over

All origins

. . . . . . . . . . . . . . . . . . 19,714,301 20,747,135 20,884,564 21,940,985 20,331,651 17,086,893 13,405,423 9,267,066 6,127,308 6,544,503

Male . . . . . . . . . . . . . . . . . . . 9,797,410 10,263,995 10,277,207 10,669,327 9,729,536 8,034,813 6,211,272 4,144,674 2,590,366 2,325,693

Female . . . . . . . . . . . . . . . . . 9,916,891 10,483,140 10,607,357 11,271,658 10,602,115 9,052,080 7,194,151 5,122,392 3,536,942 4,218,810

Non-Hispanic, single race

White . . . . . . . . . . . . . . . . . . . . 11,201,675 12,552,736 13,424,380 15,067,528 14,557,417 12,666,029 10,285,916 7,199,125 4,772,053 5,201,152

Male . . . . . . . . . . . . . . . . . . . 5,632,832 6,287,182 6,670,494 7,404,163 7,061,814 6,056,012 4,848,052 3,277,281 2,053,177 1,865,733

Female . . . . . . . . . . . . . . . . . 5,568,843 6,265,554 6,753,886 7,663,365 7,495,603 6,610,017 5,437,864 3,921,844 2,718,876 3,335,419

Black . . . . . . . . . . . . . . . . . . . . . 2,490,221 2,589,420 2,591,715 2,609,607 2,284,200 1,754,604 1,205,737 796,677 513,818 500,005

Male . . . . . . . . . . . . . . . . . . . 1,172,340 1,214,301 1,213,202 1,207,731 1,031,907 762,528 508,320 317,148 188,551 150,990

Female . . . . . . . . . . . . . . . . . 1,317,881 1,375,119 1,378,513 1,401,876 1,252,293 992,076 697,417 479,529 325,267 349,015

American Indian or

Alaska Native . . . . . . . . . . . . . 140,766 144,577 149,197 156,860 137,914 106,787 76,293 48,614 29,364 25,922

Male . . . . . . . . . . . . . . . . . . . 69,417 70,811 71,927 74,410 64,086 49,607 35,335 22,008 12,448 9,526

Female . . . . . . . . . . . . . . . . . 71,349 73,766 77,270 82,450 73,828 57,180 40,958 26,606 16,916 16,396

Asian . . . . . . . . . . . . . . . . . . . . 1,437,081 1,390,607 1,183,352 1,091,473 986,559 823,758 599,679 404,835 268,634 272,474

Male . . . . . . . . . . . . . . . . . . . 669,283 648,286 549,221 500,149 441,878 361,509 264,479 179,421 115,141 100,805

Female . . . . . . . . . . . . . . . . . 767,798 742,321 634,131 591,324 544,681 462,249 335,200 225,414 153,493 171,669

Native Hawaiian or

Other Pacific Islander . . . . . .

. 39,421 36,989 34,697 33,467 27,659 21,656 15,153 9,142 5,655 5,188

Male . . . . . . . . . . . . . . . . . . . 20,105 18,509 17,122 16,362 13,308 10,403 7,324 4,283 2,513 2,029

Female . . . . . . . . . . . . . . . . . 19,316 18,480 17,575 17,105 14,351 11,253 7,829 4,859 3,142 3,159

Hispanic

. . . . . . . . . . . . . . . . . . . 4,108,330 3,760,917 3,264,648 2,749,799 2,140,634 1,566,030 1,116,654 740,775 495,599 499,028

Male . . . . . . . . . . . . . . . . . . . 2,094,048 1,896,748 1,643,900 1,356,435 1,023,247 725,376 499,020 314,286 200,528 181,768

Female . . . . . . . . . . . . . . . . . 2,014,282 1,864,169 1,620,748 1,393,364 1,117,387 840,654 617,634 426,489 295,071 317,260

Includes origin not stated, origin not classifiable, and two or more races reported; see Technical Notes in this report.

Only one race was reported.

Includes persons of Hispanic origin of any race.

SOURCE: National Center for Health Statistics, estimates of July 1, 2018, U.S. resident population by age, sex, race, and Hispanic origin prepared by U.S. Census Bureau, 2019.

78 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

new standard replaced the 1940 standard population that had

been used for more than 50 years. The new population standard

affects levels of mortality and, to some extent, trends and group

comparisons. Of particular note are the effects on race mortality

comparisons. For detailed discussion, see: “Age Standardization

of Death Rates: Implementation of the Year 2000 Standard”

(87). Beginning with 2003 data, the traditional standard million

population along with corresponding standard weights to

six decimal places were replaced by the projected year 2000

population age distribution (Table V). The effect of the change

is negligible and does not significantly affect comparability with

age-adjusted rates calculated using the previous method. All

age-adjusted rates shown in this report are based on the 2000

U.S. standard population.

Age-adjusted rates for Puerto Rico, Guam, and Northern

Marianas were computed by applying the age-specific death rates

to the U.S. standard population. The 2000 standard population

used for computing age-adjusted rates for the territories is

shown in Table V.

Using the same standard population, death rates for the

total population and for each race–sex group were adjusted

separately. The age-adjusted rates were based on 10-year age

groups. Age-adjusted death rates are not comparable with crude

rates.

Table V. U.S. standard population

Age group (years) Population

All ages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274,633,642

Under 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,794,901

1–4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,191,619

5–14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,976,619

15–24 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38,076,743

25–34 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,233,437

35–44 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44,659,185

45–54 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37,030,152

55–64 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23,961,506

65–74 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18,135,514

75–84 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,314,793

85 and over . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,259,173

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

Table IV. Estimated population for the United States, each state, Puerto Rico, U.S. Virgin Islands, Guam, American Samoa, and

Northern Marianas, 2018

[Populations are postcensal estimates based on 2010 census, estimated as of July 1, 2018]

Area Total Area Total

United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327,167,434 New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,908,520

Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,887,871 New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,095,428

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 737,438 New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19,542,209

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,171,646 North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,383,620

Arkansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,013,825 North Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 760,077

California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39,557,045 Ohio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,689,442

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,695,564 Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,943,079

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,572,665 Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,190,713

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 967,171 Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,807,060

District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 702,455 Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,057,315

Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21,299,325 South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,084,127

Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10,519,475 South Dakota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 882,235

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,420,491 Tennessee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,770,010

Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,754,208 Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28,701,845

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12,741,080 Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,161,105

Indiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,691,878 Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 626,299

Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,156,145 Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,517,685

Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,911,505 Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,535,591

Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,468,402 West Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,805,832

Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,659,978 Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,813,568

Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,338,404 Wyoming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577,737

Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,042,718 Puerto Rico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,195,153

Massachusetts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,902,149 U.S. Virgin Islands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106,977

Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9,995,915 Guam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167,772

Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,611,179 American Samoa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50,826

Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,986,530 Northern Marianas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51,994

Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,126,452

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,062,305

Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,929,268

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,034,392

New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,356,458

SOURCES: U.S. Census Bureau. 2018 population estimates. Table 1. Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to

July 1, 2018. Available from: https://www2.census.gov/programs-surveys/popest/tables/2010-2018/state/totals/nst-est2018-01.xlsx; and International data base, 2018 (available from: https://

www.census.gov/data-tools/demo/idb/informationGateway.php).

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 79

Random variation

The mortality data presented in this report, with the

exception of data for 1972, are not subject to sampling error.

In 1972, mortality data were based on a 50% sample of deaths

because of resource constraints. Mortality data, even based on

complete counts, may be affected by random variation; that is,

the number of deaths that actually occurred may be considered

as one of a large series of possible results that could have arisen

under the same circumstances (88,89). When the number of

deaths is small, perhaps fewer than 100, random variation tends

to be relatively large. Therefore, considerable caution must be

observed in interpreting statistics based on small numbers of

deaths.

Measuring random variability—To quantify the random

variation associated with mortality statistics, an assumption

must be made regarding the appropriate underlying distribution.

Deaths, as infrequent events, can be viewed as deriving from

a Poisson probability distribution. The Poisson distribution

is simple conceptually and computationally, and provides

reasonable, conservative variance estimates for mortality

statistics when the probability of dying is relatively low (88).

Using the properties of the Poisson distribution, the standard

error (SE) associated with the number of deaths (D ) is

SE() var()DDD= =

[1]

where var(D ) denotes the variance of D.

The SE associated with crude and age-specific death rates

(R ) assumes that the population denominator (P ) is a constant

and is

SE() var varR





















[2]

The coefficient of variation or relative standard error (RSE)

is a useful measure of relative variation. The RSE is calculated by

dividing the statistic (e.g., number of deaths or death rate) into

its SE and multiplying by 100. For the number of deaths,

For crude and age-specific death rates,

RSE

()

() /

= = =100 100 100

Thus,

RSERSE() ()DR

= = 100

[3]

The SE of the age-adjusted death rate (R

) is

SE() var()



































































[4]

where:

• R

is the age-speciﬁc rate for the i th age group.

• P

is the age-speciﬁc standard population for the i th age

group from the U.S. standard population age distribution

RSE

()

= = =100 100 100

(see Table V and Age-adjusted death rate in the “Deﬁnition

of terms”).

• P

is the total U.S. standard population (all ages combined).

• D

is the number of deaths for the i th age group.

RSE for the age-adjusted rate, RSE(R

), is calculated by

dividing SE(R

) from Formula 4 by the age-adjusted death rate,

, and multiplying by 100, as in

RSE

()







100

For tables showing infant and maternal mortality rates based

on live births (B ) in the denominator, calculation of SE assumes

random variability in both the numerator and denominator. SE

for the infant mortality rate (IMR) is:

var( ) var( ) 1 1

SE( )

() ()

IMR IMR IMR

ED EB

= • + = •+

[5]

where the number of births, B, is also assumed to be distributed

according to a Poisson distribution, and E(B ) is the expectation

of B.

RSE for IMR is

RSE

()

IMR



100 100

[6]

For maternal mortality rates, Formulas 5 and 6 may be used,

substituting the maternal mortality rate for the IMR.

Formulas 1–6 may be used for all tables presented in this

report except for death rates and age-adjusted death rates shown

in Tables I–5, I–6, and I–7, which are calculated using population

figures that are subject to sampling error.

Suppression of unreliable rates—Beginning with 1989 data,

an asterisk is shown in place of a crude or age-specific death

rate based on fewer than 20 deaths, the equivalent of an RSE of

23% or more. The limit of 20 deaths is a convenient, if somewhat

arbitrary, benchmark, below which rates are considered to be too

statistically unreliable for presentation. For infant and maternal

mortality rates, the same threshold of fewer than 20 deaths is

used to determine whether an asterisk is presented in place of

the rate. For age-adjusted death rates, the suppression criterion

is based on the sum of age-specific deaths; that is, if the sum of

the age-specific deaths is less than 20, an asterisk replaces the

rate.

Confidence intervals and statistical tests based on 100

deaths or more—When the number of deaths is large, a normal

approximation may be used in calculating confidence intervals

and statistical tests. How large, in terms of number of deaths,

is to some extent subjective. In general, for crude and age-

specific death rates and for infant and maternal mortality rates,

the normal approximation performs well when the number of

deaths is 100 or greater. For age-adjusted rates, the criterion for

use of the normal approximation is somewhat more complicated

(10,87,89). Formula 7 is used to calculate 95% confidence limits

for the death rate when the normal approximation is appropriate:

L(R ) = R – 1.96(SE(R )) and U(R ) = R + 1.96(SE(R )) [7]

where L(R ) and U(R ) are the lower and upper limits of the

80 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

confidence interval, respectively. The resulting 95% confidence

interval can be interpreted to mean that the chances are 95 in

100 that the “true” death rate falls between L(R ) and U(R ).

For example, suppose that the crude death rate for Malignant

neoplasms is 186.0 per 100,000 population based on 565,469

deaths. Lower and upper 95% confidence limits using Formula

7 are calculated as

L(186.0) = 186.0 – 1.96 (0.25) = 185.5

and

U(186.0) = 186.0 + 1.96 (0.25) = 186.5

Thus, the chances are 95 in 100 that the true death rate for

Malignant neoplasms is between 185.5 and 186.5. Formula 7

also can be used to calculate 95% confidence intervals for the

number of deaths, age-adjusted death rates, infant mortality rates,

and other mortality statistics when the normal approximation is

appropriate by replacing R with D, R

, IMR, or others.

When testing the difference between two rates, R

and R

(each based on 100 or more deaths), the normal approximation

may be used to calculate a test statistic, z, such that







SE SE() ()

[8]

If |z | ≥ 1.96, then the difference between the rates is

statistically significant at the 0.05 level. If |z | < 1.96, then the

difference is not statistically significant. Formula 8 also can be

used to perform tests for other mortality statistics when the

normal approximation is appropriate (when both statistics being

compared meet the normal criteria) by replacing R

and R

with

and D

, R

and R

or others. For example, suppose that the

male age-adjusted death rate for Malignant neoplasms of trachea,

bronchus, and lung (lung cancer) is 65.1 per 100,000 U.S.

standard population in the previous data year (R

) and 63.6 per

100,000 U.S. standard population in the current data year (R

SE for each of these figures, SE(R

) and SE(R

), is calculated

using Formula 4. A test using Formula 8 can determine if the

decrease in the age-adjusted rate is statistically significant:

(0.222)

+ (0.217)

65.1 – 63.6

z 

 4.83

Because z = 4.83 > 1.96, the decrease from the previous

data year to the current data year in the male age-adjusted death

rate for lung cancer is statistically significant.

Confidence intervals and statistical tests based on fewer

than 100 deaths—When the number of deaths is not large (fewer

than 100), the Poisson distribution cannot be approximated by

the normal distribution. The normal distribution is symmetrical,

with a range from – ∞ to + ∞. As a result, confidence intervals

based on the normal distribution also have this range. The

number of deaths or the death rate, however, cannot be less than

zero. When the number of deaths is very small, approximating

confidence intervals for deaths and death rates using the

normal distribution will sometimes produce lower confidence

limits that are negative. The Poisson distribution, in contrast,

is an asymmetric distribution with zero as a lower bound—

confidence limits based on this distribution will never be less

than zero. A simple method based on the more general family of

gamma distributions, of which the Poisson is a member, can be

used to approximate confidence intervals for deaths and death

rates when the number of deaths is small (87,89). For more

information regarding how the gamma method is derived, see

“Derivation of gamma method” at the end of this section.

Calculations using the gamma method can be made using

commonly available spreadsheet programs or statistical software

(e.g., Excel or SAS) that include an inverse gamma function. In

Excel, the function “gammainv (probability, alpha, beta)” returns

values associated with the inverse gamma function for a given

probability between 0 and 1. For 95% confidence limits, the

probability associated with the lower limit is 0.05/2 = 0.025,

and with the upper limit, 1 – (0.05/2) = 0.975. Alpha and beta

are parameters associated with the gamma distribution. For

the number of deaths and crude and age-specific death rates,

alpha = D (the number of deaths) and beta = 1. In Excel, the

following formulas can be used to calculate lower and upper

95% confidence limits for the number of deaths and crude and

age-specific death rates:

L(D ) = GAMMAINV(0.025, D, 1)

and

U(D ) = GAMMAINV(0.975, D + 1, 1)

Confidence limits for the death rate are then calculated by

dividing L(D ) and U(D ) by the population (P ) at risk of dying

(see Formula 15).

Alternatively, 95% confidence limits can be estimated using

the lower and upper confidence limit factors shown in Table VI.

For the number of deaths, D, and the death rate, R,

L(D )= L • D and U(D ) = U • D [9]

L(R )= L • R and U(R ) = U • R [10]

where L and U in both formulas are the lower and upper

confidence limit factors that correspond to the appropriate

number of deaths, D, in Table VI. For example, suppose that

the death rate for non-Hispanic AIAN females aged 1–4 years is

39.5 per 100,000 and based on 50 deaths. Applying Formula 10,

values for L and U from Table VI for 50 deaths are multiplied by

the death rate, 39.5, such that

L(R ) = L(39.5) = 0.742219 • 39.5 = 29.3

and

U(R ) = U(39.5) = 1.318375 • 39.5 = 52.1

These confidence limits indicate that the chances are 95 in

100 that the actual death rate for non-Hispanic AIAN females

aged 1–4 is between 29.3 and 52.1 per 100,000.

Although the calculations are similar, confidence intervals

based on small numbers for age-adjusted death rates, infant and

maternal mortality rates, and rates that are subject to sampling

variability in the denominator are somewhat more complicated

(11,89).

Refer to the most recent version of the Mortality Technical

Appendix for more details: https://www.cdc.gov/nchs/data/

statab/techap95.pdf.

National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021 81

Table VI. Lower and upper 95% confidence limit factors for the number of deaths and death rate when the number of deaths is

less than 100

Number of

deaths (D )

Lower confidence

limit (L )

Upper confidence

limit (U )

Number of

deaths (D )

Lower confidence

limit (L )

Upper confidence

limit (U )

1. . . . . . . . . . . . . . . . . . . . . . . . . 0.025318 5.571643 51. . . . . . . . . . . . . . . . . . . . . . . . 0.744566 1.314815

2. . . . . . . . . . . . . . . . . . . . . . . . . 0.121105 3.612344 52. . . . . . . . . . . . . . . . . . . . . . . . 0.746848 1.311367

3. . . . . . . . . . . . . . . . . . . . . . . . . 0.206224 2.922424 53. . . . . . . . . . . . . . . . . . . . . . . . 0.749069 1.308025

4. . . . . . . . . . . . . . . . . . . . . . . . . 0.272466 2.560397 54. . . . . . . . . . . . . . . . . . . . . . . . 0.751231 1.304783

5. . . . . . . . . . . . . . . . . . . . . . . . . 0.324697 2.333666 55. . . . . . . . . . . . . . . . . . . . . . . . 0.753337 1.301637

6. . . . . . . . . . . . . . . . . . . . . . . . . 0.366982 2.176579 56. . . . . . . . . . . . . . . . . . . . . . . . 0.755389 1.298583

7. . . . . . . . . . . . . . . . . . . . . . . . . 0.402052 2.060382 57. . . . . . . . . . . . . . . . . . . . . . . . 0.757390 1.295616

8. . . . . . . . . . . . . . . . . . . . . . . . . 0.431729 1.970399 58. . . . . . . . . . . . . . . . . . . . . . . . 0.759342 1.292732

9. . . . . . . . . . . . . . . . . . . . . . . . . 0.457264 1.898311 59. . . . . . . . . . . . . . . . . . . . . . . . 0.761246 1.289927

10. . . . . . . . . . . . . . . . . . . . . . . . 0.479539 1.839036 60. . . . . . . . . . . . . . . . . . . . . . . . 0.763105 1.287198

11. . . . . . . . . . . . . . . . . . . . . . . . 0.499196 1.789276 61. . . . . . . . . . . . . . . . . . . . . . . . 0.764921 1.284542

12. . . . . . . . . . . . . . . . . . . . . . . . 0.516715 1.746799 62. . . . . . . . . . . . . . . . . . . . . . . . 0.766694 1.281955

13. . . . . . . . . . . . . . . . . . . . . . . . 0.532458 1.710030 63. . . . . . . . . . . . . . . . . . . . . . . . 0.768427 1.279434

14. . . . . . . . . . . . . . . . . . . . . . . . 0.546709 1.677830 64. . . . . . . . . . . . . . . . . . . . . . . . 0.770122 1.276978

15. . . . . . . . . . . . . . . . . . . . . . . . 0.559692 1.649348 65. . . . . . . . . . . . . . . . . . . . . . . . 0.771779 1.274582

16. . . . . . . . . . . . . . . . . . . . . . . . 0.571586 1.623937 66. . . . . . . . . . . . . . . . . . . . . . . . 0.773400 1.272245

17. . . . . . . . . . . . . . . . . . . . . . . . 0.582537 1.601097 67. . . . . . . . . . . . . . . . . . . . . . . . 0.774986 1.269965

18. . . . . . . . . . . . . . . . . . . . . . . . 0.592663 1.580431 68. . . . . . . . . . . . . . . . . . . . . . . . 0.776539 1.267738

19. . . . . . . . . . . . . . . . . . . . . . . . 0.602065 1.561624 69. . . . . . . . . . . . . . . . . . . . . . . . 0.778060 1.265564

20. . . . . . . . . . . . . . . . . . . . . . . . 0.610826 1.544419 70. . . . . . . . . . .

. . . . . . . . . . . . . 0.779549 1.263440

21. . . . . . . . . . . . . . . . . . . . . . . . 0.619016 1.528606 71. . . . . . . . . . . . . . . . . . . . . . . . 0.781008 1.261364

22. . . . . . . . . . . . . . . . . . . . . . . . 0.626695 1.514012 72. . . . . . . . . . . . . . . . . . . . . . . . 0.782438 1.259335

23. . . . . . . . . . . . . . . . . . . . . . . . 0.633914 1.500491 73. . . . . . . . . . . . . . . . . . . . . . . . 0.783840 1.257350

24. . . . . . . . . . . . . . . . . . . . . . . . 0.640719 1.487921 74. . . . . . . . . . . . . . . . . . . . . . . . 0.785215 1.255408

25. . . . . . . . . . . . . . . . . . . . . . . . 0.647147 1.476197 75. . . . . . . . . . . . . . . . . . . . . . . . 0.786563 1.253509

26. . . . . . . . . . . . . . . . . . . . . . . . 0.653233 1.465232 76. . . . . . . . . . . . . . . . . . . . . . . . 0.787886 1.251649

27. . . . . . . . . . . . . . . . . . . . . . . . 0.659006 1.454947 77. . . . . . . . . . . . . . . . . . . . . . . . 0.789184 1.249828

28. . . . . . . . . . . . . . . . . . . . . . . . 0.664493 1.445278 78. . . . . . . . . . . . . . . . . . . . . . . . 0.790459 1.248045

29. . . . . . . . . . . . . . . . . . . . . . . . 0.669716 1.436167 79. . . . . . . . . . . . . . . . . . . . . . . . 0.791709 1.246298

30. . . . . . . . . . . . . . . . . . . . . . . . 0.674696 1.427562 80. . . . . . . . . . . . . . . . . . . . . . . . 0.792938 1.244587

31. . . . . . . . . . . . . . . . . . . . . . . . 0.679451 1.419420 81. . . . . . . . . . . . . . . . . . . . . . . . 0.794144 1.242909

32. . . . . . . . . . . . . . . . . . . . . . . . 0.683999 1.411702 82. . . . . . . . . . . . . . . . . . . . . . . . 0.795330 1.241264

33. . . . . . . . . . . . . . . . . . . . . . . . 0.688354 1.404372 83. . . . . . . . . . . . . . . . . . . . . . . . 0.796494 1.239650

34. . . . . . . . . . . . . . . . . . . . . . . . 0.692529 1.397400 84. . . . . . . . . . . . . . . . . . . . . . . . 0.797639 1.238068

35. . . . . . . . . . . . . . . . . . . . . . . . 0.696537 1.390758 85. . . . . . . . . . . . . . . . . . . . . . . . 0.798764 1.236515

36. . . . . . . . . . . . . . . . . . . . . . . . 0.700388 1.384422 86. . . . . . . . . . . . . . . . . . . . . . . . 0.799871 1.234992

37. . . . . . . . . . . . . . . . . . . . . . . . 0.704092 1.378368 87. . . . . . . . . . . . . . . . . . . . . . . . 0.800959 1.233496

38. . . . . . . . . . . . . . . . . . . . . . . . 0.707660 1.372578 88. . . . . . . . . . . . . . . . . . . . . . . . 0.802029 1.232028

39. . . . . . . . . . . . . . . . . . . . . . . . 0.711098 1.367033 89. . . . . . . . . . . . . . . . . . . . . . . . 0.803082 1.230586

40. . . . . . . . . . . . . . . . . . . . . . . . 0.714415 1.361716 90. . . . . . . . . . . . . . . . . . . . . . . . 0.804118 1.229170

41. . . . . . . . . . . . . . . . . . . . . . . . 0.717617 1.356613 91. . . . . . . . . . . . . . . . . . . . . . . . 0.805138 1.227778

42. . . . . . . . . . . . . . . . . . . . . . . . 0.720712 1.351709 92. . . . . . . . . . . . . . . . . . . . . . . . 0.806141 1.226411

43. . . . . . . . . . . . . . . . . . . . . . . . 0.723705 1.346993 93

. . . . . . . . . . . . . . . . . . . . . . . . 0.807129 1.225068

44. . . . . . . . . . . . . . . . . . . . . . . . 0.726602 1.342453 94. . . . . . . . . . . . . . . . . . . . . . . . 0.808102 1.223747

45. . . . . . . . . . . . . . . . . . . . . . . . 0.729407 1.338079 95. . . . . . . . . . . . . . . . . . . . . . . . 0.809060 1.222448

46. . . . . . . . . . . . . . . . . . . . . . . . 0.732126 1.333860 96. . . . . . . . . . . . . . . . . . . . . . . . 0.810003 1.221171

47. . . . . . . . . . . . . . . . . . . . . . . . 0.734762 1.329788 97. . . . . . . . . . . . . . . . . . . . . . . . 0.810933 1.219915

48. . . . . . . . . . . . . . . . . . . . . . . . 0.737321 1.325855 98. . . . . . . . . . . . . . . . . . . . . . . . 0.811848 1.218680

49. . . . . . . . . . . . . . . . . . . . . . . . 0.739806 1.322053 99. . . . . . . . . . . . . . . . . . . . . . . . 0.812751 1.217464

50. . . . . . . . . . . . . . . . . . . . . . . . 0.742219 1.318375

SOURCE: National Center for Health Statistics, National Vital Statistics System, Mortality.

82 National Vital Statistics Reports, Vol. 69, No. 13, January 12, 2021

When comparing the difference between two rates (R

and

), where one or both of the rates are based on fewer than

100 deaths, a comparison of 95% confidence intervals may

be used as a statistical test. If the 95% confidence intervals do

not overlap, then the difference can be said to be statistically

significant at the 0.05 level. A simple rule of thumb is: If R

> R

then test if L(R

) > U(R

), or if R

> R

, then test if L(R

) > U(R

Positive tests denote statistical significance at the 0.05 level. For

example, suppose that non-Hispanic race AIAN females aged

1–4 have a death rate (R

) of 39.5 based on 50 deaths, and non-

Hispanic Asian females aged 1–4 have a death rate (R

) of 20.1

per 100,000 based on 86 deaths. The 95% confidence limits for

and R

calculated using Formula 10 would be

L(R

) = L(39.5) = 0.742219 • 39.5 = 29.3

and

U(R

) = U(39.5) = 1.318375 • 39.5 = 52.1

L(R

) = L(20.1) = 0.799871 • 17.9 = 16.1

and

U(R

) = U(20.1) = 1.234992 • 17.9 = 24.8

Because R

> R

and L(R

) > U(R

), it can be concluded that

the difference between the death rates for non-Hispanic AIAN

females aged 1–4 and non-Hispanic Asian females of the same

age is statistically significant at the 0.05 level. That is, accounting

for random variability, non-Hispanic Asian females aged 1–4

have a death rate significantly lower than that for non-Hispanic

AIAN females of the same age.

This test also may be used to perform tests for other

statistics when the normal approximation is not appropriate for

one or both of the statistics being compared, by replacing R

and

with D

and D

, R'

and R'

or others.

Users of the method of comparing confidence intervals

should be aware that this method is a conservative test for

statistical significance—the difference between two rates may, in

fact, be statistically significant even though confidence intervals

for the two rates overlap (90). Caution should be observed

when interpreting a nonsignificant difference between two rates,

especially when the lower and upper limits being compared

overlap only slightly.

Derivation of gamma method—For a random variable X

that follows a gamma distribution G(y,z ), where y and z are

the parameters that determine the shape of the distribution

(91), E(X ) = yz and Var(X ) = yz

. For the number of deaths, D,

E(D ) = D and Var(D ) = D. It follows that y = D and z = 1, and thus,

D ~ G(D,1) [11]

From Equation 11, it is clear that the shape of the distribution

of deaths depends only on the number of deaths.

For the death rate, R, E(R) = R and Var(R ) = D/P

. It follows,

in this case, that y = D and z = P

–1

, and thus,

R ~ G(D,P

–1

) [12]

A useful property of the gamma distribution is that for

X ~ G(y,z ), X can be divided by z such that X/z ~ G(y,1). This

converts the gamma distribution into a simplified, standard

form, dependent only on parameter y. Expressing Equation 12 in

its simplified form gives:

R/P

–1

= D ~ G(D,1) [13]

From Equation 13, it is clear that the shape of the distribution

of the death rate also is dependent solely on the number of

deaths.

Using the results of Equations 11 and 13, the inverse gamma

distribution can be used to calculate upper and lower confidence

limits. Lower and upper 100(1 – a) percent confidence limits for

the number of deaths, L(D ) and U(D ), are estimated as

L(D) = G

–1

(D,1)

(a / 2) and U(D) = G

–1

(D +1,1)

(1 – a /2) [14]

where G

–1

represents the inverse of the gamma distribution and

D + 1 in the formula for U(D) reﬂects a continuity correction,

which is necessary because D is a discrete random variable and

the gamma distribution is a continuous distribution. For a 95%

conﬁdence interval, a = 0.05. For the death rate, it can be shown

that

L(R ) = L(D )/P and U(R ) = U(D )/P [15]

For more detail regarding the derivation of the gamma

method and its application to age-adjusted death rates and other

mortality statistics, see references 10, 88, and 90.

Availability of mortality data

Mortality data are available in publications, unpublished

tables, and electronic products as described on the NCHS

mortality website: https://www.cdc.gov/nchs/deaths.htm. More

detailed analysis than this report provides can be obtained from

the mortality public-use data set issued each data year. Since

1968, the data set has been available through NCHS in ASCII

format and can now be downloaded: https://www.cdc.gov/nchs/

data_access/Vitalstatsonline.htm. Additional resources available

from NCHS include Vital Statistics of the United States, Mortality;

Vital and Health Statistics, Series 20 reports; and National Vital

Statistics Reports.

Definition of terms

Age-adjusted death rate—The death rate used to make

comparisons of relative mortality risks across groups and over

time. This rate should be viewed as a construct or an index rather

than a direct or actual measure of mortality risk. Statistically,

it is a weighted average of age-specific death rates, where the

weights represent the fixed population proportions by age.

Age-specific death rate—Deaths per 100,000 population in

a specified age group, such as 1–4 or 5–9 years, for a specified

period.

Crude death rate—Total deaths per 100,000 population for a

specified period. This rate represents the average chance of dying

during a specified period for persons in the entire population.

Infant deaths—Deaths of infants under age 1 year.

Neonatal deaths—Deaths of infants aged 0–27 days.

Postneonatal deaths—Deaths of infants aged 28 days–11

months.

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Suggested citation

Murphy SL, Xu JQ, Kochanek KD, Arias E,

Tejada-Vera B. Deaths: Final data for 2018.

National Vital Statistics Reports; vol 69 no 13.

Hyattsville, MD: National Center for Health

Statistics. 2020.

All material appearing in this report is in

the public domain and may be reproduced

or copied without permission; citation as to

source, however, is appreciated.

National Center for Health Statistics

Brian C. Moyer, Ph.D., Director

Amy M. Branum, Ph.D., Acting Associate

Director for Science

Division of Vital Statistics

Steven Schwartz, Ph.D., Director

Isabelle Horon, Dr.P.H., Acting Associate

Director for Science

Contents

Abstract .......................................................1

Highlights ......................................................1

Mortality experience in 2018 .....................................1

Comparison to previous year .....................................2

Introduction ....................................................2

Methods ......................................................3

Results and Discussion ...........................................4

Deaths and death rates ..........................................4

Expectation of life at birth and at specified ages .......................7

Leading causes of death .........................................9

Other select causes ...........................................10

Effect on life expectancy of changes in mortality by age and

cause of death ..............................................11

Injury mortality by mechanism and intent ..........................12

State of residence .............................................12

Infant mortality ...............................................12

Maternal mortality ............................................13

Additional mortality tables based on 2018 final data ..................15

References ....................................................15

List of Detailed Tables ...........................................18

List of Internet Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Technical Notes ................................................68

Acknowledgments

This report was prepared in the Division of Vital Statistics (DVS) under the

direction of Steven Schwartz, Director, DVS; Isabelle Horon, Acting Associate

Director for Science, DVS; Robert N. Anderson, Chief, Mortality Statistics Branch

(MSB); and Elizabeth Arias, Team Leader, Statistical Analysis and Research Team

(MSB). Brigham Bastian, Sally Curtin, and Arialdi Miniño (MSB) provided content

review. Donna L. Hoyert and Melonie Heron (MSB), and David W. Justice of the

Data Acquisition, Classification and Evaluation Branch (DACEB), contributed to

Technical Notes. Rajesh Virkar, Chief, Information Technology Branch (ITB), and

Joseph Bohn, David Johnson, and Veronique Benie (ITB) provided computer

programming support. Veronique Benie also prepared the mortality file.

Registration Methods staff and DACEB staff provided consultation to state

vital statistics offices regarding collection of the death certificate data on which

this report is based. The report was edited and produced by NCHS Office of

Information Services, Information Design and Publishing Staff: Danielle Taylor

edited the report; typesetting was done by Kyung Park and Ebony Davis; and

graphics were produced by Dottie Day.