The Leading Causes of Death in the US, and How They Have Changed

Picture a county coroner's office in the American Midwest at the end of a long week. On one desk sits a stack of death certificates waiting to be coded. A clerk is working through them line by line: heart failure, age 88. Lung cancer, age 71. Accidental fentanyl toxicity, age 29. Motor vehicle collision, age 19. Alzheimer's disease, age 94. Each certificate gets a code from the International Classification of Diseases, and each code eventually lands in a national database run by the Centers for Disease Control and Prevention.

That database is the most detailed record of death anywhere on earth. In 2023 it counted 3,090,964 deaths in the United States, around 8,470 a day. You can watch the global total climbing on our live death counter. This article looks at the other half of the story: not how many Americans die, but what they die of, and how dramatically that list has changed.

The top 10 causes of death in the US

These are the leading causes of death from the CDC's final 2023 data, the most recent full year.

Rank	Cause	Deaths (2023)	Share of all deaths
1	Heart disease	680,981	22.0%
2	Cancer	613,349	19.8%
3	Unintentional injuries	222,698	7.2%
4	Stroke	162,639	5.3%
5	Chronic lower respiratory disease	145,357	4.7%
6	Alzheimer's disease	114,034	3.7%
7	Diabetes	95,190	3.1%
8	Kidney disease	55,253	1.8%
9	Chronic liver disease and cirrhosis	52,222	1.7%
10	COVID-19	49,932	1.6%

Together, these ten causes account for about seven in every ten American deaths. The top two alone kill around 1.3 million people a year. Our daily breakdown of the same data is in how many people die in the US every day.

Unlike the UK, which ranks cancers separately and puts dementia first (see the leading causes of death in the UK), the CDC groups all cancers into one category. That is why the two countries' lists look so different at first glance, even though their underlying patterns are fairly similar.

A century of change

The single most striking thing about the US list is how recently it took its modern shape. In 1900, Americans mostly died of infections, and many of them were children.

Rank	1900	1950	2023
1	Pneumonia and influenza	Heart disease	Heart disease
2	Tuberculosis	Cancer	Cancer
3	Diarrhoea and enteritis	Stroke	Unintentional injuries
4	Heart disease	Accidents	Stroke
5	Stroke	Diseases of early infancy	Chronic lower respiratory disease

1900 and 1950 rankings from historical US vital statistics; categories are approximate equivalents.

In 1900, US life expectancy at birth was around 47 years. Three of the top five causes were infectious, and a large share of deaths came from diarrhoeal disease among young children, a pattern that still exists in parts of the world today, as we explain on our diarrhoeal disease page. By 1950, antibiotics, vaccines, clean water and better nutrition had pushed infections down the list, and the chronic diseases of middle and old age had taken over.

Heart disease has been the leading cause of death in the US almost every year since the early 1920s. It held the top spot even during the pandemic, when COVID-19 rose as high as third.

The rise and fall of the biggest killers

Within that broad shape, individual causes have moved a great deal over the last half century.

Cause	Trend since the 1970s	Main reason
Heart disease	Age-adjusted death rate down by roughly two thirds	Less smoking, statins, blood pressure drugs, better emergency care
Stroke	Down sharply, but progress has stalled since about 2013	Blood pressure control, now offset by obesity and diabetes
Cancer	Death rate down about a third since its 1991 peak	Less smoking, screening, better treatment
Alzheimer's disease	Rising steadily	An ageing population and better diagnosis
Unintentional injuries	Rising since 2000s, mainly overdoses	Opioids and then fentanyl
Chronic liver disease	Rising	Alcohol and fatty liver disease

The heart disease story is one of modern medicine's biggest successes, and it is told in more detail in why cardiovascular disease kills more than everything else. The American Cancer Society estimates that the fall in cancer death rates since 1991 has meant more than four million fewer cancer deaths than would otherwise have occurred.

The injury line is going the wrong way. Unintentional injuries were the fifth leading cause in the early 2000s; they climbed to third, largely because of drug overdoses, which now make up close to half of all injury deaths. Provisional data for 2024 shows overdoses falling sharply, so this category may slip again. The global context is in how many people die from drug overdoses every day.

The leading cause depends on your age

The national ranking is dominated by older adults, because that is when most deaths occur. For younger Americans, the list is completely different.

Age group	Leading cause	Second	Third
Under 1	Congenital anomalies	Short gestation and low birth weight	Sudden infant death
1 to 9	Unintentional injuries	Congenital anomalies	Homicide or cancer
10 to 14	Unintentional injuries	Suicide	Cancer
15 to 24	Unintentional injuries	Suicide	Homicide
25 to 34	Unintentional injuries	Suicide	Homicide
35 to 44	Unintentional injuries	Heart disease	Cancer
45 to 64	Cancer	Heart disease	Unintentional injuries
65 and over	Heart disease	Cancer	Stroke or Alzheimer's

Pattern from CDC WISQARS and NCHS leading-cause tables for recent years; positions two and three in some groups vary between years.

From age 1 to 44, unintentional injuries are the leading cause of death for Americans: overdoses, car crashes, drowning, falls and fires. Firearms, counted across suicide, homicide and accidents, are now the leading single mechanism of death for children and teenagers aged 1 to 19. We look at that in how many people die from guns every day.

If you are in the US and thinking about suicide, you can call or text 988 at any time to reach the Suicide and Crisis Lifeline. Our suicide page covers the wider picture.

Men and women

Heart disease is the number one killer of both American men and American women, but the rest of the list diverges.

Rank	Men	Women
1	Heart disease	Heart disease
2	Cancer	Cancer
3	Unintentional injuries	Stroke
4	Stroke	Chronic lower respiratory disease
5	Chronic lower respiratory disease	Alzheimer's disease
Also in top 10	Suicide, chronic liver disease	Unintentional injuries, kidney disease

Unintentional injuries are third for men but lower for women, reflecting the fact that men account for around 70% of overdose deaths and most road deaths. Suicide appears in the male top ten but not the female one. Alzheimer's disease ranks higher for women, partly because women live longer and partly because about two thirds of Americans with Alzheimer's are women.

The result is a gap of more than five years in life expectancy: about 75.8 for men and 81.1 for women in 2023. We explore the reasons in why men die younger than women, and look at the female picture worldwide in the leading causes of death in women.

Causes that do not make the top 10

Some of the most discussed causes of death in American public life sit just outside the top ten, or are hidden inside larger categories.

Cause	Approx. US deaths (2023)	Where it sits
Suicide	~49,300	11th leading cause
Influenza and pneumonia	~47,000	Just outside the top 10
Firearm deaths (all intents)	~46,700	Split across suicide, homicide and accidents
Motor vehicle crashes	~41,000	Inside unintentional injuries
Septicemia	~40,000	Around 12th to 13th
Homicide	~22,000	Outside the top 15 overall, top 3 for ages 15 to 34

Sepsis is a good example of how death certificate rules shape the ranking. It is often listed as a contributing cause rather than the underlying one, so the official count understates how many deaths it plays a part in. We cover it in how many people die from sepsis every day.

The risk factors behind the list

Most of the top ten share a small group of root causes. The CDC attributes around 480,000 deaths a year to smoking alone, including second-hand smoke, making it the largest preventable cause of death in the country.

Risk factor	Causes on the top 10 it drives
Smoking	Heart disease, cancer, stroke, chronic lower respiratory disease
High blood pressure	Heart disease, stroke, kidney disease
Obesity and poor diet	Heart disease, diabetes, kidney disease, several cancers, liver disease
Alcohol	Liver disease, cancer, injuries
Physical inactivity	Heart disease, diabetes, stroke, some cancers

High blood pressure alone touches four of the top ten, which is why it is sometimes called the silent killer. Kidney disease, eighth on the list, is driven largely by diabetes and hypertension together; we explain that link in how many people die from kidney disease every day. Obesity, meanwhile, is involved in more of the list than any single other factor, as we set out in how obesity contributes to 5 of the top 10 causes of death.

How the US compares with the world

The US list is broadly similar to other high-income countries, with one big exception: deaths of younger adults.

Rank	United States	World (WHO)
1	Heart disease	Ischaemic heart disease
2	Cancer	Stroke
3	Unintentional injuries	COPD
4	Stroke	Lower respiratory infections
5	Chronic lower respiratory disease	Lung cancer

No other wealthy country has unintentional injuries ranked so high. That single difference, together with firearm deaths and higher rates of diabetes and obesity, explains a large share of the life expectancy gap between the US and countries like Japan, Australia and Spain. You can compare the US with any other country using our country comparison tool, or explore the United States page and the wider Americas region.

While you were reading this

You have spent about 12 minutes with this article. In that time, roughly 71 Americans have died. Around 16 of them died of heart disease, about 14 of cancer, about 5 from unintentional injuries, and around 4 from a stroke. One or two of them were under 35, and for them the most likely cause was an overdose, a crash or a gunshot, not a disease.

Around the world, the total over those same 12 minutes is more than 1,400. You can watch it happen in real time on our live death counter, see how the leading global causes compare on our causes of death page, or estimate your own outlook with the Death Clock.

---

Data sources: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) final 2023 mortality data and Data Brief on mortality in the United States, CDC WISQARS leading causes of death reports, historical US vital statistics (1900 and 1950), American Cancer Society Cancer Statistics, Alzheimer's Association, World Health Organization Global Health Estimates. Figures are rounded where marked; rankings by age and sex vary slightly between years. This article is for informational purposes only and does not constitute medical advice.