Causes of Death in the United States

Related Chapters:
Opioid Crisis
•• Chapters on Specific Controlled Substances
•• Chapters Relating to Harm Reduction

Leading Causes of Death in the US

Page last updated Nov. 11, 2020 by Doug McVay, Editor.

41. Alcohol Mortality and Other Annual Costs in the US

"Excessive alcohol use* accounted for an estimated average of 80,000 deaths and 2.3 million years of potential life lost (YPLL) in the United States each year during 2001–2005, and an estimated $223.5 billion in economic costs in 2006. Binge drinking accounted for more than half of those deaths, two thirds of the YPLL, and three quarters of the economic costs."

* Excessive alcohol use includes binge drinking (defined by CDC as consuming four or more drinks per occasion for women or five or more drinks per occasion for men), heavy drinking (defined as consuming more than one drink per day on average for women or more than two drinks per day on average for men), any alcohol consumption by pregnant women, and any alcohol consumption by youths aged less than 21 years.

Kanny, Dafna; Garvin, William S.; and Balluz, Lina, "ital Signs: Binge Drinking Prevalence, Frequency, and Intensity Among Adults — United States, 2010," Morbidity and Mortality Weekly Report (Atlanta, GA: Centers for Disease Control and Prevention, January 13, 2012) Vol. 61, No. 1, p. 14.

42. Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost (YPLL) in the US

"Overall, we found that alcohol use accounted for approximately 3.5% of all cancer deaths, or about 19 500 persons, in 2009. It was a prominent cause of premature loss of life, with each alcohol-attributable cancer death resulting in about 18 years of potential life lost. Although cancer risks were greater and alcohol-attributable cancer deaths more common among persons who consumed an average of more than 40 grams of alcohol per day (‡ 3 drinks), approximately 30% of alcohol-attributable cancer deaths occurred among persons who consumed 20 grams or less of alcohol per day. About 15% of breast cancer deaths among women in the United States were attributable to alcohol consumption."

David E. Nelson, Dwayne W. Jarman, Jürgen Rehm, Thomas K. Greenfield, Grégoire Rey, William C. Kerr, Paige Miller, Kevin D. Shield, Yu Ye, and Timothy S. Naimi. (2013). Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States. American Journal of Public Health. e-View Ahead of Print. doi: 10.2105/AJPH.2012.301199
Abstract at http://ajph.aphapublications.o...

43. Alcohol-Attributable Cancer Deaths in the US

"Our estimate of 19,500 alcohol-related cancer deaths is greater than the total number of deaths from some types of cancer that receive much more prominent attention, such as melanoma or ovarian cancer,36 and it amounted to more than two thirds of all prostate cancer deaths in 2009.36 Reducing alcohol consumption is an important and underemphasized cancer prevention strategy, yet receives surprisingly little attention among public health, medical, cancer, advocacy, and other organizations in the United States, especially when compared with efforts related to other cancer prevention topics such as screening, genetics, tobacco, and obesity."

David E. Nelson, Dwayne W. Jarman, Jürgen Rehm, Thomas K. Greenfield, Grégoire Rey, William C. Kerr, Paige Miller, Kevin D. Shield, Yu Ye, and Timothy S. Naimi. (2013). Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States. American Journal of Public Health. e-View Ahead of Print. doi: 10.2105/AJPH.2012.301199
Abstract at http://ajph.aphapublications.o...

44. Deaths by Homicide in the US

"Assault (homicide), the 17th leading cause of death in 2014, dropped from among the 15 leading causes of death in 2010 but is still a major issue for some age groups. In 2014, homicide remained among the 15 leading causes of death for age groups 1–4 (3rd), 5–14 (5th), 15–24 (3rd), 25–34 (3rd), 35–44 (5th), and 45–54 (13th)."
According to the CDC, there were a total of 15,809 deaths by assault (homicide) in the US in 2014.

Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016, p. 10, and Table 10, p. 44.

45. Deaths by Suicide in the US

"The age-adjusted death rate increased significantly between 2013 and 2014 for five leading causes: unintentional injuries (2.8%), stroke (0.8%), Alzheimer’s disease (8.1%), suicide (3.2%), and Chronic liver disease and cirrhosis (2.0%)."
According to the CDC, there were 42,773 deaths by suicide in the United States in 2014.

Kochanek KD, Murphy SL, Xu JQ, Tejada-Vera B. Deaths: Final data for 2014. National vital statistics reports; vol 65 no 4. Hyattsville, MD: National Center for Health Statistics. 2016, p. 10, and Table 10, p. 44.

46. Global Estimated Drug-Related Mortality, 2011

"UNODC estimates that there were between 102,000 and 247,000 drug-related deaths in 2011, corresponding to a mortality rate of between 22.3 and 54.0 deaths per million population aged 15-64. This represents between 0.54 per cent and 1.3 per cent of mortality from all causes globally among those aged 15-64.20 The extent of drug-related deaths has essentially remained unchanged globally and within regions."

UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 10.

47. Alcohol Poisoning Deaths in the US, 2010-2012

"On average, 6 people died every day from alcohol poisoning in the US from 2010 to 2012. Alcohol poisoning is caused by drinking large quantities of alcohol in a short period of time. Very high levels of alcohol in the body can shutdown critical areas of the brain that control breathing, heart rate, and body temperature, resulting in death. Alcohol poisoning deaths affect people of all ages but are most common among middle-aged adults and men."

"Alcohol Poisoning Deaths: A deadly consequence of binge drinking," CDC Vital Signs, January 2015, p. 1.

48. Leading Causes of Death by Race/Ethnicity, 2008

The Centers for Disease Control reported that in 2008, HIV disease was the 25th leading cause of death in the US for non-Hispanic whites, the 10th leading cause of death for non-Hispanic blacks, and the 17th leading cause of death for Hispanics.

Heron, Melonie P., PhD, "Deaths: Leading Causes for 2008," National Vital Statistics Reports, Vol. 60, No. 6 (Hyattsville, MD: National Center for Health Statistics, June 6, 2012), p. 12, Table E.

49. Illicit Drug Use

"Illicit drug use is associated with suicide, homicide, motor-vehicle injury, HIV infection, pneumonia, violence, mental illness, and hepatitis. An estimated 3 million individuals in the United States have serious drug problems. Several studies have reported an undercount of the number of deaths attributed to drugs by vital statistics; however, improved medical treatments have reduced mortality from many diseases associated with illicit drug use. In keeping with the report by McGinnis and Foege, we included deaths caused indirectly by illicit drug use in this category. We used attributable fractions to compute the number of deaths due to illicit drug use. Overall, we estimate that illicit drug use resulted in approximately 17000 deaths in 2000, a reduction of 3000 deaths from the 1990 report."

Mokdad, Ali H., PhD, James S. Marks, MD, MPH, Donna F. Stroup, PhD, MSc, Julie L. Gerberding, MD, MPH, "Actual Causes of Death in the United States, 2000," Journal of the American Medical Association, (March 10, 2004), G225 Vol. 291, No. 10, 1242.

50. Homicide Rates - Basic International Comparisons, 2012

"The global average homicide rate stands at 6.2 per 100,000 population, but Southern Africa and Central America have rates over four times higher than that (above 24 victims per 100,000 population), making them the sub-regions with the highest homicide rates on record, followed by South America, Middle Africa and the Caribbean (between 16 and 23 homicides per 100,000 population). Meanwhile, with rates some five times lower than the global average, Eastern Asia, Southern Europe and Western Europe are the sub-regions with the lowest homicide levels.
"Almost three billion people live in an expanding group of countries with relatively low homicide rates, many of which, particularly in Europe and Oceania, have continued to experience a decrease in their homicide rates since 1990. At the opposite end of the scale, almost 750 million people live in countries with high homicide levels, meaning that almost half of all homicides occur in countries that make up just 11 per cent of the global population and that personal security is still a major concern for more than 1 in 10 people on the planet."

UNODC Global Study on Homicide 2013 (United Nations publication, Sales No. 14.IV.1), p. 12.

51. Adverse Drug Reactions

"Adverse drug reactions are a significant public health problem in our health care system. For the 12,261,737 Medicare patients admitted to U.S. hospitals, ADRs were projected to cause the following increases: 2976 deaths, 118,200 patient-days, $516,034,829 in total charges, $37,611,868 in drug charges, and $9,456,698 in laboratory charges. If all Medicare patients were considered, these figures would be 3 times greater."

C. A. Bond, PharmD, FASHP, FCCP, and Cynthia L. Raehl, PharmD, FASHP, FCCP, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, Texas, "Adverse Drug Reactions in United States Hospitals" Pharmacotherapy, 2006;26(5):601-608.

52. Dangers of New Prescription Drugs

"Each year offers new examples of injuries and deaths caused by untoward dangers in prescription drugs. Prominent illustrations from recent years include Vioxx, a popular arthritis painkiller that more than doubled the risk of heart attacks and strokes,6 a risk that lingered long after users stopped taking the drug;7 'Phen-fen,' a diet drug that caused heart damage;8 and Propulsid, a drug that reduced gastric acid but also threatened patients’ hearts.9 Once information on these side-effects became known to the public, the manufacturers of each of these drugs stopped selling them and, eventually, paid millions or billions of dollars to settle claims for resulting injuries.10 Merck, for example, having withdrawn the profitable Vioxx drug11 from the market in 2004, settled nearly 50,000 Vioxx cases in late 2007 for $4.85 billion.12 In 2009, Eli Lilly agreed to plead guilty and pay $1.415 billion in criminal and civil penalties for promoting its antipsychotic drug, Zyprexa, as suitable for uses not approved by the Food and Drug Administration (“FDA”).13 These cases may be among the more prominent, but they represent just the tip of the iceberg of damage caused by prescription drugs."

Owen, David G., "Dangers in Prescription Drugs: Filling a Private Law Gap in the Healthcare Debate," Connecticut Law Review (Hartford, CT: University of Connecticut School of Law, February 2010) Volume 42, Number 3, p. 737.

53. Marijuana Safety - DEA Administrative Law Judge's Ruling

"3. The most obvious concern when dealing with drug safety is the possibility of lethal effects. Can the drug cause death?
"4. Nearly all medicines have toxic, potentially lethal effects. But marijuana is not such a substance. There is no record in the extensive medical literature describing a proven, documented cannabis-induced fatality.
"5. This is a remarkable statement. First, the record on marijuana encompasses 5,000 years of human experience. Second, marijuana is now used daily by enormous numbers of people throughout the world. Estimates suggest that from twenty million to fifty million Americans routinely, albeit illegally, smoke marijuana without the benefit of direct medical supervision. Yet, despite this long history of use and the extraordinarily high numbers of social smokers, there are simply no credible medical reports to suggest that consuming marijuana has caused a single death.
"6. By contrast aspirin, a commonly used, over-the-counter medicine, causes hundreds of deaths each year.
"7. Drugs used in medicine are routinely given what is called an LD-50. The LD-50 rating indicates at what dosage fifty percent of test animals receiving a drug will die as a result of drug induced toxicity. A number of researchers have attempted to determine marijuana's LD-50 rating in test animals, without success. Simply stated, researchers have been unable to give animals enough marijuana to induce death.
"8. At present it is estimated that marijuana's LD-50 is around 1:20,000 or 1:40,000. In layman terms this means that in order to induce death a marijuana smoker would have to consume 20,000 to 40,000 times as much marijuana as is contained in one marijuana cigarette. NIDA-supplied marijuana cigarettes weigh approximately .9 grams. A smoker would theoretically have to consume nearly 1,500 pounds of marijuana within about fifteen minutes to induce a lethal response.
"9. In practical terms, marijuana cannot induce a lethal response as a result of drug-related toxicity."

US Department of Justice, Drug Enforcement Administration, "In the Matter of Marijuana Rescheduling Petition" (Docket #86-22), September 6, 1988, p. 56-57.

54. Adverse Drug Reaction Deaths in US Hospitals

"Our study revealed that experiencing an ADR [Adverse Drug Reaction] while hospitalized substantially increased the risk of death (1971 excess deaths, OR 1.208, 95% CI 1.184-1.234). This finding reflects about a 20% increase in mortality associated with an ADR in hospitalized patients. Extrapolating this finding to all patients suggests that 2976 Medicare patients/year and 8336 total patients/year die in U.S. hospitals as a direct result of ADRs; this translates to approximately 1.5 patients/hospital/year."

C. A. Bond, PharmD, FASHP, FCCP and Cynthia L. Raehl, PharmD, FASHP, FCCP, "Adverse Drug Reactions in United States Hospitals," Pharmacotherapy, 2006;26(5):601-608.

55. Leading Causes of Death 2000

"The leading causes of death in 2000 were tobacco (435,000 deaths; 18.1% of total US deaths), poor diet and physical inactivity (400,000 deaths; 16.6%), and alcohol consumption (85,000 deaths; 3.5%). Other actual causes of death were microbial agents (75,000), toxic agents (55,000), motor vehicle crashes (43,000), incidents involving firearms (29,000), sexual behaviors (20,000), and illicit use of drugs (17,000)."

Note: According to a correction published by the Journal on January 19, 2005, "On page 1240, in Table 2, '400,000 (16.6)' deaths for 'poor diet and physical inactivity' in 2000 should be '365,000 (15.2).' A dagger symbol should be added to 'alcohol consumption' in the body of the table and a dagger footnote should be added with 'in 1990 data, deaths from alcohol-related crashes are included in alcohol consumption deaths, but not in motor vehicle deaths. In 2000 data, 16,653 deaths from alcohol-related crashes are included in both alcohol consumption and motor vehicle death categories."

Mokdad, Ali H., PhD, James S. Marks, MD, MPH, Donna F. Stroup, PhD, MSc, Julie L. Gerberding, MD, MPH, "Actual Causes of Death in the United States, 2000," Journal of the American Medical Association, (March 10, 2004), G225 Vol. 291, No. 10, p. 1238, 1240.
Source for Correction: Journal of the American Medical Association, Jan. 19, 2005, Vol. 293, No. 3, p. 298.

56. Acetaminophen-Related Liver Injury

"... acetaminophen-related liver injury led to approximately
• 56,000 emergency department visits (1993–1999),
• 26,000 hospitalizations (1990–1999), and
• 458 deaths (1996–1998).
"Of these cases, unintentional acetaminophen overdose was associated with
• 13,000 emergency department visits (1993–1999),
• 2189 hospitalizations (1990–1999), and
• 100 deaths (1996–1998) (71 FR 77314 at 77318)."

Federal Register, "Organ-Specific Warnings; Internal Analgesic, Antipyretic, and Antirheumatic Drug Products for Over-the-Counter Human Use; Final Monograph," Vol. 74, No. 81, Wednesday, April 29, 2009, p. 19385.

57. Deaths and Hospitalizations From Use of Non Steroidal Anti-Inflammatory Drugs (NSAIDS)

"Each year, use of NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) accounts for an estimated 7,600 deaths and 76,000 hospitalizations in the United States." (NSAIDs include aspirin, ibuprofen, naproxen, diclofenac, ketoprofen, and tiaprofenic acid.)

Robyn Tamblyn, PhD; Laeora Berkson, MD, MHPE, FRCPC; W. Dale Jauphinee, MD, FRCPC; David Gayton, MD, PhD, FRCPC; Roland Grad, MD, MSc; Allen Huang, MD, FRCPC; Lisa Isaac, PhD; Peter McLeod, MD, FRCPC; and Linda Snell, MD, MHPE, FRCPC, "Unnecessary Prescribing of NSAIDs and the Management of NSAID-Related Gastropathy in Medical Practice," Annals of Internal Medicine (Washington, DC: American College of Physicians, 1997), September 15, 1997, 127:429-438.
Citing: Fries, JF, "Assessing and understanding patient risk," Scandinavian Journal of Rheumatology Supplement, 1992;92:21-4.

58. Lethal Dose by Substance

"The most toxic recreational drugs, such as GHB (gamma-hydroxybutyrate) and heroin, have a lethal dose less than 10 times their typical effective dose. The largest cluster of substances has a lethal dose that is 10 to 20 times the effective dose: These include cocaine, MDMA (methylenedioxymethamphetamine, often called 'ecstasy') and alcohol. A less toxic group of substances, requiring 20 to 80 times the effective dose to cause death, include Rohypnol (flunitrazepam or 'roofies') and mescaline (peyote cactus). The least physiologically toxic substances, those requiring 100 to 1,000 times the effective dose to cause death, include psilocybin mushrooms and marijuana, when ingested. I’ve found no published cases in the English language that document deaths from smoked marijuana, so the actual lethal dose is a mystery."

Gable, Robert S., "The Toxicity of Recreational Drugs," American Scientist (Research Triangle Park, NC: Sigma Xi, The Scientific Research Society, May-June 2006) Vol. 94, No. 3, p. 207.

59. Mentions of Kratom in Overdose Deaths in the US

"Data on 27,338 overdose deaths that occurred during July 2016–December 2017 were entered into SUDORS, and 152 (0.56%) of these decedents tested positive for kratom on postmortem toxicology (kratom-positive). Postmortem toxicology testing protocols were not documented and varied among and within states. Kratom was determined to be a cause of death (i.e., kratom-involved) by a medical examiner or coroner for 91 (59.9%) of the 152 kratom-positive decedents, including seven for whom kratom was the only substance to test positive on postmortem toxicology, although the presence of additional substances cannot be ruled out (4).

"In approximately 80% of kratom-positive and kratom-involved deaths in this analysis, the decedents had a history of substance misuse, and approximately 90% had no evidence that they were currently receiving medically supervised treatment for pain. Postmortem toxicology testing detected multiple substances for almost all decedents (Table). Fentanyl and fentanyl analogs were the most frequently identified co-occurring substances; any fentanyl was listed as a cause of death for 65.1% of kratom-positive decedents and 56.0% of kratom-involved decedents. Heroin was the second most frequent substance listed as a cause of death (32.9% of kratom-positive decedents), followed by benzodiazepines (22.4%), prescription opioids (19.7%),** and cocaine (18.4%)."

Olsen EO, O’Donnell J, Mattson CL, Schier JG, Wilson N. Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017. MMWR Morb Mortal Wkly Rep 2019;68:326–327. DOI: