couple standing at gravesite

We may want to live forever (and might even believe we will when we’re young), but the most certain thing in life is, unfortunately, death. The good news is that Americans are living longer than ever before. According to the Centers for Disease Control and Prevention (CDC), the average life expectancy in the United States in 2019 was 78.8 years, up from 78.7 years in 2018. Women tend to live a bit longer than men (81.4 years vs. 76.3 years).

The leading causes of death in the United States are generally the same as those worldwide, with a couple of key exceptions. As the World Health Organization (WHO) noted, the international top 10 list includes neonatal conditions and diarrheal diseases. These rarely lead to death in the United States, but around the globe, they claim the lives of more than 4 million individuals annually, largely in developing nations.

Although their order may change slightly, in general, the same diseases and conditions make the list of leading causes of death in the United States year after year. In 2020, however, the novel coronavirus became the third leading cause of mortality (via USA Facts).

Heart disease

heart and stethoscope

Heart disease is the leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), about 655,000 Americans die each year of the condition.

Heart disease is actually an umbrella term for a number of conditions. Per Healthline, coronary artery disease (CAD) is the most common type of heart disease and is caused by a buildup of plaque in the arteries that supply the heart. Atherosclerosis is a more general term that describes this buildup and hardening of the arteries elsewhere in the body. Cardiomyopathy is another form of heart disease in which the heart becomes weak and unable to function properly. Other forms of heart disease include congenital heart defects, arrhythmias, and infections.

Although a heart attack is an obvious sign of an underlying issue with the heart, there are many other more subtle symptoms that can alert you that something isn’t right with your ticker. These include lightheadedness, shortness of breath, chest pain, and a fluttering or irregular heartbeat. Because there are so many types of heart disease, there are a large number of potential causes and risk factors. When it comes to CAD, high blood pressure, high cholesterol, smoking, and obesity increase an individual’s risk substantially.

Cancer

According to the CDC, "cancer is the second leading cause of death in the United States," claiming the lives of 599,274 Americans in 2018. There’s some discrepancy, however, between the most common cancers and those that kill the most people. Breast cancer, lung cancer, and prostate cancer are the most frequently diagnosed cancers, while lung cancer, colorectal cancer, and pancreatic cancer account for the largest number of deaths each year.

Although it may seem like lung cancer is very different from prostate cancer, the process driving all cancers is the same. According to the National Cancer Institute, "In all types of cancer, some of the body’s cells begin to divide without stopping and spread into surrounding tissues." Unlike normal body cells, cancer cells are less specialized and can ignore the usual mechanisms that stop cells from dividing out of control. They can also "hide" from the immune system, which would normally clear away damaged or diseased cells.

Approximately 39.5 percent of Americans will be diagnosed with some form of cancer during their lifetime. Although cancer is the second leading cause of death, it’s important to recognize that cancer survival rates are on the rise. "As of January 2019, there were an estimated 16.9 million cancer survivors" (via National Cancer Institute).

Accidents and unintentional injuries

Accidents and unintentional injuries are the third leading cause of death in the United States. In 2018 they resulted in 167,127 deaths. Of these, 37,991 were motor vehicle deaths, and 37,455 were falls. The largest proportion, however — 62,399 fatalities — were the result of unintentional poisoning.

As the Centers for Disease Control and Prevention (CDC) explained, unintentional poisoning can occur among both children and adults. Adult poisoning deaths are usually drug-related and include overdoses on illegal or legal drugs used for recreational purposes, poisoning from legal drugs taken incorrectly, and unexpected side-effects from prescription medications. Overdoses on illegal and prescription opiates like heroin and OxyContin make up the majority of drug-related poisoning deaths and are of particular concern among public health officials. Breathing in toxic levels of carbon monoxide also results in several hundred poisoning deaths each year. In addition, exposure to certain pesticides and chemicals can cause serious illness or death, especially among agricultural and industrial workers.

If you suspect that you or someone you know has overdosed on a drug or been exposed to a dangerous substance, contact Poison Control immediately.

Chronic lower respiratory diseases

Chronic lower respiratory diseases (CLRD) are the fourth leading cause of death in the United States and were responsible for 159,486 deaths in 2018. These include chronic obstructive pulmonary disease (COPD, which encompasses chronic bronchitis and emphysema), asthma, and several other conditions.

In all forms of CLRD, the airways become obstructed or damaged. Although acute bronchitis is usually the result of an infection and does not cause lasting damage, chronic bronchitis is usually the result of smoking or secondhand smoke exposure. Inflammation in the lungs’ bronchial tubes causes scarring, swelling, and excess mucus production. Emphysema is also usually caused by long-term smoking and involves the destruction of the alveoli, the sacs deep in the lungs where oxygen and carbon dioxide are exchanged. Asthma is caused by the airways overreacting to a particular trigger, such as exercise, cold weather, or allergies. During an asthma attack, the bronchial tubes in the lungs become swollen and inflamed, and the small muscles surrounding the airways tighten, causing the bronchial tubes to narrow. Although an asthma attack can be life-threatening without treatment, asthma does not cause permanent damage to the lungs as chronic bronchitis and emphysema do.

Stroke

Stroke is the fifth leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), 147,810 people died of a stroke in 2018. Roughly 7.8 million Americans (three percent of the population) will have at least one stroke in their lifetime.

The Mayo Clinic identified three types of stroke. Ischemic strokes are "the most common" and occur when the blood vessels supplying the brain become blocked with arterial plaque or a clot. A transient ischemic attack (TIA), also known as a "ministroke," is similar, but the blockage is only temporary and doesn’t cause permanent brain damage. A hemorrhagic stroke occurs "when a blood vessel in your brain leaks or ruptures." High blood pressure, smoking, high cholesterol, diabetes, and obesity are risk factors that increase a person’s chances of having a stroke. Being male and/or African American and the use of synthetic estrogens also increase stroke risk.

Time is of the essence when someone has a stroke. The acronym F.A.S.T. can help you identify the signs of a stroke and underscores the importance of acting quickly. Look for drooping on one side of the face, the inability to raise both arms and keep them level, and slurred or altered speech.

Alzheimer’s disease

Alzheimer’s disease is the sixth leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), the condition claimed the lives of 122,019 individuals in 2018.

As the Alzheimer’s Association explained, "Alzheimer’s is the most common cause of dementia, a general term for memory loss and other cognitive abilities serious enough to interfere with daily life." It accounts for 60 to 80 percent of all dementia cases. Although most individuals with Alzheimer’s are over age 65, the condition is "not a normal part of aging." Although the exact cause of Alzheimer’s is unknown, the buildup of protein fragment "plaques" and "tangles" within brain cells that prevent them from functioning properly is a likely culprit. Alzheimer’s is progressive, and there is currently no cure, although the earlier a diagnosis is made, the better the condition can be managed.

The cognitive decline of Alzheimer’s does not directly lead to death. However, as the disease advances and individuals lose the ability to perform basic tasks like walking and chewing, they become increasingly frail and susceptible to a number of secondary conditions. The most common cause of death among Alzheimer’s patients is pneumonia.

Diabetes

According to the American Diabetes Association (ADA), diabetes is the seventh leading cause of death, killing more than 83,000 individuals each year. The condition may even be "underreported as a cause of death." The ADA noted that "studies have found that only about 35% to 40% of people with diabetes who died had diabetes listed anywhere on the death certificate and about 10% to 15% had it listed as the underlying cause of death."

Per Mayo Clinic, there are several types of diabetes, but all involve the body’s inability to make or effectively use insulin. Type 1 diabetes is an autoimmune disease in which the body "destroys your insulin-producing cells in the pancreas." Type 2 diabetes, on the other hand, occurs when the body’s cells become resistant to the effects of insulin, and the pancreas can’t create enough insulin to compensate. Poorly managed diabetes can lead to a number of life-threatening complications. If untreated, both extremely low blood sugar (hypoglycemia) and very high blood sugar (hyperglycemia) can lead to death. Diabetes also dramatically increases an individual’s risk for heart attack, stroke, and kidney failure. Poor blood flow to the feet may lead to foot or leg amputation, which increases the risk for life-threatening postoperative infections.

Influenza and pneumonia

In 2018, influenza and pneumonia resulted in the deaths of 59,120 Americans, making it the eighth leading cause of death that year. This ranking can change from year to year, however, based on the severity of individual flu seasons. This is because the influenza virus mutates easily, so different strains circulate each year. The Centers for Disease Control and Prevention (CDC) estimates that, since 2010, influenza and pneumonia (the most common serious complication of the flu) have killed between 12,000 and 61,000 people annually. The 2017-2018 flu season was the deadliest in recent history, while the 2011-2012 season was the mildest.

It’s very difficult for the CDC to determine exactly how many people die each year from influenza and its complications. One reason is that "states are not required to report" influenza deaths in adults to the CDC. When an individual dies of complications from the flu (such as pneumonia or an aggravated pre-existing condition like heart disease), the initial influenza infection has often either resolved or was never officially diagnosed in the first place, so it isn’t listed as a cause of death on the death certificate.

Although not 100 percent effective, a seasonal flu shot is the best way to protect against influenza.

Kidney disease

Kidney disease was the ninth leading cause of death in 2018, resulting in 51,386 deaths that year. Kidney disease is an umbrella term for any condition that causes damage to the kidneys and impairs their ability to perform their important tasks of filtering the blood, balancing electrolytes and fluid in the body, and regulating blood pressure. Chronic kidney disease is most commonly caused by diabetes or high blood pressure, and many people don’t realize they have kidney issues until the damage is moderate or severe. Kidney disease is a progressive condition with five stages. Once a person’s kidneys are severely compromised, they require dialysis, a procedure in which blood is passed through a machine that removes waste products. According to Medscape, "the 5-year survival rate for a patient undergoing long-term dialysis in the United States is approximately 35%, and approximately 25% in patients with diabetes."

Two common forms of kidney disease include nephrotic syndrome and nephritis. Nephrotic syndrome occurs when your kidneys allow too much protein to leave the body in urine. This is usually the result of damage to the small blood vessels (glomeruli) in your kidneys that filter the blood. Nephritis, on the other hand, is an inflammation of the glomeruli.

Suicide

In 2018, 48,344 Americans committed suicide, making it the tenth leading cause of death that year. Firearms were involved in a majority (24,432) of suicide deaths, with suffocation and intentional poisoning (including drug overdoses) constituting most of the remainder.

According to WebMD, suicide rates are highest among teens, young adults, and those over 65. Other at-risk groups include "people who have lost a spouse, have attempted suicide before or have family members who did, have been abused, have a substance abuse problem or a painful, disabling, or terminal illness, or work in certain professions, like police officers." WebMD also noted that although "women are three times as likely to attempt suicide, men are far more likely to complete the act." Suicide rates also vary substantially from state to state. Wyoming, New Mexico, Montana, and Alaska have suicide rates roughly two and a half to three times higher than New Jersey, New York, Rhode Island, and Massachusetts.

If you or someone you know is struggling with thoughts of suicide, the Suicide Prevention Lifeline can help. The American Society for Suicide Prevention also offers a host of valuable resources for those in crisis or needing mental health care.

Chronic liver disease and cirrhosis

According to the Centers for Disease Control and Prevention (CDC), 42,838 individuals died of chronic liver disease and cirrhosis in 2018, making these conditions the 11th leading cause of death that year.

Cirrhosis is the final stage of chronic liver disease and occurs when scar tissue replaces healthy tissue in the liver. This scar tissue prevents the liver from performing its many vital functions, including filtering out toxins, producing bile to aid digestion, storing glucose for energy, and building proteins for use throughout the body. Cirrhosis has many causes, including long-term alcohol use, hepatitis, and nonalcoholic fatty liver disease. The liver is a vital organ, and chronic damage to it can produce a variety of symptoms. These include jaundice (yellowing of the skin and eyes), ascites (fluid buildup in the belly), extreme fatigue and weakness, and kidney failure. Depending on the cause, cirrhosis may be reversible in some cases. Most of the time, however, the damage is permanent and treatment focuses on preventing or slowing additional damage. That being said, in advanced cases, a liver transplant may be required.

Septicemia

Although the Centers for Disease Control and Prevention (CDC) releases reports on the most common causes of death each year, data on less common fatalities can be more variable. For example, in 2018,the CDC recorded 40,655 deaths from septicemia. This would make it the 12th leading cause of death in the United States that year. However, the Sepsis Alliance reported that septicemia kills approximately 258,000 Americans annually, which would make it the third leading cause of death.

According to Healthline, "septicemia occurs when a bacterial infection elsewhere in the body … enters the bloodstream. This is dangerous because the bacteria and their toxins can be carried through the bloodstream to your entire body." If left untreated, septicemia can progress to sepsis, in which an overresponse from the immune system causes widespread inflammation that blocks "oxygen from reaching vital organs, resulting in organ failure" and death. Although any infection can lead to septicemia, those in the lungs, kidneys, abdomen, and urinary tract are the most likely to spread into the bloodstream. People hospitalized for another condition are at substantially increased risk for septicemia. Symptoms (such as fever, rapid heart rate, confusion, nausea and severe drops in blood pressure) can appear quickly and require urgent medical attention.

Essential hypertension and hypertensive renal disease

In 2017, the Centers for Disease Control and Prevention (CDC) attributed 35,316 deaths to essential hypertension and hypertensive renal disease, making these conditions the 13th leading cause of death that year.

According to a paper published in the journal Circulation, essential hypertension, also known as primary or idiopathic hypertension, is high blood pressure that isn’t caused by another condition, such as kidney failure. Essential hypertension accounts for approximately 95 percent of all cases of high blood pressure in the United States. As the Mayo Clinic explained, high blood pressure is a risk factor for a number of serious conditions, including heart disease, stroke, and kidney disease — all leading causes of death. Although hypertension is generally a chronic condition, in some instances, it rises so quickly that it becomes a medical emergency. If an individual dies during such an emergency (usually from stroke, heart attack, or a ruptured aorta), essential hypertension may be listed among the causes of death.

Hypertensive renal disease or renal hypertension, on the other hand, is high blood pressure caused by damage to the kidneys. It’s a form of secondary hypertension but carries all the same risks as essential hypertension.

Parkinson’s disease

In 2017, Parkinson’s disease was listed as a cause of death for 31,963 individuals, making it the 14th leading cause of death that year.

Parkinson’s disease is a progressive neurological condition in which brain cells gradually break down or die. Although the exact cause of Parkinson’s is unknown, researchers believe a combination of genes and environmental triggers are to blame. Symptoms worsen over time and may include tremors, rigid muscles, slowed movement, and altered speech. In more advanced cases, individuals can have trouble chewing and swallowing, cognitive impairments, inability to control the bladder and bowels, and several other symptoms that make everyday tasks difficult or impossible.

As with Alzheimer’s disease, another neurodegenerative condition, Parkinson’s disease doesn’t directly cause death. Falls and pneumonia are two common causes of death among Parkinson’s patients. Problems with movement put individuals at greater risk of a serious fall, and difficulties chewing and swallowing increase the chances of aspiration pneumonia (when food goes "down the wrong pipe" and ends up in the lungs instead of the stomach). In general, however, people with Parkinson’s die of the same diseases that other individuals die of, such as heart disease and cancer.

Coronavirus surge

A week ago president-elect Joe Biden again shared his prediction that the nation was headed towards a "very dark winter," at which time U.S. News & World Report says we were headed towards our 10 millionth case. As of today, The New York Times reports that we are at 11.2 million, and so far, there have been nearly a quarter of a million deaths. What’s really shocking is that in many states, the rate of infection appears to be steadily on the rise, as shown by COVID-tracking data from CNN Health.

While the news regarding Pfizer’s and Moderna’s latest vaccine trials has us all feeling more optimistic about the long-term prognosis for the virus, the fact remains that it won’t do us much good if we don’t manage to survive until the vaccine is widely available to everyone. In the meantime, however, the grim infection count just keeps on soaring. Why is the virus roaring back with a vengeance, or did it ever actually go away?

Too many of us have grown complacent with our COVID precautions

Christmas tree with masks

The way the U.S. Surgeon General sees it, the recent surge in coronavirus cases is most likely due to "pandemic fatigue." Jerome Adams recently told NPR that everyone’s been social distancing, wearing masks, quarantining, and taking other mitigation measures since February or March, and many are just plain tired of it. Over the summer, we could at least get together and engage in social activities outdoors where there was less risk of virus transmission, but now that the cold weather is here again, people are tempted to get back to indoor holiday celebrations with friends and family.

In fact, an Axios/Ipsos poll indicates that 18 percent of respondents plan to celebrate the holidays as they normally do without taking any precautions. What’s more, Christmas shopping may be particularly perilous this year, as by late October the numbers of those saying they always kept their proper 6-foot distance had slipped to 47 percent, way down from a high of 67 percent back in April.

So is a new lockdown in the cards? We certainly hope not, but Adams warns to do your part by minding what he calls "the three Ws:" wash your hands (and disinfect other surfaces), wear a mask, and watch your distance from everybody else. Sure, it’s a pain in the you-know-what, but true holiday spirit means making sure that you, your loved ones, and everyone else you encounter survive to see a new year.