Leading Causes of Death in America, Data Analysis

The Top 10 Causes

These are the exact 2017 figures from the CDC NCHS dataset, death counts and the real direction of each age-adjusted rate between 1999 and 2017:

#	Cause	Deaths (2017)	Rate trend (1999–2017)
1	Heart disease	647,457	Declining 35%
2	Cancer	599,108	Declining 23%
3	Unintentional injuries	169,936	Rising sharply +41%
4	CLRD	160,201	Falling 7%
5	Stroke	146,383	Declining 41%
6	Alzheimer's disease	121,404	Rising sharply +83%
7	Diabetes	83,564	Declining 14%
8	Influenza and pneumonia	55,672	Declining 39%
9	Kidney disease	50,633	Roughly flat
10	Suicide	47,173	Rising sharply +40%

Explore each cause in detail on PlainHealth's causes pages, with state-by-state breakdowns and full trend data for every year from 1999 to 2017.

The toll over time, 1999–2017

Total deaths from these ten leading causes rose 9% from 1,905,826 to 2,081,531 - a rising toll driven by a larger, older population even as the age-adjusted rates of the biggest chronic causes fell.

Source: CDC WONDER, Underlying Cause of Death (CDC NCHS / NVSS), 1999–2017.

“The headline isn't that more Americans are dying, it's that the heart disease and cancer rates are quietly falling, while overdoses and suicide climb against the trend.”

How Rankings Changed from 1999 to 2017

The leading cause rankings were not static over this 19-year window. Several notable shifts occurred:

Cause	1999 Rank	2017 Rank	Movement
Heart Disease	1	1	Stable, still #1, but rate declined significantly
Cancer	2	2	Stable, rate declining, gap with #1 narrowing
Unintentional Injuries	5	3	Rose 2 spots, drug overdose epidemic
Stroke	3	5	Fell 2 spots, major treatment improvements
Alzheimer's Disease	8	6	Rose 2 spots, aging population + better coding
Suicide	11	10	Entered top 10, consistent rise since 2000

The two most important structural changes: stroke's decline (due to blood pressure management breakthroughs) and unintentional injuries' rise (due to the opioid epidemic). These trends are visible in state-level data too, check your state page for local patterns.

The Drug Overdose Surge (1999–2017)

No single trend in this dataset is more dramatic than the rise of drug overdose deaths. From 1999 to 2017, age-adjusted overdose death rates more than quadrupled nationally. This drove unintentional injuries from the 5th to the 3rd leading cause of death, a massive public health shift.

The epidemic has distinct geographic patterns. Appalachian states (West Virginia, Kentucky, Ohio, Tennessee) saw the earliest and sharpest increases due to aggressive opioid prescribing in communities with high rates of physical labor and industrial injury. New England states (New Hampshire, Vermont, Massachusetts) also showed early surges due to prescription pill trafficking routes. By 2017, few states remained untouched. Explore the unintentional injuries cause page to see the state-by-state picture.

Geographic Patterns in Leading Causes

PlainHealth tracks mortality trends from 1999 to 2017, a period of significant change. Several geographic patterns are visible in the cause-level data:

Southeast "stroke belt": Mississippi, Alabama, Arkansas, Louisiana, and Georgia consistently show the highest heart disease and stroke death rates. This pattern has persisted for decades and reflects higher rates of hypertension, obesity, diabetes, and smoking alongside limited rural healthcare access.
Mountain West and suicide: Montana, Wyoming, Alaska, and Nevada consistently rank high for suicide deaths. Rural isolation, limited mental health services, high firearm ownership, and cultural barriers to seeking help are contributing factors.
Utah and low cancer rates: Utah's low cancer death rates are partially explained by the large Mormon population, which has historically low smoking and alcohol use rates, major cancer risk factors.
COPD and Appalachia: West Virginia, Kentucky, and Mississippi have the highest COPD death rates, linked to high historical smoking rates and occupational coal dust exposure.

What This Data Means for Public Health

The most important insight from 19 years of mortality data is that the leading killers are largely modifiable. Heart disease, stroke, diabetes, and COPD are strongly influenced by behavioral risk factors: smoking, diet, physical activity, and blood pressure management. Even cancer death rates have declined significantly through tobacco cessation and screening programs.

The rising causes, drug overdoses and suicide, represent newer public health challenges that require different approaches: addiction treatment access, mental health services, community support systems, and changes in prescribing practices. Their rise is not inevitable, it reflects policy choices, funding decisions, and treatment gaps that can be addressed.

For a deeper understanding of how causes have evolved over time, see our guide on how mortality rates have changed.

Note on Post-2017 Context

This dataset ends in 2017. Since then, several significant events have reshaped US mortality:

COVID-19 (2020–present): Added ~350,000–500,000 deaths in its peak years, temporarily becoming the #1 or #2 cause of death. Also caused excess deaths from delayed care for chronic conditions.
Fentanyl crisis (2016–present): Drug overdose deaths accelerated further after 2017 as illicit fentanyl became dominant. The overdose crisis grew significantly worse after this dataset ends.
Declining life expectancy (2015–2017): The US saw three consecutive years of declining life expectancy before 2017, a historically rare event driven by overdoses and suicide. This trend continued in 2018–2019.

For current data, consult CDC WONDER directly.

Frequently Asked Questions

What is the number one cause of death in the US?

Heart disease has been the leading cause of death in the United States for decades, accounting for approximately 600,000–700,000 deaths per year. Cancer is the second leading cause. Together, they account for roughly 45% of all US deaths. The good news is that age-adjusted death rates for both have been declining, but the number of raw deaths remains high because the US population is aging and growing.

Are deaths from heart disease increasing or decreasing?

The age-adjusted death rate from heart disease has been declining steadily since the 1960s, with a roughly 25% decline between 1999 and 2017. Better medications (statins, ACE inhibitors, beta-blockers), surgical interventions (stents, bypass surgery), and reduced smoking all contributed. However, the obesity epidemic and rising rates of diabetes and hypertension have slowed the decline in recent years.

Why do leading causes differ between states?

State differences reflect a combination of factors: demographic composition, prevalent health behaviors (smoking rates, obesity rates, physical activity), access to healthcare, socioeconomic conditions, occupational exposures, and environmental factors. States with older populations have higher rates of heart disease and cancer. States with higher poverty rates tend to have higher rates of diabetes and COPD. The opioid epidemic created large geographic variation in unintentional injury rates.

What are "unintentional injuries"?

Unintentional injuries include accidental drug overdoses, motor vehicle crashes, falls, drowning, fire, and poisoning. Drug overdoses, primarily opioids, have driven this category upward significantly since 2000, making unintentional injuries the third leading cause of death. In many states, drug overdoses now kill more people than motor vehicle crashes and falls combined. This category's rise is one of the most dramatic trend changes in modern US health statistics.

Why is Alzheimer's disease rising as a cause of death?

Two factors: the US population is aging (Alzheimer's primarily affects people over 65), and changes in how Alzheimer's is recognized and reported on death certificates have increased its classification as an underlying cause. Greater awareness and diagnostic capability have also improved detection. Both factors are real, more people genuinely have Alzheimer's (due to aging), and more of those deaths are now correctly recorded as Alzheimer's deaths.

How does COVID-19 fit into this data?

It does not, PlainHealth's CDC NCHS dataset ends in 2017, three years before the COVID-19 pandemic. COVID-19 became the third leading cause of death in 2020 and 2021, dramatically reshaping the leading cause rankings. It also caused "excess deaths" from delayed care for heart disease, cancer, and other conditions. For current data including COVID-19 impacts, consult CDC WONDER directly.

Sources

CDC National Center for Health Statistics, Leading Causes of Death, 1999–2017
CDC WONDER, Underlying Cause of Death database
National Institute on Drug Abuse, Drug Overdose Death Rates

This content is for informational purposes only and does not constitute medical advice. For health concerns, consult a qualified healthcare provider. Figures are drawn directly from the CDC NCHS Underlying Cause of Death dataset (1999–2017); see our methodology for how age-adjusted rates are calculated.