COVID-19 was the third leading cause of death in the U.S. in both 2020 and 2021, according to the National Institutes of Health (NIH).

To date, over 1.02 million people in the U.S. have died from COVID-19, according to data from The New York Times and Our World in Data. Between March 2020 and October 2021, COVID-19 accounted for 1 in 8 deaths, or 350,000 deaths, in the U.S. The leading cause of death during that time period was heart disease, followed by cancer. These two causes accounted for 1.29 million deaths in that time frame.

Across age groups 15 years and older, COVID-19 was among the top five leading causes of death. Accidents and strokes were the fourth and fifth leading causes behind COVID-19 overall. Researchers at the National Cancer Center, which is part of NIH, found that in 2020, COVID-19 was the fourth and fifth leading cause of death among people ages 45–54 and 35–44, respectively. However, in 2021, COVID-19 became the first and second leading cause of death in these age groups. Unfortunately, COVID-19 hit older demographics even harder, as COVID-19 was the second leading cause of death in 2020, but dropped to third in 2021, likely because of targeted vaccination efforts in this age group.

In addition to causing direct deaths in the U.S., COVID-19 also had other negative health impacts. Deaths from other causes, including heart disease, accidents, stroke, Alzheimer’s disease and diabetes, increased from 2019 to 2020. Researchers think this could be due to patients delaying care during the pandemic, exacerbating their conditions without earlier treatment for fear of catching COVID-19. In addition, more impacts are likely to come in the future, as the pandemic may have prevented many people from receiving regular cancer screenings.

The findings were published in JAMA Internal Medicine.