Assessment of COVID-19 as the underlying cause of death among children and young people aged 0 to 19 years in the US

This supplemental content accompanies an assessment of COVID-19 as the underlying cause of death among U.S. children and young people aged 0 to 19 years. The purpose is to contextualize COVID-19 mortality within the leading causes of death across pediatric age groups by ranking it alongside established cause-of-death categories.

Leading causes of death were tabulated using the National Center for Health Statistics (NCHS) 113 Selected Causes of Death List for ages 0–19 years and, for infant analyses, the NCHS 130 Selected Causes of Infant Death List. COVID-19 deaths were evaluated for the period August 1, 2021–July 31, 2022. Comparisons for other causes used 2019 data. Population size estimates by single year of age for 2019 and 2021 were obtained from the U.S. Census Bureau to compute crude death rates (per 100,000 for most age groups; per 1,000 live births for infant-specific tables). Data source included CDC WONDER (https://wonder.cdc.gov). Rankings, deaths, crude rates, and percentage contributions among the top 10 causes were provided for age groups: <1 year, 1–4 years, 5–9 years, 10–14 years, and 15–19 years. Neonatal (<28 days) and late-infant (28–365 days) leading causes were additionally presented.

Across all analyzed age groups, COVID-19 ranked among the 10 leading causes of death. For ages <1 year (2019 leading causes; COVID-19 measured Aug 2021–Jul 2022), COVID-19 ranked 7th with 153 deaths (crude rate 4.3 per 100,000). For ages 1–4 years, COVID-19 ranked 7th with 91 deaths (0.6 per 100,000). For ages 5–9 years, COVID-19 ranked 6th with 89 deaths (0.4 per 100,000). For ages 10–14 years, COVID-19 ranked 6th with 110 deaths (0.5 per 100,000). For ages 15–19 years, COVID-19 ranked 5th with 378 deaths (1.8 per 100,000). In neonatal infants (<28 days), COVID-19 was not a leading cause of death; however, among infants aged 28–364 days, COVID-19 was a top 10 cause. In older pediatric groups, accidents, suicide, and homicide remained the leading causes, with malignant neoplasms and congenital anomalies also prominent, while COVID-19 featured within the top 10 across groups.

The rankings indicate that COVID-19 represents a notable cause of mortality among U.S. children and young people, consistently appearing among the leading causes of death across most pediatric age strata. While perinatal conditions dominate mortality in the first 28 days of life (rendering COVID-19 not a leading cause in that interval), COVID-19 emerges as a top 10 cause from late infancy onward. These findings contextualize COVID-19 mortality relative to other major pediatric risks, such as unintentional injuries, suicide, and homicide in adolescence, and congenital anomalies and malignancies in younger ages.

Supplemental analyses demonstrate that COVID-19 ranks among the 10 leading causes of death for U.S. children and young people aged 0–19 years, with variation by age group and absence from the neonatal top causes. These rankings provide context for pediatric COVID-19 mortality alongside established leading causes. Future research could refine age-specific risk assessments and examine trends over time as pandemic conditions and interventions evolve.