COVID-19 was an underlying cause associated with approximately 345,000 deaths during 2020, making it the third-leading cause of death behind heart disease and cancer, two new CDC reports on preliminary mortality data show.

Why it matters: The estimated death rate increased by nearly 16% from 2019, with mortality highest among older people, men or people from disproportionately affected racial and ethnic minority groups.

The big picture: The highest numbers of overall deaths and COVID-19 deaths came during April and December. COVID-19 was reported as the underlying cause of death or a contributing cause of death for an estimated 377,883 of total deaths.

• COVID-19 was the third-leading underlying cause of death in 2020, replacing suicide as one of the top 10 leading causes of death.
• Hispanic and American Indian or Alaska Native persons had the highest COVID-19 death rates.

Background: Concerns have been raised that some death certificates were being improperly attributed to COVID-19 and inflated deaths, another report notes.

• The CDC assessed hundreds of thousands of death certificates as of February 2021 and confirmed 97% had a co-occurring diagnosis that was a plausible chain-of-event condition to COVID-19 like pneumonia or respiratory failure or a significant contributing condition like hypertension or diabetes.
• Only 5.5% of death certificates had COVID-19 without any other conditions listed.

Noteworthy: The data are provisional and subject to change as the National Center for Health Statistics learns more.

Editor's note: This story has been updated to clarify that COVID-19 was an underlying cause associated with approximately 345,000 deaths. When tallied with the deaths for which COVID-19 was a contributing factor, that number is estimated to be 377,883.