Inserm’s Centre d’épidémiologie des causes médicales de décès (CépiDc-Inserm), the Direction de la recherche, des études et de l’évaluation des statistiques (DREES) and Santé Publique France are analyzing the medical causes of death of people living and dying in France in 2021. Two complementary studies, which present these results, are published jointly in Études et Résultats (DREES) and in the Bulletin épidémiologique hebdomadaire (Santé publique France). They are based on the national statistics on causes of death produced by Inserm’s CépiDc, based on exhaustive collection and analysis of the medical sections of death certificates. The article in the Bulletin épidémiologique hebdomadaire (BEH) analyzes the major causes of death in 2021, compared with the 2015-2019 period and 2020. It highlights developments that break with recent trends. The publication Études et Résultats (Studies and Results ) details trends in Covid-19 mortality, month by month and by region. It also examines trends in institutional places of death by cause. Finally, it presents an initial estimate of the causes of death in 2022.
In 2021, the total number of deaths will be 660,168, lower than in 2020 (667,497 deaths), but still significantly higher than in previous years, even taking into account the aging of the population. In 2021, the Covid-19 vaccination campaign will be stepped up to complement management and prevention measures linked to the circulation of Sars-CoV-2.
Covid-19, still the 3rd leading cause of death in 2021
In 2021, Covid-19 remained the 3rd leading cause of death in France (9.2% of all deaths), behind tumors (25.7%), the leading cause, and diseases of the circulatory system (20.9%), the second leading cause. Covid-19 directly caused the death of 60,895 people in France in 2021, the majority of them elderly (median age 84), who were slightly younger than in 2020 (median age 86 in 2020).
As detailed in Études et Résultats, the number of deaths attributed to Covid-19 varied considerably from month to month, but also according to age group, with a pronounced drop in deaths among people over 85 throughout the 1st half of the year, while the trend was less marked for younger people. These age-specific trends over the course of the year can be linked to the Covid-19 vaccination schedule and to management and personal protection measures.
Two-thirds of Covid-19 deaths in 2021 took place in public healthcare establishments, which account for just 43% of all-cause deaths.
In addition, Covid-19 mortality has intensified in the French overseas departments and regions (DROM) compared with 2020, with a marked epidemic peak in August 2021 in the West Indies. Lastly, the epidemic has affected French regions in a heterogeneous way, with an extension southwards and, more slightly, westwards compared to 2020.
A break in the trend for certain major causes in 2021
Mortality from tumors continues to fall, with the exception of pancreatic tumors and melanomas, which are still on the rise.
An analysis of causes of death reveals significant increases in mortality from diseases of the circulatory system in 2021, and from endocrine and digestive diseases from 2020. These increases represent a break with the trends for the years 2015-2019, as detailed in the article on. Deviations from past trends are consistent with international results.
An initial estimate of the rates and number of deaths by cause, based on the first fully automatic processing of death certificates in 2022, suggests that these increases will continue in 2022.
These increases in mortality could be linked to indirect effects of the Covid-19 epidemic (delays in treatment, greater social isolation affecting behavior, increased harmful alcohol consumption, difficulties in accessing care, sequelae for those with Covid-19 as an associated cause, etc.), although it is not possible at this stage to assess the contribution of these factors to the observed increase. Other factors unrelated to the epidemic cannot be ruled out. These results call for further studies to analyse these mortality increases in greater depth.
Finally, the health crisis has accentuated the upward trend in the proportion of deaths occurring at home, whereas the majority of Covid-19 deaths take place in hospital. There has been a shift in deaths from other causes (notably tumors) from institutions to the home. This can be partly explained by the greater use of hospitalization at home, even outside epidemic crisis periods.
