These studies are based on the national statistics on causes of death produced by Inserm’s CépiDc through the comprehensive collection and analysis of the medical sections of death certificates. The BEH article analyzes the leading causes of death in 2021 in comparison to the 2015–2019 period and to 2020. It highlights trends that break with recent patterns. The Études et Résultats publication, meanwhile, details the evolution of Covid-19 mortality month by month and by region. It also examines changes in the institutional settings of death by cause. Finally, it presents an initial estimate of causes of death in 2022.

In 2021, the total number of deaths was 660,168, lower than in 2020 (667,497 deaths), but it remains significantly higher than in previous years even when accounting for the aging population. The year 2021 was marked by the ramp-up of the COVID-19 vaccination campaign, in addition to management and prevention measures related to the spread of SARS-CoV-2.

COVID-19, still the third leading cause of death in 2021

In 2021, COVID-19 remained the third ^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 deaths of 60,895 people in France in 2021, mostly older adults (median age of 84), who were slightly younger than in 2020 (median age of 86 in 2020).

As detailed in the Studies and Results, the number of deaths attributed to COVID-19 varied significantly by month, but differed by age group, with a particularly sharp decline in deaths among people over 85 throughout the first half of the year, whereas for younger people, the changes were less pronounced. These age-specific trends over the course of the year can be linked to the COVID-19 vaccination schedule and the timeline of public health management and protection measures.

Two-thirds of Covid-19 deaths in 2021 occurred in public healthcare facilities, which otherwise account for only 43% of all-cause deaths.

Furthermore, Covid-19 mortality increased in the overseas departments and regions (DROM) compared to 2020, with a particularly sharp epidemic peak in August 2021 in the Antilles. Finally, the regions of mainland France were affected by the epidemic to varying degrees, and compared to 2020, there was a spread toward the south and, to a lesser extent, toward the west.

A break in the trend for certain major causes in 2021

Mortality from tumors continues to trend downward, with the exception of pancreatic tumors and melanomas, which are still on the rise.

Analysis of causes of death reveals notable increases in mortality from circulatory system diseases in 2021 and from endocrine and digestive system diseases starting in 2020. These increases represent a break from the trends observed between 2015 and 2019, as detailed in the BEH article. The deviations from past trends are consistent with international findings.

A preliminary estimate of mortality rates and the number of deaths by cause, based on an initial fully automated processing of 2022 death certificates, suggests that these increases will continue into 2022.

These increases in mortality could be linked to indirect effects of the COVID-19 pandemic (delayed medical care, greater social isolation affecting behavior, increased harmful alcohol consumption, difficulties accessing care, long-term effects for those with COVID-19 as a contributing cause, ...) although it is not yet possible to assess the extent to which these factors contribute to the observed increase. Other factors unrelated to the pandemic cannot be ruled out. These findings warrant further studies to conduct a more in-depth analysis of these increases in mortality.

Finally, the health crisis has accentuated the upward trend in the proportion of deaths occurring at home, whereas the majority of deaths due to COVID-19 occur in hospitals. There has been a shift in deaths from other causes (particularly cancer) from healthcare facilities to the home. This can be explained in part by the increased use of home hospitalization, even outside of periods of epidemic crisis.