Three Years of Record High Mortality and Low Fertility Leave Many States with More Deaths than Births

Key Findings

image of gravestone and baby
With Covid-induced mortality at record highs and continuing low fertility during the past three years, U.S. births exceeded deaths by the smallest margin in more than a century. 

Recent fertility and mortality data reflect Covid’s continued grim impact on U.S. demographic trends. From 2020 to 2022, there were 1.26 million Covid deaths, excluding the excess deaths from conditions aggravated by the pandemic. Deaths increased significantly in every state. Between 2020 and 2022, the United States averaged 3,373,000 deaths annually: the most in history and 18 percent more than in 2019. In the same period, births declined by 3 percent to 3,645,000 annually. The net result was a 74 percent decline in the surplus of births over deaths from 892,000 in 2019 to an average of just 272,000 annually between 2020 and 2022: the smallest annual natural gains in a century. In 24 states, the substantial rise in deaths combined with fewer births produced a natural decline in the population over the three years of the pandemic. Deaths exceeded births in 20 states in all three pandemic years, 3 states in two years, and 4 in one year (Figure 1). In contrast, births consistently exceeded deaths in just 24 states including D.C., though the gap between births and deaths narrowed significantly in many of these states during the pandemic. Such widespread natural decline is unprecedented. At least 22 states had a natural decline in each of the three pandemic years. Prior to the pandemic, the most states with more deaths than births in a year was 5 in 2019. There will be fewer states with more deaths than births in 2023 if the recent reductions in Covid deaths persist. But many of the demographic factors contributing to rising mortality and declining fertility predate the pandemic, so deaths will continue to exceed births in some states in the near term and in more states in the future.

Figure 1. Number of Years that Deaths Exceed Births in States, 2020 to 2022

image of map displaying US states that are color coded in bright red, light red, pink, and blue to indicate number of years deaths exceeded births in those states from 2020 to 2022

Analysis: K.M. Johnson, Carsey School, University of New Hampshire. Source: 2020 and 2021 are final births and deaths, 2022 provisional estimates of births and deaths from NCHS-CDC. 

About the Author
photo of ken johnson

Kenneth M. Johnson is senior demographer at the Carsey School of Public Policy, professor of sociology at the University of New Hampshire, and an Andrew Carnegie Fellow.  His research was supported by the NH Agricultural Experiment Station through joint funding from the USDA National Institute of Food and Agriculture (under Hatch-Multistate project W5001, award number 7003437) and the state of New Hampshire. The opinions are his and not those of the sponsoring organizations. The research assistance of Tyrus Parker and GIS support of Barbara Cook are gratefully acknowledged.