Heart and cardiovascular disease is the leading cause of death among the Amish, just as it is for the general U.S. population. In one study of a Western New York Amish settlement, cardiovascular causes accounted for 54% of all deaths. What sets the Amish apart isn’t the type of disease that kills them most often, but the unique mix of lifestyle, genetic, and occupational factors that shift their overall risk profile in surprising ways.
Cardiovascular Disease Remains the Top Killer
Research spanning several decades and multiple Amish settlements consistently points to heart and circulatory problems as the primary cause of death. A 1970s project covering settlements in Northern Indiana, Holmes County, and Lancaster County found that the leading causes of death among both Amish and non-Amish neighbors were cardiovascular. In a survey of Amish in Milverton, Ontario, 45% of respondents named circulatory conditions as a personal health problem.
The picture isn’t uniform across communities, though. Amish men aged 49 to 69 had a significantly lower risk of cardiovascular death than their non-Amish peers, while Amish women over 70 actually had a higher risk. In Northern Indiana, rates of cardiovascular disease among the Amish exceeded the national average. These differences likely reflect variations in diet, physical demands, and access to emergency care across settlements. Some researchers have noted that Amish cardiovascular death rates might be even lower if communities had the same access to emergency transportation and communication as the general population.
Why Cancer Rates Are Unusually Low
Cancer is typically the second leading cause of death in the U.S., but the Amish have a strikingly lower burden. The overall cancer rate among Ohio Amish adults was 60% of the state average. For tobacco-related cancers, the rate dropped to just 37% of the Ohio average, reflecting very low smoking rates, especially among Amish women. Lung cancer incidence was only 13% of the expected rate, and no cases of cervical or laryngeal cancer were found at all.
Even cancers unrelated to tobacco occurred at 72% of the general Ohio rate. Breast cancer incidence was 58% of expected, prostate cancer 62%, and melanoma just 33%. The lower melanoma rate likely connects to traditional clothing that covers most skin. The absence of cervical cancer confirms findings from earlier studies and may relate to lower rates of the sexually transmitted virus that causes it. Together, these patterns mean cancer contributes proportionally less to Amish mortality than it does in the broader population.
Accidental Death Is a Major Factor
One area where the Amish face significantly higher risk is accidental injury and death, largely driven by their way of life. At one Level I trauma center, the top three causes of fatal injuries among Amish patients were falls (34.4%), being struck as a pedestrian (21.9%), and farming accidents (15.6%). These reflect the realities of agricultural work, elevated structures like barns and silos, and sharing roads with fast-moving motor vehicles.
Horse-and-buggy travel is particularly dangerous. Pennsylvania data from 2011 to 2013 recorded roughly 89 buggy crashes per 100,000 Amish residents per year, with a fatality rate of 2.6%, more than double the 1% fatality rate for all vehicle crashes statewide. Farm equipment crashes were even deadlier at 4.1% fatality. Off-road farming incidents were especially likely to be fatal. These accident rates make unintentional injury a disproportionately large share of Amish deaths compared to the general population.
Genetic Disorders and Infant Health
The Amish descend from a small group of European founders, and centuries of marriage within the community have concentrated certain rare genetic mutations. Several of these cause severe conditions in infancy. Amish lethal microcephaly, a fatal brain development disorder, occurs at carrier rates of 1 in 14 to 1 in 22 in Lancaster County. A condition causing rigid muscles and uncontrollable seizures in newborns has carrier rates of 1 in 21 to 1 in 36. A severe form of muscle weakness affecting infants has carrier rates around 1 in 16 to 1 in 19.
Other inherited conditions include a disorder where the body cannot properly break down certain proteins (with carrier rates as high as 1 in 8 in some communities), a dangerous buildup of bilirubin in newborns, and a syndrome linked to sudden infant death. Despite these risks, studies have found that overall Amish infant death rates in some settlements are comparable to those of other rural white populations in the same state. Researchers suggest that protective social factors within Amish communities, such as strong family support and low substance use, may offset the elevated genetic risks.
Lifestyle Factors That Shift the Balance
The Amish lifestyle creates a distinctive health profile that both protects against and contributes to different causes of death. On the protective side, their physically active daily routines are significant. Farming, manual labor, and walking instead of driving mean most Amish people get far more exercise than the average American. This higher activity level is one reason researchers believe the Amish tend to live longer than non-Amish populations despite using hospitals less frequently. Their diets are heavy on fruits and vegetables, though also high in fats, and tobacco use is comparatively low.
There’s even a genetic advantage in at least one community. In the Berne, Indiana, Amish settlement, researchers discovered a mutation that lowers levels of a protein involved in aging and blood clotting. Carriers of this mutation had longer protective caps on their chromosomes (a marker of biological youth), lower fasting insulin, less diabetes, and a measurably longer life span. The finding suggests that some Amish communities carry genetic variants that actively slow aging.
Working against these advantages are limited access to preventive screenings, delayed emergency care due to rural locations and lack of phones, and low vaccination rates. Roughly 92% of Amish children in one study were unvaccinated, and Amish children were hospitalized for vaccine-preventable diseases at more than twice the expected rate. While infectious disease outbreaks can be serious, they don’t rival cardiovascular disease or accidents as overall causes of death. The combination of high physical activity, low cancer rates, elevated accident risk, and rare genetic conditions creates a mortality pattern that looks quite different from the American average, even though the number one killer is the same.