The people dying from COVID-19 are overwhelmingly older adults with chronic health conditions. The average age of those who die in the hospital is around 65, and the risk climbs steeply after 60. But age alone doesn’t tell the full story. Underlying diseases, immune status, race, and even where someone lives all shape who is most vulnerable.
Age Is the Single Strongest Risk Factor
Among hospitalized patients who die from COVID-19, the average age is roughly 65. Data from South Africa comparing variant waves illustrates just how steep the age gradient is: during the Delta wave, the case fatality rate for people 60 and older was 11.7%, compared to 2.5% for those aged 40 to 59 and just 0.45% for adults 20 to 39. The Omicron variant brought those numbers down across the board, with a fatality rate of 2.4% for people over 60, but the relative pattern held. Older people remain several times more likely to die than younger adults from the same infection.
This doesn’t mean younger people are immune to fatal outcomes. Adults in their 40s and 50s with multiple chronic conditions still face meaningful risk, and the virus has killed people in every age group. But for anyone under 40 without underlying health problems, the risk of death is very low with current variants.
Chronic Conditions That Raise the Risk
The CDC lists more than a dozen conditions that increase the likelihood of severe illness and death from COVID-19. The ones that show up most often among people who die in the hospital are high blood pressure, type 2 diabetes, obesity, and chronic kidney disease. Heart conditions, chronic lung disease, chronic liver disease, and cancer also appear frequently. Having dementia or other neurological conditions raises risk as well.
What matters is not just having one of these conditions but how many you have. Research on hospitalized patients found that people who died had a higher average number of comorbidities than those who survived. Each additional condition compounds the body’s difficulty fighting the virus, making it harder to maintain oxygen levels, clear infection, and avoid organ damage. Someone who is 70 with diabetes and kidney disease faces a fundamentally different level of danger than a healthy 70-year-old.
Weakened Immune Systems
People whose immune systems are suppressed, whether from cancer treatment, organ transplants, autoimmune medications, or conditions like HIV, remain among the most vulnerable. Their bodies produce a weaker response to both infection and vaccination, which means they’re less protected even when fully up to date on shots. The CDC specifically identifies immunocompromising conditions as a risk factor for hospitalization, intensive care, ventilator use, and death.
This group faces a cruel double bind: they’re more likely to get severely ill and less likely to benefit from the tools designed to prevent it. Antiviral treatments can help, but they work best when started very early after symptoms begin, which requires quick access to testing and prescriptions that not everyone has.
Nursing Homes and Long-Term Care
Long-term care facilities were devastated early in the pandemic and have continued to account for a disproportionate share of deaths. As of January 2022, residents and staff of these facilities made up at least 23% of all COVID-19 deaths in the United States, totaling more than 200,000 people. That’s roughly one in four deaths occurring in a setting that houses a tiny fraction of the population.
The reasons are straightforward: residents tend to be elderly, have multiple chronic illnesses, and live in close quarters where respiratory viruses spread easily. Staffing shortages and infection control challenges made containment difficult, particularly before vaccines became available.
Racial and Ethnic Disparities
COVID-19 has not killed evenly across racial and ethnic groups. A study examining U.S. mortality data from 2020 through 2023 found that American Indian and Alaska Native communities experienced the highest cumulative death rate: 154 per 100,000 people. Native Hawaiian and Pacific Islander populations (124 per 100,000), Black Americans (124 per 100,000), and Hispanic Americans (123 per 100,000) all faced death rates well above the white population’s rate of 82 per 100,000. Asian Americans had the lowest rate at 55 per 100,000.
These gaps reflect longstanding inequities in healthcare access, housing density, occupational exposure, and rates of chronic disease rather than any biological difference. Many of the hardest-hit communities had higher proportions of essential workers who couldn’t work from home, less access to timely medical care, and higher baseline rates of conditions like diabetes and hypertension.
By 2023, these disparities had shifted somewhat. White Americans actually had the highest single-year death rate that year (24.9 per 100,000), followed by American Indian/Alaska Native individuals (23.3) and Black Americans (21.4). Hispanic and Asian Americans had the lowest 2023 rates. This shift likely reflects differences in vaccination uptake, booster coverage, and access to treatment across communities in the later stages of the pandemic.
Men Die at Higher Rates Than Women
Studies of hospitalized patients consistently find that most of those who die are male. This pattern has held across countries and variants. The reasons likely involve a combination of biological factors (differences in immune response between sexes) and behavioral ones (men are less likely to seek early medical care on average and have higher rates of certain risk factors like smoking and cardiovascular disease).
How Current Variants Compare to Earlier Ones
The virus circulating today is far less lethal per infection than the strains that dominated in 2020 and 2021. The Delta variant had a case fatality rate of about 2.6% across all ages. Omicron dropped that to 0.78%, a 70% reduction. For people over 60, the drop was from nearly 12% to about 2.4%. Subvariants of Omicron have shown similar fatality rates to one another, with no significant differences between them.
This decline comes from a combination of the virus evolving to be less inherently deadly in the lower lungs, widespread immunity from prior infections and vaccination, and better treatment options. But a lower fatality rate applied to enormous numbers of infections still produces significant death tolls, and the people dying remain concentrated in the same high-risk groups.
Treatment Has Changed the Odds
Oral antiviral treatment, when given within three days of symptom onset, reduced the risk of hospitalization or death by 89% in a major clinical trial of high-risk, unvaccinated adults. In that study, fewer than 1% of treated patients were hospitalized and none died, compared to 7% hospitalized and 7 deaths in the group that received a placebo. Another oral antiviral achieved a 30% reduction in the same outcomes.
These treatments have meaningfully changed who dies, but only when people actually receive them. Getting tested early, having a doctor who will prescribe the medication quickly, and being able to afford it all create barriers. People who are isolated, lack insurance, or don’t recognize their symptoms as COVID-19 can miss the narrow treatment window entirely. The same communities that face higher death rates also tend to face more of these access barriers.