COVID-19 was the third leading cause of death in the United States for the second year in a row in 2021, with death rates rising for most age groups, a government study showed on Friday.

COVID-19 was the underlying or contributing cause of 460,513 deaths in the United States last year, a nearly 20% jump compared to 2020, the study by the U.S. Centers for Disease Control and Prevention (CDC) showed.

The researchers analyzed death certificate data for deaths occurring among residents in the United States during January to December last year. They found that 2021 saw the highest overall death rate since 2003, with heart disease and cancer being the first and the second leading cause of death, respectively.

The overall death rate was lowest among children aged 5 to 14 years old, and highest among people aged 85 and above, a trend similar to 2020, the report found. Deaths peaked in the months of January and September.

COVID-19 was associated with 111.4 per 100,000 deaths in the United States in 2021, compared to 93.2 per 100,000 deaths in 2020, CDC data showed. COVID death rates were lowest among those aged 1 to 4 years and 5 to 14 years.

While COVID death rates were the highest for those 85 years and older in 2021, those rates fell from 2020. There were 94,884 COVID-19 related deaths last year among those aged 85 and above compared with 122,707 in 2020, data showed.

Age groups under 75 saw significant increases in deaths, the researchers found.

The report also found that the overall age-adjusted U.S. death rate rose nearly 1% from 2020 to 2021.