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. 2025 Aug 11:333549251358657.
doi: 10.1177/00333549251358657. Online ahead of print.

Most Common Causes of Death Among Travelers on Aircraft and Maritime Vessels and During Land-Border Crossings Reported to the Centers for Disease Control and Prevention, 2008-2022

Leigh Ellyn Preston  1 , Justice King  1 , Nancy Ortiz  1 , Francisco Alvarado-Ramy  1 , Clive Brown  1 , Sundari Mase  1 , Shannon L Gearhart  1 , Deborah L Christensen  1 , George A Pourakis  1 , Maureen Fonseca-Ford  1 , Erin E Rothney  1 , Zenia K Sunavala  1 , Samantha D Swisher  1   2 , Leslie Hausman  1   2 , Alida M Gertz  1
Affiliations

Most Common Causes of Death Among Travelers on Aircraft and Maritime Vessels and During Land-Border Crossings Reported to the Centers for Disease Control and Prevention, 2008-2022

Leigh Ellyn Preston et al. Public Health Rep. .

Abstract

Objectives: Historically, the most frequent cause of death reported to the Centers for Disease Control and Prevention (CDC) among travelers on conveyances has been cardiovascular disease, mirroring all-cause mortality in the US population. Infectious disease transmission, particularly during large-scale outbreaks, also poses a risk to travelers. To determine leading causes of death on conveyances and whether they were affected by the COVID-19 pandemic, we describe causes of death on conveyances reported to CDC from 2008 through 2022.

Methods: We queried CDC's Port Health Activity Reporting System for traveler deaths on, or immediately after disembarking from, an aircraft or maritime vessel or during land-border crossings reported to CDC from July 1, 2008, through December 31, 2022. We examined data on cause of death, age, travel mode, and traveler type (passenger vs crew). We also calculated crude annual mortality rates for each conveyance type. To assess factors associated with deaths due to infectious diseases (vs deaths due to noninfectious conditions), we performed logistic regression.

Results: During the analysis period, 2910 deaths on conveyances were reported. Across all conveyances, the most common causes were cardiovascular- or pulmonary-related conditions (2116 of 2910; 73%) for each year except 2020, when COVID-19 was the most common. Crew (vs passengers) had significant associations with death due to infectious causes (vs noninfectious causes; adjusted odds ratio = 2.12; 95% CI, 1.32-3.40).

Conclusions: Travelers with cardiovascular- or pulmonary-related conditions should consult their health care providers prior to international travel. All travelers should check travel recommendations such as those currently available on CDC travel pages. Public health authorities should consider population-based mitigation measures aimed at transmission risk reduction to limit morbidity and mortality during infectious disease outbreaks.

Keywords: aircraft; border health; cruise ship; land crossing; mortality; travel.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

This chart presents the number of deaths caused by various diseases and conditions during travel on maritime vessels and aircraft, and during land-border crossings, from July 1, 2008, to December 31, 2022. The data was sourced from the Port Health Activity Reporting System. The chart is a stacked bar graph, where each bar represents a year, and the segments of each bar represent the number of deaths caused by different causes. The causes of death are color-coded and included in the legend at the top of the chart. Starting from 2008, there is an overall increasing trend in the number of deaths caused by COVID-19. In the early years, the deaths caused by infectious diseases (not Covid-19) were the most significant. Over the years, deaths caused by pre-existing chronic conditions and cardiovascular- or pulmonary-related conditions saw a decrease. COVID-19 deaths peaked in 2020 and 2021, while deaths from infectious diseases (not Covid-19) decreased substantially in 2022. Other causes of death remained relatively stable throughout the years, with a slight increase in deaths caused by injury/trauma in 2022.
Figure 1.
Causes of death by year among travelers on maritime vessels and aircraft conveyances and during land-border crossings reported to the Centers for Disease Control and Prevention, July 1, 2008, through December 31, 2022. Data source: Port Health Activity Reporting System.
A) The graph shows the causes of death, categorized by type and condition, among travelers on maritime vessels from 2008 to 2022, with a notable increase in COVID-19 deaths in 2020. (B) The graph illustrates the crude mortality rate per million travelers on maritime vessels for the same period, with a significant spike in 2020 due to the No Sail Order.
Figure 2.
(A) Causes of death by year among travelers on maritime vessels reported to the Centers for Disease Control and Prevention, July 1, 2008, through December 31, 2022. The No Sail Order was instituted in March 2020. Data source: Port Health Activity Reporting System. (B) Crude mortality rate per 10 million travelers among travelers on maritime vessels reported to the Centers for Disease Control and Prevention, by year, July 1, 2008, through December 31, 2022. The No Sail Order was instituted in March 2020. Data sources: US Customs and Border Protection Planning, Program Analysis, and Evaluation and Port Health Activity Reporting System.
The chart consists of two graphs labeled A and B. Graph A displays the number of deaths among travelers on aircraft conveyances reported to the Centers for Disease Control and Prevention from July 1, 2008, through December 31, 2022. Graph B shows the crude mortality rate per 10 million travelers on aircraft conveyances for the same period. Graph A has multiple categories: COVID-19, cardiovascular- or pulmonary-related conditions, infectious disease (not COVID-19), injury/trauma, other, and preexisting chronic condition. Graph B has a single metric. There are notable peaks in the number of deaths in 2020 and a significant increase in the crude mortality rate in the same year.
Figure 3.
(A) Causes of death among travelers on aircraft conveyances reported to the Centers for Disease Control and Prevention, by year, July 1, 2008, through December 31, 2022. Data source: Port Health Activity Reporting System. (B) Crude mortality rate per 10 million travelers among travelers on aircraft reported to the Centers for Disease Control and Prevention, by year, July 1, 2008, through December 31, 2022. Data sources: Bureau of Transportation Statistics, Port Health Activity Reporting System. Note: During much of 2020, air travel restrictions based on flight origin location were in place for air travelers entering the United States. During much of 2021, pretravel testing requirements were in place, and for much of 2022, vaccination requirements were in place for air travelers entering the United States.
A bar chart displays the number of deaths among travelers crossing land borders and the crude mortality rate per 10 million travelers from 2008 to 2022. The deaths are categorized by cause, while the crude mortality rate shows the mortality rate per 10 million travelers.
Figure 4.
(A) Causes of death among travelers crossing land borders reported to the Centers for Disease Control and Prevention, by year, July 1, 2008, through December 31, 2022. Data source: Port Health Activity Reporting System. (B) Crude mortality rate per 10 million travelers among travelers crossing a land border reported to the Centers for Disease Control and Prevention, by year, July 1, 2008, through December 31, 2022. Data sources: Bureau of Transportation Statistics and Port Health Activity Reporting System.
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