A graph shows the number of deaths per year according to Watauga County death records.

WATAUGA — Like many communities across America, COVID-19 was a significant cause of death in Watauga County in 2020, but not the leading cause in a year that saw more deaths than any in the last 20.

In 2020, Watauga County experienced more deaths — 456 — than any other year since 2000, according to death records provided by the Watauga County Register of Deeds. The leading cause of death for those who died in Watauga County was tobacco use.

Watauga County’s death rate was 77 deaths per 10,000 people — the second highest death rate in the past 20 years. In 2002, when the population was 44,570, the death rate was 79 per 10,000 people and 356 people died in the county, according to the Watauga County Register of Deeds.

As of April 27, county census data is not available from the Census Bureau. The 2020 population for Watauga County is based on an estimate by the North Carolina Office of State Budget and Management. The final 2020 population census numbers could be fewer or greater than estimated.

The 2020 death records list multiple identifying factors including resident city, state and county. Of the 456 deaths, 355 were listed as residing in Watauga County.

“This has been a difficult year for all of us, and our thoughts and prayers go out to those who have experienced illness and death of loved ones,” said AppHealthCare Health Director Jennifer Greene. “We encourage everyone to take care of yourself and your loved ones because this past year with COVID-19 has shown us again that we are all connected.”

AppHealthCare spokesperson Melissa Bracey said the agency encourages people to focus on prevention when thinking about how to be healthy and decrease their risk of death from preventive factors. Bracey said poor nutrition, lack of physical activity and tobacco use increase the risk of illness and death from preventable illnesses like respiratory issues, high blood pressure and heart disease.

Tobacco use

Tobacco use contributed to the death of approximately 17.1 percent — or about one in five — of the people who died in Watauga County last year.

Smoking is the leading cause of preventable death in America with nearly 480,000 deaths per year, according to the Centers for Disease Control and Prevention. That’s roughly one in five deaths annually.

Of the 456 deaths last year in the county, 40 were listed as “yes” and 38 were listed that tobacco use “probably” contributed to their death. Tobacco use did not contribute to 196 people’s deaths while 182 were listed as “unknown.”

Sixty-six percent of the people who had “yes” or “probably” listed for tobacco use contributing to their death were men.

Bracey said the agency is able to provide free Nicotine Replace Therapy for residents of Alleghany, Ashe, Avery, Watauga and Wilkes counties, in addition to free counseling services through QuitlineNC.

“We have a dedicated focus on providing and educating the community on how to prevent tobacco use and resources to quit when they’re ready,” Bracey said. “We work at both an individual level and policy level to tackle tobacco use in our communities.”

For example, Bracey said AppHealthCare has trained providers and clinicians who are able to provide and link patients to cessation resources.

“We also work at a policy level with community leaders and advocates to educate and implement smoke-free and tobacco-free policies — examples include smoke-free multi-unit housing, tobacco-free schools and smoke/tobacco-free workplace policies,” Bracey said. “We also work with the school systems to educate youth about tobacco use and vaping and implement tobacco cessation media campaigns that link people to cessation resources.”

QuitlineNC provides free cessation resources and services to any North Carolina resident who is trying to quit smoking. The QuitlineNC number is 1 (800) 784-8669, and more information can be found at

According to the CDC, smoking causes cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease, which includes emphysema and chronic bronchitis. The CDC states that smoking also increases risk for tuberculosis, certain eye diseases and problems of the immune system, including rheumatoid arthritis.

Approximately six people died from lung cancer last year, according to the county death records. Another 24 people died from COPD and more than 50 people died from heart-related causes.


COVID-19 factored into 33 deaths last year, according to the death records. Of those, 14 were not residents of Watauga County. 

The average age of those who died from COVID-19 complications was 81. The youngest person to die in Watauga County from the virus was 57 while the oldest was 96.

Nineteen of the people who died from COVID-19 were men while 14 were women, according to the records.

According to the CDC, there were between 545,600–660,200 estimated excess deaths in the United States from Jan. 26, 2020 to Feb. 27, 2021. The CDC defines excess deaths as the number of persons who have died from all causes above the expected number of deaths for a given place and time. Estimates of excess deaths can provide a comprehensive account of mortality likely related to the COVID-19 pandemic, including deaths that are both directly and indirectly associated with COVID-19, according to the CDC.

Thirty-one Watauga County residents have died from COVID-19 since the start of the pandemic as of April 27.


Heart-related complications were the cause of death for roughly 13 percent of those who died last year. In Watauga County, that includes cardiac arrest, congestive heart failure, coronary artery disease or cardiopulmonary arrest.

Congestive heart failure occurs when heart muscles don’t pump blood as well as it should, according to the Mayo Clinic. Certain conditions which narrow arteries in a heart — such as coronary artery disease or high blood pressure — gradually leave a heart too weak or stiff to fill and pump efficiently.


More than 50 people died from respiratory related complications last year. Those do not include deaths due to COVID-19. At least 30 of those deaths were from respiratory failure, which develops when the lungs can’t get enough oxygen into the blood, according to the National Heart, Lung and Blood institute.

The NHLBI stated that causes for respiratory failure include conditions that make it difficult to breathe in or out, lung collapse, fluid in lungs, problems with breathing muscles and conditions affecting the brain’s control of a person’s breathing.

Twenty-four people also died from pneumonia, which is an infection that inflames the air sacs in one or both lungs, according to the Mayo Clinic.


Watauga County had at least 45 people die from Alzheimer's disease or dementia-related complications in 2020. According to the CDC, as many as 5.8 million Americans were living with Alzheimer’s disease in 2020.

In addition to memory issues, symptoms of Alzheimer's disease can include trouble handling money and paying bills, difficulty completing familiar tasks at home or work, and decreased or poor judgement.

The average age of those who died from Alzheimer’s or dementia-related causes of death was 87.

People can reduce their risks of cognitive decline by creating key lifestyle habits, according to the Alzheimer's Association. Key habits include working out, challenging the brain and not smoking. More ways to prevent cognitive decline can be found at

Mental health

At least seven people died by suicide in 2020, according to the records. If you or someone you know is struggling with suicidal thoughts, call the Daymark Recovery Services 24-hour crisis line at (866) 275-9552 or the National Suicide Hotline at 1 (800) 273-8255.

“This year has brought forth a lot of stress and anxiety, and we encourage everyone to also take care of your mental health,” said Bracey, the spokesperson for AppHealthCare. “This is just as important as your physical health because stress, anxiety and worry can show up in physical ways for our bodies and affect our overall health. Take time to care for yourself and others around you and reach out for help if you need it.”

Another seven people had a drug toxicity listed as their cause of death, including at least two from methamphetamine toxicity.

Moving forward

Health-related issues — like heart disease and respiratory illnesses — occurred prior to COVID-19, Bracey said. AppHealthCare director Greene encourages people to seek out primary medical care and have regular checkups with a health care provider so they can focus on prevention.

“We all benefit when we are able to focus on prevention efforts like being vaccinated, quitting tobacco use, getting regular physical activity and eating healthy," Greene said. “We know some people have delayed this routine care due to the pandemic, and we would highly recommend you take time to see your health care provider for preventive care.”

Each year AppHealthCare compiles and releases a report highlighting the health of Alleghany, Ashe and Watauga counties through a range of metrics AppHealthCare reviews.

This summer, AppHealthCare will release the Community Health Assessment for Alleghany, Ashe and Watauga counties. The assessment is released every three years. Bracey said the 2021 report will focus on key areas like leading causes of death, county health data and information about COVID-19.

"We conducted a survey with residents to gauge their opinions on how COVID-19 has affected their health and well-being and will include this information and data in this year’s Community Health Assessment," Bracey said.

The latest report released was the 2019 State of the County’s Health report for Watauga County, which can be found at

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