COVID-19 became the second leading cause of death globally in the year after it was declared a pandemic, according to a study published in the Lancet.

While heart disease remained the top killer, COVID “radically altered” the main five causes of death for the first time in 30 years, displacing stroke, the publication said. In 2021, 94 in every 100,000 people died from COVID, on an age-standardized basis.

Since 1990, global life expectancy increased by 6.2 years, mainly due to reductions in death from diarrhea and lower respiratory infections and better outcomes for people suffering from a stroke or ischemic heart disease.