COVID-19 as the leading cause of hospital deaths in the Brazilian public health system in 2020

•There was a 16.7% increase in the number of hospital deaths in 2020 compared with 2019 in Brazil.•More than 19% of hospital deaths in 2020 were related to coronavirus disease 2019 (COVID-19), which was the leading cause of hospital death.•Forty percent of COVID-19 deaths were in individuals of black/brown ethnicity and 75% were among adults aged ≥60 years.•Brazil experienced a high death toll due to the COVID-19 pandemic in 2020. Objectives: To describe the profile of hospital deaths in Brazil according to cause of admission during the pre-pandemic (2019) and pandemic periods (2020). Methods: Descriptive study based on individual-level records of all hospital admissions with death outcomes reimbursed by the Brazilian National Health System in 2019 and 2020. Results: The number of hospital deaths increased by 16.7% in 2020 compared with 2019 (522,686 vs 609,755). Coronavirus disease 2019 (COVID-19) was associated with 19.5% (118,879) of all hospital deaths in 2020, surpassing diseases of the circulatory system (15.4%, 93,735) and diseases of the respiratory system (14.9%, 91,035). Conclusions: COVID-19 was the main cause of death in public hospitals in Brazil in 2020.