evidence: Among adults aged ≥65 years who were unvaccinated or had received a bivalent COVID-19 vaccine booster dose, 8,161 COVID-19–associated deaths in the 20 U.S. jurisdictions were reported during September 18, 2022–April 1, 2023. Overall, 58% of deaths occurred among adults aged ≥80 years; this distribution was consistent among vaccinated and unvaccinated persons and across the three variant periods. Mortality rates among adults aged ≥65 years peaked in December 2022 during the BQ.1/BQ.1.1 predominance period. Higher mortality rates were observed among unvaccinated persons during all three periods of Omicron lineage predominance (Table).