AJPM Focus (Dec 2023)

Ethnoracial Disparities in Rates of Non-Natural Causes of Death After the 2020 COVID-19 Outbreak in New York State

  • Thomas E. Smith, MD,
  • Tatiana Ledneva, MS,
  • Dana E. Cohen, MPA,
  • Kelly S. Ramsey, MD,
  • Michael J. Bauer, MS,
  • Jay Carruthers, MD,
  • Mary Beth Conroy, MPH,
  • Sally R. Dreslin, MA, MS, RN,
  • Marcus Friedrich, MD, MBA,
  • Mingzeng Sun, PhD,
  • Madelyn S. Gould, PhD, MPH,
  • Michael Schoenbaum, PhD,
  • Mark Olfson, MD, MPH

Journal volume & issue
Vol. 2, no. 4
p. 100151

Abstract

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Introduction: COVID-19 was associated with increases in non-natural cause mortality in the U.S., including deaths due to drug overdose, homicide, and motor vehicle crashes. Initial reports indicated higher rates of non-natural mortality among ethnoracial minority groups. This report aims to clarify these disparities by documenting trends in non-natural mortality across ethnoracial groups during the 2020 COVID-19 surge in New York State. Methods: We report monthly trends in non-natural cause mortality (overall and stratified by ethnoracial status) in New York State from January 2019 through December 2020, which included the COVID-19 onset in March 2020. Results: Total mean monthly unintentional overdose rates per 100,000 increased from 17.45 (before surge: January 2019–February 2020) to 23.19 (after surge: March 2020–December 2020) (mean difference=5.73, 95% CI=3.82, 7.65; p<0.001). Mean monthly homicide death rates increased from 2.34 before surge to 3.55 after surge (mean difference=1.20, 95% CI=0.60, 1.81; p<0.001), with the increase seen primarily in the non-Latinx Black population. Although increasing unintentional overdose death rates before surge equally affected non-Latinx White, Latinx, and non-Latinx Black persons, they remained high for non-Latinx Black persons but dropped for the other 2 groups after the pandemic onset. None of the ethnoracial subgroups showed significant increases in suicide or motor vehicle crash death rates. Conclusions: Non-Latinx Black persons showed disproportionately high and sustained increased rates of unintentional overdose and homicide death rates after the 2020 COVID-19 surge in New York State. Fatality review and death scene investigation research is needed to better understand these disparities.

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