Increases in ‘deaths of despair' during the COVID-19 pandemic in the USA and UK

Objectives The COVID-19 pandemic significantly impacted mental health, health-related behaviours such as drinking and illicit drug use, and the accessibility of health and social care services. How these pandemic shocks affected "despair”-related mortality in different countries is less clear. This study uses public data to compare deaths from alcohol, drugs and suicide in the USA and UK to identify similarities or differences in the impact of the pandemic on important non-COVID causes of death across countries and to consider the public health implications of these trends. Study design and methods Data was taken from publicly available mortality figures for England & Wales, Northern Ireland, Scotland and the United States of America 2001-2021 and analysed descriptively through age-standardised and age-specific mortality rates from suicide, alcohol and drug use. Results Alcohol-specific deaths increased in all countries between 2019 and 2021, most notably in the USA and, to a lesser extent, England & Wales. Suicide rates did not increase markedly during the pandemic in any of the included nations. Drug-related mortality rates rose dramatically over the same period in the USA but not in other nations. Conclusions Mortality from ‘deaths of despair' during the pandemic has displayed divergent trends between causes and countries. Concerns about increases in deaths by suicide appear to have been unfounded, while deaths due to alcohol have risen across the UK and in the USA and across almost all age groups. Scotland and the USA had similarly high levels of drug-related deaths pre-pandemic, but the differing trends during the pandemic highlight the different underlying causes of these drug death epidemics and the importance of tailoring policy responses to these specific contexts.

Moderators of changes in smoking, drinking and quitting behaviour associated with the first COVID-19 lockdown in England.

AIM: To estimate changes in smoking, drinking and quitting behaviour from before to during the first COVID-19 lockdown in England, and whether changes differed by age, sex or social grade. DESIGN: Representative cross-sectional surveys of adults, collected monthly between August 2018 and July 2020. SETTING: England. PARTICIPANTS: A total of 36 980 adults (≥ 18 years). MEASUREMENTS: Independent variables were survey month (pre-lockdown: August-February versus lockdown months: April-July) and year (pandemic: 2019/20 versus comparator: 2018/19). Smoking outcomes were smoking prevalence, cessation, quit attempts, quit success and use of evidence-based or remote cessation support. Drinking outcomes were high-risk drinking prevalence, alcohol reduction attempts and use of evidence-based or remote support. Moderators were age, sex and occupational social grade (ABC1 = more advantaged/C2DE = less advantaged). FINDINGS: Relative to changes during the same time period in 2018/19, lockdown was associated with significant increases in smoking prevalence [+24.7% in 2019/20 versus 0.0% in 2018/19, adjusted odds ratio (aOR) = 1.35, 95% confidence interval (CI) = 1.12-1.63] and quit attempts (+39.9 versus -22.2%, aOR = 2.48, 95% CI = 1.76-3.50) among 18-34-year-olds, but not older groups. Increases in cessation (+156.4 versus -12.5%, aOR = 3.08, 95% CI = 1.86-5.09) and the success rate of quit attempts (+99.2 versus +0.8%, aOR = 2.29, 95% CI = 1.31-3.98) were also observed, and did not differ significantly by age, sex or social grade. Lockdown was associated with a significant increase in high-risk drinking prevalence among all socio-demographic groups (+39.5 versus -7.8%, aOR = 1.80, 95% CI = 1.64-1.98), with particularly high increases among women (aOR = 2.17, 95% CI = 1.87-2.53) and social grades C2DE (aOR = 2.34, 95% CI = 2.00-2.74). Alcohol reduction attempts increased significantly among high-risk drinkers from social grades ABC1 (aOR = 2.31, 95% CI = 1.78-3.00) but not C2DE (aOR = 1.25, 95% CI = 0.83-1.88). There were few significant changes in use of support for smoking cessation or alcohol reduction, although samples were small. CONCLUSIONS: In England, the first COVID-19 lockdown was associated with increased smoking prevalence among younger adults and increased high-risk drinking prevalence among all adults. Smoking cessation activity also increased: more younger smokers made quit attempts during lockdown and more smokers quit successfully. Socio-economic disparities in drinking behaviour were evident: high-risk drinking increased by more among women and those from less advantaged social grades (C2DE), but the rate of reduction attempts increased only among the more advantaged social grades (ABC1).

Alcohol deaths rise sharply in England and Wales

A spike is concerning but we mustn’t lose sight of longer term trends across the UK

Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis.

BACKGROUND: Deaths directly linked to COVID-19 infection may be misclassified, and the pandemic may have indirectly affected other causes of death. To overcome these measurement challenges, we estimate the impact of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality from week 10 of 2020, when the first COVID-19 death was registered, to week 47 ending 20 November 2020 in England and Wales through an analysis of excess mortality. METHODS: We estimated age and sex-specific excess mortality risk and deaths above a baseline adjusted for seasonality with a systematic comparison of four different models using data from the Office for National Statistics. We additionally provide estimates of life expectancy at birth and lifespan inequality defined as the SD in age at death. RESULTS: There have been 57 419 (95% prediction interval: 54 197, 60 752) excess deaths in the first 47 weeks of 2020, 55% of which occurred in men. Excess deaths increased sharply with age and men experienced elevated risks of death in all age groups. Life expectancy at birth dropped 0.9 and 1.2 years for women and men relative to the 2019 levels, respectively. Lifespan inequality also fell over the same period by 5 months for both sexes. CONCLUSION: Quantifying excess deaths and their impact on life expectancy at birth provide a more comprehensive picture of the burden of COVID-19 on mortality. Whether mortality will return to-or even fall below-the baseline level remains to be seen as the pandemic continues to unfold and diverse interventions are put in place.