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.

Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality.

The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.