Years of life lost due to deaths of despair and COVID-19 in the United States in 2020: patterns of excess mortality by gender, race and ethnicity

Int J Equity Health. 2023 Aug 23;22(1):161. doi: 10.1186/s12939-023-01949-9.

Abstract

Background: In 2020 COVID-19 was the third leading cause of death in the United States. Increases in suicides, overdoses, and alcohol related deaths were seen-which make up deaths of despair. How deaths of despair compare to COVID-19 across racial, ethnic, and gender subpopulations is relatively unknown. Preliminary studies showed inequalities in COVID-19 mortality for Black and Hispanic Americans in the pandemic's onset. This study analyzes the racial, ethnic and gender disparities in years of life lost due to COVID-19 and deaths of despair (suicide, overdose, and alcohol deaths) in 2020.

Methods: This cross-sectional study calculated and compared years of life lost (YLL) due to Deaths of Despair and COVID-19 by gender, race, and ethnicity. YLL was calculated using the CDC WONDER database to pull death records based on ICD-10 codes and the Social Security Administration Period Life Table was used to get estimated life expectancy for each subpopulation.

Results: In 2020, COVID-19 caused 350,831 deaths and 4,405,699 YLL. By contrast, deaths of despair contributed to 178,598 deaths and 6,045,819 YLL. Men had more deaths and YLL than women due to COVID-19 and deaths of despair. Among White Americans and more than one race identification both had greater burden of deaths of despair YLL than COVID-19 YLL. However, for all other racial categories (Native American/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander) COVID-19 caused more YLL than deaths of despair. Also, Hispanic or Latino persons had disproportionately higher mortality across all causes: COVID-19 and all deaths of despair causes.

Conclusions: This study found greater deaths of despair mortality burden and differences in burden across gender, race, and ethnicity in 2020. The results indicate the need to bolster behavioral health research, support mental health workforce development and education, increase access to evidence-based substance use treatment, and address systemic inequities and social determinants of deaths of despair and COVID-19.

Keywords: Addiction Medicine; COVID-19; Epidemiology; Mental Health; Mortality; Substance Use.

Publication types

  • Comparative Study

MeSH terms

  • Alcohol-Related Disorders / epidemiology
  • Alcohol-Related Disorders / ethnology
  • Alcohol-Related Disorders / mortality
  • Alcohol-Related Disorders / psychology
  • American Indian or Alaska Native / psychology
  • American Indian or Alaska Native / statistics & numerical data
  • Asian / psychology
  • Asian / statistics & numerical data
  • Black or African American / psychology
  • Black or African American / statistics & numerical data
  • COVID-19* / epidemiology
  • COVID-19* / ethnology
  • COVID-19* / psychology
  • Cause of Death
  • Cost of Illness
  • Cross-Sectional Studies
  • Drug Overdose / epidemiology
  • Drug Overdose / ethnology
  • Drug Overdose / mortality
  • Drug Overdose / psychology
  • Ethanol
  • Ethnicity / psychology
  • Ethnicity / statistics & numerical data
  • Female
  • Health Inequities*
  • Hispanic or Latino / psychology
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Life Expectancy / ethnology
  • Male
  • Mortality, Premature* / ethnology
  • Native Hawaiian or Other Pacific Islander / psychology
  • Native Hawaiian or Other Pacific Islander / statistics & numerical data
  • Race Factors
  • Sex Factors
  • Social Determinants of Health* / ethnology
  • Social Determinants of Health* / statistics & numerical data
  • Suicide / ethnology
  • Suicide / psychology
  • Suicide / statistics & numerical data
  • United States / epidemiology
  • White / psychology
  • White / statistics & numerical data

Substances

  • Ethanol