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Lack of timely access to vital statistics data has hindered detailed analysis of trends in mortality during COVID-19. Many countries have also documented a sudden decline in all or some death types at the onset of lockdowns, followed by an increase or return to average in the post-lockdown period. 4 Notwithstanding this heterogeneity, decreased motor vehicle collision-related fatalities 10, 22, 25, 26 and increased substance use 3, 27 - 33 manifested consistently across jurisdictions. It has been suggested that the effects are likely to vary among countries and over time, possibly as a result of overall community disease burden, the impact of public health measures, the availability of mental health services, and the economic capacity to support the affected population. Given the variation of the studies thus far, the indirect effects of the COVID-19 pandemic on the frequency of non-natural deaths are unclear.
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These include decreased, 4 - 10 increased, 7 - 9, 11 - 13 and steady 8, 13 - 22 suicide rates as well as increased, 23 decreased, 10, 24 and steady 21 - 23 homicide rates. Various countries and jurisdictions report differing trends when comparing pre-pandemic death data to during or post-lockdown death types. 1, 2, 3 How the increased prevalence of these conditions translate into morbidity and mortality is of growing public health concern, especially in the context of prolonged and recurrent public health measures intended to protect the population by slowing the spread of COVID-19. Further, this study examines multiple lockdown stages, including analyses of death trends during so-called ‘reopening’ phases.Ī growing body of literature suggests that the COVID-19 pandemic has exacerbated the prevalence of mental illness, domestic violence, and substance use. This provides a study population that is generalizable to large administrative regions and countries. Ontario has the largest death investigation system in North America and is composed of a large, culturally diverse collection of urban, suburban, and rural communities. We have shown the indirect effects of the pandemic and related public health measures on rates of homicide, suicides, and accidental deaths, as well as an estimated increase in over 1500 drug-related fatalities during the pandemic. Our research is, to our knowledge, the single largest study worldwide that investigates all three non-natural manners of death (non-natural deaths= 77,655) that includes reporting of drug-related fatalities. This study offers a comprehensive data set regarding non-natural manners of death and their associated types of death. The results are interpreted and reported reflecting the American Statistical Association's (ASA) current statement on statistical significance and p-values. Our research uses an evidence-based, statistically robust approach to investigate the indirect consequences of the COVID-19 pandemic and related public health measures across multiple stages of provincially defined ‘lockdown’ measures as compared to the previous decade. Although motor vehicle collision associated fatalities appeared to decrease slightly in 2020 (RR 0⋅89, 95% CI 0⋅81-0⋅96 p=0⋅0039 estimated annual effect of 78 less deaths), we could not conclude any lockdown-associated effect, particularly when compared to 2019 (RR 0⋅26, 95% CI 0⋅75-1⋅1 p=0⋅26). This finding held up to ‘interrupted time series’ robustness testing, indicating that 2020 had substantially more drug-related deaths, even when accounting for the linear increasing trend over time. There was an excess of over 1,500 accidental drug-related deaths that occurred during 2020 (RR 2⋅5, 95% CI 2⋅4-2⋅7 p<0⋅001).
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However, during the first stage of lockdown (Stage 0), there was a decrease in the rate of suicides compared to all combinations of recent years from 2013 onwards (RRs 0⋅82-0⋅86, combined 95% CI 0⋅69-0⋅99 max p=0⋅039 estimated effect of 30 less deaths in Stage 0). The rate of suicides also did not show an overall major change in 2020 (RR 1⋅02, 95% CI 0⋅96-1⋅1 p=0⋅50 estimated annual effect=27 more deaths in 2020).
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There was no major change to the rate of homicides during 2020 compared to 2009-2019 (RR 1⋅1, 95% CI 0⋅95-1⋅2 p=0⋅19 estimated annual effect=21 more deaths in 2020).