Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

Abstract

Background The effects of the COVID-19 pandemic on non-natural manners of death in Ontario is not known. Understanding the indirect consequences of the pandemic and related public health measures (i.e. lockdown) fills a vital need to inform best practice in public health and guide policy decisions. Methods The Office of the Chief Coroner and the Ontario Forensic Pathology Service (OCC-OFPS) investigate sudden and unexpected deaths in the province of Ontario. The number of homicides, suicides, and accidental deaths (non-natural deaths=77,655) were extracted from the centralized Coroner's Information System database (total deaths=197,966), across four provincially defined stages of lockdown related to the COVID-19 pandemic (March 17 to December 31, 2020), and crude rates (per 100,000 people) were compared to the previous eleven years. Findings 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). 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). 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). 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). 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. 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). Interpretation In Ontario, the short-term effects of the COVID-19 pandemic did not greatly increase homicide or suicide rates, nor decrease motor vehicle collision fatality rates; however, the longer-term impact of the pandemic remains to be elucidated and ongoing vigilance is warranted in the event that other trends emerge. Accidental drug-related fatalities substantially increased during all stages of the lockdown, marking an urgent need for consideration in policy. These results highlight the vital role of death investigation systems in providing high quality and timely data to inform public health recommendations.

Exploring characteristics of increased suicide during the COVID-19 pandemic in Japan using provisional governmental data

“… 2 , 3 To illustrate, the increasing prevalence of major depressive and anxiety disorders in 2020 was positively related to the degree of pandemic seriousness in 204 countries 5 ; however, contrary to expectations, most studies from numerous countries reported that suicide mortality in 2020 did not increase, with the exceptions of Japan, India, Puerto Rico and Vienna (in Austria). 6 , 7 , 8 , 9 , 10 , 11 , 12 – 13 …”

Opioid-related deaths in Ontario correctional facilities and penitentiaries (2009–2019)

“…The increasing availability and use of extremely potent synthetic opioids has become a significant risk to public safety, resulting in 16,364 reported opioid-related deaths in Canada between January 2016 and March 2020 [ 5 ]. Furthermore, recent studies have shown an acute exacerbation of this accelerating trend of drug-related deaths throughout the COVID-19 pandemic, demonstrating an apparent compounding effect of the overlap of the opioid epidemic and COVID-19 pandemic in the drug-using population [ 6 ].…”

“…Fig 6. Number of acute drug toxicity deaths per year compared to the number of cases where naloxone was detected in acute drug toxicity death cases…”

Analyzing the changing relationship between personal consumption and suicide mortality during COVID-19 pandemic in Japan, using governmental and personal consumption transaction databases

“…It is easily speculated that such deterioration in the psychosocial conditions of individuals would be correlated to increases in suicide mortality (1). However, unexpectedly, such increases in rates of suicide mortality were not observed in most upper-middle income countries/regions in 2020, with the exception of Japan and Vienna, Austria (7)(8)(9)(10)(11)(12)(13)(14)(15). Some countries even experienced decreases in the rates of suicide following the start of the pandemic.…”