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Excess Fatal Overdoses in the United States During the COVID-19 Pandemic by Geography and Substance Type: March
Jay Chandra1, Marie-Laure Charpignon1, Anushka Bhaskar1
1Jay Chandra is with Harvard Medical School, Harvard University, Boston, MA. Marie-Laure Charpignon and Munther A. Dahleh are with the Institute for Data, Systems, and Society, Massachusetts Institute of Technology, Cambridge. Anushka Bhaskar and Andrew Therriault are with the Department of Government, Harvard University, Cambridge. Yea-Hung Chen is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Alyssa Mooney is with the Institute for Health Policy Studies, University of California, San Francisco. Mathew V. Kiang is with the Department of Epidemiology and Population Health, Stanford University, Stanford, CA. Francesca Dominici is with the Department of Biostatistics, T. H. Chan School of Public Health, Harvard University, Boston.
Abstract:
Objectives. To assess heterogeneity in pandemic-period excess fatal overdoses in the United States, by location (state, county) and substance type. Methods. We used seasonal autoregressive integrated moving average (SARIMA) models to estimate counterfactual death counts in the scenario that no pandemic had occurred. Such estimates were subtracted from actual death counts to assess the magnitude of pandemic-period excess mortality between March 2020 and August 2021. Results. Nationwide, we estimated 25 668 (95% prediction interval [PI] = 2811, 48 524) excess overdose deaths. Specifically, 17 of 47 states and 197 of 592 counties analyzed had statistically significant excess overdose-related mortality. West Virginia, Louisiana, Tennessee, Kentucky, and New Mexico had the highest rates (20-37 per 100 000). Nationally, there were 5.7 (95% PI = 1.0, 10.4), 3.1 (95% PI = 2.1, 4.2), and 1.4 (95% PI = 0.5, 2.4) excess deaths per 100 000 involving synthetic opioids, psychostimulants, and alcohol, respectively. Conclusions. The steep increase in overdose-related mortality affected primarily the southern and western United States. We identified synthetic opioids and psychostimulants as the main contributors. Public Health Implications. Characterizing overdose-related excess mortality across locations and substance types is critical for optimal allocation of public health resources. (Am J Public Health. 2024;114(6):599-609. https://doi.org/10.2105/AJPH.2024.307618).
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