Heterogeneity in deaths of despair: excess mortality in the US during the Covid-19 pandemic

The impact of Covid-19 on mortality includes both direct effects of the virus and indirect effects mediated through other causal pathways. In the United States, the indirect effects, particularly from suicides, overdoses and alcohol-induced causes (i.e. deaths of despair) (1) are understudied. Here, we estimated excess non-Covid deaths and deaths of despair, in the US overall, in each state and in 72 demographic strata. Nationally, 114,230 (127,597) excess non-Covid deaths, 19,074 (33,559) excess poisoning deaths and 8,746 (13,771) excess alcohol-induced deaths were estimated during 2020 (2021). Excess poisoning and alcohol-induced mortality were highest among the 35-44 and the 55-64 year groups, respectively. The Black and the American Indian/Alaskan Native populations had the highest excess poisoning and alcohol-induced mortality, respectively. Fewer suicides than expected occurred nationally, but excess suicides were estimated among Black youth. These findings suggest that additional resources need to be mobilized to limit increases in deaths of despair. ### Competing Interest Statement JS and Columbia University declare partial ownership of SK Analytics. JS consulted for BNI. KMK and SK have no competing interests. ### Funding Statement This work is supported by a grant from the US National Institute of Mental Health (R01-MH121410), a contract from the US Centers for Disease Control and Prevention (75D30122C14289), and a gift from the Morris-Singer Foundation. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors