Retrospective analysis of disparities and excess mental health, opioid and alcohol mortality associated with the COVID-19 pandemic.

Introduction: The COVID-19 pandemic has caused a devastating increase in morbidity and mortality; however there is limited understanding of the continued toll of COVID-19 on mental health, opioid and alcohol related deaths.

Methods: We conducted a cross-sectional, retrospective study designed using the Wide Ranging Online Data for Epidemiologic Research database from the United States (US) Center for Disease Control. This database contains all death certificate information on US residents. We examined trends of excess death by mental health and substance abuse (opioid and alcohol) among racial groups. Excess death was defined as the difference between observed number of deaths in a time period compared to the historic/expected number of deaths in a prior period. We compared mortality rates in the reference period 2018-2019 (pre-pandemic) with 2020-2021 (early pandemic), and 2022-2023 (late pandemic). We compared excess mortality in racial subgroups of Black and White individuals. Mental health deaths were attributed by International Statistical Classification of Diseases (ICD) F06, F10-F19, F20-F29, F51, F51-F60 opioid deaths (ICD X40-X44, X60-X64, X85, Y10-Y14), and alcohol deaths (ICD E24.4, F10, G31).

Results: Compared to referent period (2018-2019), there was an increase in deaths attributed to Mental and Behavioral Disorders by 35.9% in 2020-2021 (early) and by 30.1% in 2022-2023 (late). This was consistent across opioid related mortality with an increase by 43.5% in 2020-2021 and 36.1% in 2022-2023, and increase in alcohol related deaths by 35.3% in 2020-2021 and 28.1% in 2022-2023. On subgroup analysis Black compared to white individuals demonstrated significantly increased rates of mortality due to Mental health (43.6% vs 34.4% p = 0.0029) in 2020-2021. This disparity was especially seen in excess opioid mortality in Black compared to white individuals (75.3% vs 36.8% p < 0.0001 in 2020-2021, and 89.5% vs 24.7% in 2022-2023 p < 0.0001). Black individuals compared to white individuals had excess death due to alcohol (43.5% vs 33.6%, p value 0.0002) in 2020-2021.

Conclusion: The COVID-19 pandemic has led to significant and persistent increase in mental health and substance abuse mortality. Excess mortality has significantly and disproportionately affected Black individuals compared to white individuals, highlighting the need for future studies to identify and eliminate the healthcare disparities.