‘Deaths of Despair’ contribute to 17% rise in Minnesota’s death rate during COVID-19 pandemic

The COVID-19 pandemic was associated with a 17% increase in the death rate in Minnesota during the first year of the pandemic compared to the two previous years, according to a new study published by researchers at Mayo Clinic. Deaths were driven by both COVID-19 and other causes, with a surprising increase found in preventable "deaths of despair" caused by overdose, alcohol use and malnutrition. Data showed that racial and ethnic minority populations as well as older adults were disproportionately affected.  

To examine the effects of the pandemic on deaths across the state, researchers analyzed finalized Minnesota death certificate data available through the Rochester Epidemiology Project for 89,910 deaths in 2018-19 and 52,030 deaths in 2020. This study represents the first analysis of complete population-level data in Minnesota on COVID-19 analyzing all-cause and cause-specific mortality in 2020. 

According to the study's lead author, Rozalina McCoy, M.D., an endocrinologist and primary care physician, COVID-19 caused or contributed to almost 10% of all Minnesota deaths in 2020. While the authors anticipated that they would see an increase in deaths caused by delayed diagnosis or treatment of chronic diseases or serious acute illnesses, they were surprised to find that this mostly was not the case. Instead, the study revealed a profound rise in "deaths of despair."  

Image of Rozalina McCoy, MD
Rozalina McCoy, M.D.

Specifically, the researchers identified a 68% increase in assault by firearms, a 49% increase in accidental poisonings, a 48% increase in malnutrition and a 25% increase in liver disease.   

"We were expecting to see heart disease, cancer, stroke, all those things where people delay care, and we didn't see any of that," says Dr. McCoy. One particularly notable finding was the effect of malnutrition, specifically among older women living in rural areas. 

"I think that social isolation was a major driving cause of this, especially as many older people were being very careful about not being exposed to COVID-19 before they could be vaccinated, as churches and other places of worship and community centers were closed, and as many community and social services organizations stopped seeing people in the home," she adds. "I really worry about lonely, isolated older people with no support system." 

Researchers also noted that racial and ethnic minority populations, especially Native Americans, were disproportionately affected. Authors say the study’s findings revealed disparities in certain populations due to a lack of access to medical care.  

Dr. McCoy raises concerns that certain populations were more likely to be placed at risk for severe COVID-19, including those employed in occupations that are not amenable to distance work, with more comorbidities, or living in multigenerational households or in houses where they cannot isolate when ill. 

Seeking solutions 

She noted the importance of addressing the social determinants of health, which appeared to be strong drivers of death among Minnesotans. Social determinants of health are the conditions in which people are born, live, learn and age, affecting a wide range of health, functioning, and quality-of-life outcomes and risks. She further pointed out that addressing health disparities in affected communities is not a one-size-fits-all approach. 

"We need to identify the highest priority needs of each community and then work with community members and leaders to develop solutions to the specific problems they face," says Dr. McCoy. "These solutions need to be co-created, community-based and culturally sensitive."  

The team plans to continue to assess the pandemic's long-term effect on Minnesota death rates and identify practical solutions to mitigate the effects.   

The researchers note that the findings serve as a reminder of the need for continued vigilance in the face of COVID-19 and the importance of supporting communities and populations affected by the pandemic. They also call for continued monitoring of excess mortality over time. 

The Rochester Epidemiology Project is a Minnesota medical records-linkage system that has linked electronic health record data for research purposes for the past 50 years. 

The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provided methodologic expertise throughout the study. The Mayo Clinic Department of Emergency Medicine supported the research. Review the study for a complete list of authors, disclosures and funding. 

—Vincent Jacobbi