Researchers at the Philadelphia Department of Public Health have found that significant increases in mortality during the COVID-19 pandemic are not entirely attributable to COVID-19 itself, and the burden of these increases fell on non-Hispanic Black Philadelphians. 

PHILADELPHIA–Researchers at the Philadelphia Department of Public Health looked at estimated excess death rates from 2020-2021 due to specific causes not related to COVID-19 and made an unexpected finding. They used death certificate data from Philadelphia to provide a timely estimate of trends and differences in mortality. Weekly death counts in Philadelphia between 2018 and 2019, specifically, give a snapshot of what mortality could have been in 2020-2021 if the COVID-19 pandemic had not occurred. By comparing these earlier pre-pandemic data to the actual death counts during the pandemic in 2020-2021 they could calculate excess deaths. They found that the number of deaths that occurred was larger than the number of deaths expected based on the 2018-2019 trends. It appeared that, in addition to excess mortality in 2020-2021 that was largely driven by COVID-19, there were also excess deaths due to other causes.

The researchers observed that not all excess mortality—the gap between expected and observed deaths—during the COVID-19 pandemic was directly attributable to infection with SARS-CoV2-2, the causative agent of COVID-19. The pandemic caused profound disruptions in society, including interruptions in health care and increased stress, anxiety, and mental strain. These disruptions may have contributed to excess mortality from causes other than COVID-19. Further, pre-pandemic differences in death rates by race/ethnicity appeared to have been widened both by COVID-19 and by non-COVID-19 causes of death.

Dr. Megan Todd, Chief Epidemiologist for the Health Department, said: “the COVID-19 pandemic has been very challenging for Philadelphians – there is the virus itself, of course, but also large-scale income and job loss and increased stress levels. These economic and social factors can cause additional negative consequences for health and mortality. We can think of these consequences as indirect effects of the pandemic.”

In order to get the most accurate picture of death rates had the pandemic not occurred, Dr. Todd and Annaka Scheeres, Senior Research and Data Scientist at the Health Department, looked at the most common pre-COVID-19 causes of death: heart disease, cancer, injury (including homicide, drug overdoses, traffic crashes, and falls), cerebrovascular disease (stroke), diabetes, septicemia, influenza and pneumonia, chronic respiratory diseases, and chronic kidney diseases. They also calculated excess death rates by different population groups—by age (< 50 or 50+), by sex (male and female), and by race/ethnicity (non-Hispanic Black and non-Hispanic white; the researchers omitted other groups due to small counts of deaths).

Dr. Todd and Ms. Scheeres found significant excess mortality due to many of these same causes during the pandemic in 2020-2021. Among older Philadelphians (aged 50+), COVID-19 was responsible for the bulk of these excess death counts. However, they also noted that this was not the case among younger Philadelphians (aged <50). Among young non-Hispanic Black men, homicides and drug overdoses were responsible for more excess deaths than COVID-19. Among young non-Hispanic Black women, drug overdoses were responsible for more excess deaths than COVID-19. And younger non-Hispanic white men and non-Hispanic white women did not experience excess death rates in 2020-2021 compared to 2018-2019.

These observations build on prior research showing pre-existing racial mortality disparities had been exacerbated by deaths due to COVID-19. The researchers suggest that this study is preliminary evidence that non-COVID-19 mortality during the pandemic further contributed to disparities, notably at younger ages, where the mortality risk from COVID-19 was small. This is an urgent call to think broadly about the impacts of COVID-19 on health and mortality and to center equity in pandemic response and pre-preparedness planning.

This study was published in the American Journal of Public Health’s November 2022 edition.