Deaths of Despair Before, During, and after the COVID-19 Pandemic, England 2014-2022

Background: The term ‘deaths of despair’ has been coined to describe deaths from alcohol use, substance use, suicide, and mental ill health. Earlier studies have shown that mortality rates are increasing and that they vary significantly by socio-economic group. We explore trends in deaths of despair in England before, during, and after the COVID-19 pandemic. We examine the differences in the mortality rates by sex and socio-economic group. Methods: Deaths of despair were identified using a routine administrative dataset and grouped by sex, deprivation, and underlying cause of death, each year between 2014 and 2022. Annual years of life lost and directly standardised mortality rates were calculated for all deaths of despair, and for deaths of despair by sex and deprivation quintile. Annual absolute and relative differences in mortality rates between men and women and between the most and least deprived quintile of areas, were estimated. Log-linear models were fitted to these trends to test whether mortality rates and inequalities in mortality rates diverged from the secular trend during the COVID-19 pandemic. Findings: Directly standardised mortality rates increased from 22.6 per 100,000 population (95% CI 22.2 to 23) in 2014 to 30.1 (95% CI 29.6 to 30.5) in 2022. Absolute differences between men and women grew from 19.4 (95% CI 18.6 to 20.2) in 2014 to 24.7 (95% CI 23.8 to 25.6) in 2022. There were also changes in the absolute difference in mortality rates between the most and least deprived areas, increasing from 28.7 (95% CI 27.3 to 30.1) in 2014 to 35.8 (95% CI 34.2 to 37.4) in 2022. Relative differences by sex and deprivation were similar in 2014 and 2022, but decreased significantly (p < 0.05) during the COVID-19 pandemic by sex, and increased significantly (p < 0.05) by deprivation. Approximately one sixth (16.6 %) of all years of life lost in 2022 were due to deaths of despair. Interpretation: Deaths of despair are rising, and increased more rapidly during the COVID-19 pandemic. Relative differences in mortality rates by sex and deprivation were similar in 2014 and in 2022, but the gap between the sexes closed during the COVID-19 pandemic, whilst the gap increased between the most and least deprived areas. Funding: The project was funded by the Health Foundation. Declaration of Interest: The authors have no competing interests to declare.