ROCHESTER — A recent Mayo Clinic study finds that Minnesota's death rate increased by 17% in 2020. Predictably, COVID-19 was a major contributor to mortality, but deaths of despair also grew during the first year of the pandemic.
The study, published Monday in BMC Public Health , used death certificate data provided through the Rochester Epidemiology Project and compared the 89,910 deaths recorded in 2018 and 2019 to the 52,030 deaths in 2020.
"One out of every 10 deaths in the state was due to COVID," said Dr. Rozalina McCoy, an endocrinologist, associate professor of medicine at Mayo Clinic and the study's lead author. "That's a lot. It's one of the major leading causes of death."
While COVID-19 played a big role in that 17% increase in mortality across the state, McCoy's team found that "deaths of despair" also increased in 2020. For this category, the researchers looked at overdoses and accidental poisonings, assault by firearms, malnutrition, alcoholic liver disease, and other chronic liver diseases.
McCoy said the term "deaths of despair" encompasses deaths related to social issues and was first used to describe deaths associated with the opioid epidemic and suicide. The research team added firearm and malnutrition deaths into this category.
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"We still think that it reflects the underlying principle of death of despair, the collapse of the social fabric of our society, with people being stressed and isolated from each other," McCoy said.
Malnutrition deaths, examined within the study for the first time by McCoy and her team, are among the striking statistics in the report. They found a 48% increase in malnutrition deaths in 2020, and the most affected group of people were older women in rural areas who lived alone.
"Churches and social groups either went virtual or closed, and for many older people, being virtual is just as good as closed, that they couldn't access them," McCoy said. "You have older people living in rural areas becoming isolated and not getting enough food and really struggling, and I think that's kind of where we see the malnutrition."
Deaths from accidental poisonings also jumped up by 49%. Causes of death in this category include opioids, other drugs and non-drug poisonings such as carbon monoxide. Teens, young adults and people of color saw the greatest increases in poisoning and overdose deaths during 2020.
"Opioids, in general, are the majority of overdose deaths, but they changed from 55.6% before the pandemic to now 63.3% in 2020," McCoy said.
Researchers also found a 68% increase in firearm deaths and a 25% increase for liver disease-related deaths in 2020. For firearms, more men died than women, but the proportion of women killed by firearms grew.
"My main concern is whether these are domestic violence-related deaths," McCoy said. "There's no way to know with this data, and I think that it's going to be very important to get a sense about what happened with domestic violence."
There are two silver linings within the report. The first is that McCoy's team didn't find an increase in deaths by suicide, which are often under the deaths of despair umbrella. McCoy said her hypothesis, which hasn't been tested with the data available yet, is that with stay-at-home guidance, more people weren't alone when they experienced a mental health crisis.
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"When everybody was stuck at home, for those people who were having thoughts of suicide of self-harm, because they were not alone, they were able to get through this crisis," McCoy said.
The other silver lining is that the research doesn't show a rise in deaths that would be connected to delays in screenings and other health care while COVID ravaged hospitals. The research team expected to see some additional deaths from cancer, heart attacks and strokes during this time period, but that didn't play out in the data.
"There was so much concern that people are forgoing needed medical care, and as a result of not seeking the care that they need — either because they're afraid to go to the hospital or the hospitals are full from COVID — there was a concern that people aren't getting the care they need and are dying as a result," she said.
A big takeaway from this study, according to McCoy, is how community (and a lack of it) is an important aspect for people's health. This information could inform future public health precautions if, or when, the state faces another pandemic.
"Hindsight is always 20/20, or not even, because we still don't know what would have been the best way to deal with the pandemic," McCoy said. "All we know is what we see now in the rearview mirror, and I think the way we shut down with no lifeline for many people, that resulted in death that potentially could have been avoided."
In the future, the research team will evaluate Minnesota's deaths in 2021 and 2022 to look at excess mortality over the course of the pandemic.
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