'Deaths of despair' spiked in Washington in 2020, exceeding deaths from COVID

Jan. 10—They've come to be known as "deaths of despair" — fatalities from drug overdoses, alcohol use, and suicide. Research has shown they've been on the rise for decades in the United States, and have contributed to the decline in life expectancy over the last few years.

Since the start of the pandemic, we've understandably paid a lot of attention to deaths from COVID-19. But the pandemic may have led to far more deaths than just those directly attributed to the virus.

Data from the Centers for Disease Control and Prevention shows that deaths of despair spiked during 2020. In Washington, drug overdoses, alcohol use and suicide accounted for about 3,900 deaths, according to my analysis of the data. That's an increase of almost 600 deaths from 2019.

In fact, it also exceeds the number of Washingtonians who died from COVID in 2020, which the CDC pegs at nearly 3,300. COVID was the fifth leading cause of death in the state in 2020.

According to my analysis, Washington is one of only eight states where deaths of despair outnumbered COVID deaths in 2020. The others are Oregon, Utah, Maine, Vermont, West Virginia, Alaska and Hawaii. These states, with the exception of West Virginia, had the lowest COVID death rates in 2020. They also, with the exception of Utah, had deaths of despair rates above the national average. West Virginia had the highest rate of deaths of despair.

Nationally, deaths from drug overdoses and alcohol use both increased significantly in 2020, but deaths by suicide declined a little. This pattern held true in Washington, as well.

Many public health experts had been worried about a spike in suicides because of the economic and emotional hardships brought on by the pandemic. While this didn't happen for the overall population, there was an increase among certain groups, including young people (below 35 years) and among Black, Hispanic and Native American men. The rates decreased for white and Asian men, and decreased or remained unchanged for women among all racial/ethnic groups.

It may seem counterintuitive, but suicide rates typically fall during times of national crisis — at least initially — as people tend to pull together.

In Washington there were 1,212 deaths from intentional self-harm in 2020, 50 fewer than in 2019. But suicides did increase among certain groups here, including younger people (those under age 45). There was also an increase in the number of suicides and among Hispanic men and women, and Asian women.

The biggest increase in deaths of despair in Washington was among deaths caused by drug overdoses and alcohol poisoning, reflecting the crises in opioid and methamphetamine addiction. These accounted for 1,641 deaths in 2020, an increase of nearly 500 from 2019.

The rates of these deaths increased among both men and women, among all the major racial/ethnic groups, and across all age groups.

There was also a spike in deaths from liver disease caused directly by alcohol use. More than 1,000 Washingtonians died from alcoholic liver disease in 2020, up about 150 from 2019. Again, the rates increased among both men and women, among all the major racial/ethnic groups, and across age groups (starting with the 25- to 34-year-old cohort).

Much of the conversation around deaths of despair has centered on white, working-class people. That's because the initial research on this subject by Princeton economists Anne Case and Angus Deaton — they coined the term "deaths of despair" — focused on the dramatic rise in these deaths among this demographic since the 1990s.

Their research showed how white working-class people (men, in particular) were dying of these causes at an unprecedented rate, and they linked this trend to rising income inequality, unemployment and other economic factors tied to the erosion of America's working class.

But the rise in deaths of despair is also evident among other groups.

In Washington, from 2015 to 2020, Native American men and women died from these causes at the highest rate in Washington, followed by white men. Black men had the fourth-highest rate.

The rates were lowest for Asian men and women, and Hispanic women.

Although there is a wide variance in the rates of deaths of despair along racial/ethnic and gender lines, the rates have been increasing across the board in Washington. The economic and emotional hardships brought on by the pandemic seem to have contributed to the increase in these deaths in 2020.

There is also a significant gap between urban and rural Washington in deaths of despair. These deaths are far more likely to occur in rural parts of the state, which also tend to be poorer.

King County has one of the lowest rates of deaths of despair. However, the number of these deaths also increased in King County during the pandemic. In 2020, the age-adjusted rate of deaths from these causes was 40 per 100,000 population.

In Jefferson County, the rate was 98 per 100,000. Other Washington counties with very high rates in 2020 include Clallam, Lewis, Yakima and Grays Harbor.

A note on the data: Researchers who have explored this topic have used slightly varying definitions for deaths of despair. For this column, I included all deaths determined to be caused by intentional self-harm; deaths from liver disease determined to be caused by alcohol; and drug overdose and alcohol poisoning deaths determined to be accidental, or where the intent was undetermined.

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