Overdose-related cardiac arrests significantly increased during pandemic

Overdose-related cardiac arrests increased significantly in 2020 in the United States, particularly among “Latinx” and Black individuals, according to results of a cohort study published in JAMA Psychiatry.

“Existing overdose death records from the CDC describing pandemic-related increases are only available on an approximately 7-month lag and are not broken down by race/ethnicity or other social factors,” Joseph Friedman, MPH, of the Center for Social Medicine and Humanities at the University of California, Los Angeles, told Healio Psychiatry. “We used a national sample representing about 90% of emergency medical service [EMS] activations in 2020, and available in near real-time, to track overdose rates by month, race/ethnicity and other characteristics.”

Friedman and colleagues evaluated these trends during the COVID-19 pandemic through December 2020. They also sought to assess the concordance with provisional total overdose mortality as reported by the CDC through May 2020. They obtained data via more than 11,000 EMS agencies in 49 U.S. states that took part in the National EMS Information System, and they included 83.7 million EMS activations that involved patient contact. Year and month of occurrence of cardiac arrest linked to overdose, patient race/ethnicity, census region and division, county-level urbanicity and zip code-level racial/ethnic composition, poverty and educational attainment served as exposures. Friedman and colleagues compared cardiac arrests linked to overdose per 100,000 EMS activations with patients contact in 2020 with a baseline of values from 2018 and 2019. Further, they compared aggregate numbers of cardiac arrests linked to overdose and percentage increases with provisional total mortality according to CDC records from rolling 12-month windows with end months that spanned January 2018 through July 2020.

A total of 33.4 million EMS activations occurred in 2020, of which 16.8 million (50.2%) involved women and 16.3 million (48.8%) involved non-Hispanic white individuals. Results showed a national increase of 42.1% in 2020 for cardiac arrests linked to overdose, with 42.3 per 100,000 EMS activations at baseline compared with 60.1 per 100,000 EMS activations in 2020. The researchers noted the highest percentage increases among Black (50.3%) and “Latinx” (49.7%) individuals, with the latter term representing a gender-neutral alternative for Latino or Latina, as well as among people who lived in more impoverished neighborhoods (46.4%) and in the Pacific states (63.8%), despite these groups having lower rates at baseline. EMS record availability preceded that of CDC mortality figures by 6 to 12 months, and Friedman and colleagues observed high concordance for months with availability of both data sets. The CDC may report an expected total of approximately 90,632 overdose deaths for 2020, assuming the historical association between EMS-observed and total overdose mortality holds true, according to the researchers.

“Overdose deaths are spiking during the pandemic and these increases are disproportionately affecting Black and Latinx communities, as well as people living in Western states,” Friedman said. “Considerable efforts in overdose prevention are needed as part of the post-pandemic recovery. These will be especially important for more vulnerable communities who have experienced the double burden of higher rates of COVID-19 death as well as larger increases in overdose mortality.”