Mortality trends in a Sri Lankan urban population before and during the COVID-19 pandemic based on autopsies referred to a forensic institution in Colombo

Abstract

Introduction: There is much debate on how the COVID–19 pandemic has affected health and mortality of populations. This study aims to compare the mortality trends within a Sri Lankan urban community before and during the pandemic. Methods: All autopsies referred through six police divisions to the Department of Forensic Medicine and Toxicology, Colombo between 1st of January 2019 to 31st of July 2021 were analysed using a proforma based on demographic data, circumstances and causes of death. Results: A total of 1398 deaths (Mean age 58.71 +/- 18.59) were analysed. M:F ratio was ~7:3. More deaths reported in the first 7 months of 2021 (n=525) than the previous two years (n 2019=463; n2020=410). Significant differences (p<0.001) in the mean ages of deaths were noted in 2019, 2020 and 2021 (54.69; 58.84 and 62.18 respectively). The percentage of natural deaths increased from 63.5% in 2019 to 78.1% in 2021 while the percentage of accidental deaths were 16.6%, 17.8% and 10.3% in the three years respectively. Majority of deaths were due to cardiovascular causes (2019=36.1%; 2020=33.7%; 2021=39.0%). 2021 had a significant increase in deaths from infections (23.8%) compared to other years (p< 0.001). There were 144 SARS CoV-2 positive deaths out of which 74.3% were within May-July 2021. COVID-19 was a direct or contributory cause of death in >80% of these cases. From 2019 to 2021, a significant reduction was observed for road traffic fatalities (p<0.001) while suicides dropped from 10.2% to 4.8% and homicides dropped from 1.7% to 0.6%. Conclusion: Although, there is an apparent reduction in unnatural deaths including traffic fatalities, suicides and homicides during the COVID-19 pandemic, overall mortality rates have drastically increased in 2021 with cardiovascular diseases and infections accounting for more than 60% of deaths. The results reflect the potentially harmful effects of disruption of hospital services and reluctance for seeking healthcare during the COVID-19 pandemic.