Study data published in JAMA Psychiatry identified a significant spike in overdose-related cardiac arrests in the United States during the COVID-19 pandemic compared with prior years. The greatest increases in overdose deaths were observed among Latinx and Black/African American individuals. These findings underscore the necessity of overdose prevention programs, particularly as a component of pandemic recovery infrastructure.  

Investigators extracted data from the National Emergency Medical Services (EMS) Information System (NEMSIS), a cohort network of over 11,000 EMS agencies in 49 US states. The database contains real-time information from more than 87% of all EMS activations nationwide. Using these data, investigators calculated weekly, monthly, and annual rates of EMS-reported overdose-related cardiac arrests.

Outcomes were reported as a rate per 100,000 EMS activations with patient contact. Rates were also stratified by the 4 US census regions and 9 US census divisions; by urban/rural status; by patient race/ethnicity groups as reported by EMS provider; and by neighborhood characteristics, including poverty level and educational access. Total numbers of overdose-associated cardiac arrests in 2020 were compared with baseline mortality data reported by the Centers for Disease Control and Prevention (CDC) in 2018 and 2019.


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The 2020 NEMSIS database included information from 33.4 million EMS patient encounters, including 19,957 overdose-associated cardiac arrests. Among all EMS patient encounters in 2020, 16.8 million (50.2%) involved patients who were women and 16.3 million (48.8%) involved non-Hispanic White patients.

The rate of overdose-associated cardiac arrests began to climb in April 2020, and a record number of 2112 cardiac arrests were reported in May 2020. Overall, overdose-related cardiac arrests were elevated by 42.1% nationally in the year 2020 compared with 2018-2019 (42.3 vs 60.1 EMS activations per 100,000).

The most significant increases were observed among Latinx (+49.7%) and Black or African American individuals (+50.3%). Specifically, the number of cardiac arrests in Latinx individuals rose from 38.8 to 58.1 activations per 100,000 between 2018-2019 and 2020. Among Black individuals, the number of patient activations rose from 21.5 to 32.3 per 100,000.

Rates of increase were also significant in patients living in more impoverished neighborhoods (+46.4%; 42.0 per 100,000 activations at baseline vs 61.5 per 100,000 activations in 2020) and in patients living in Pacific states (+63.8%; 33.1 per 100,000 activations at baseline vs 54.2 per 100,000 activations in 2020). Based on observed trends in overdose-associated cardiac arrests in 2020, investigators estimated that a total of 90,632 (95% CI: 85,737-95,525) overdose deaths may have occurred in 2020.

Data from this cohort study underline the significant impact of the COVID-19 pandemic period on overdose-related cardiac arrests, particularly in communities of color and lower-income neighborhoods. As study limitations, the investigators noted that race/ethnicity data were missing for around 20% of all patient encounters, limiting the confidence in race/ethnicity-stratified figures. Additionally, cardiac arrests are only a proxy for total overdose mortality and should be interpreted with caution.

“Unprecedented overdose deaths during the pandemic necessitate investments in overdose prevention as an essential aspect of the COVID-19 response and postpandemic recovery,” the investigators wrote. “This is particularly urgent for more socioeconomically disadvantaged and racial/ethnic minority communities subjected to the compounded burden of disproportionate COVID-19 mortality and rising overdose deaths.”

Reference

Friedman J, Mann NC, Hansen H, et al. Racial/ethnic, social, and geographic trends in overdose-associated cardiac arrests observed by US emergency medical services during the COVID-19 pandemic. JAMA Psychiatry. Published online May 26, 2021. doi: 10.1001/jamapsychiatry.2021.0967