Impact of COVID-19 lockdown policy on homicide, suicide, and motor vehicle deaths in Peru

Abstract

Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.22 deaths per million men per month (95% CI: -14.45, -9.98) and 3.55 deaths per million women per month (95% CI:-4.81, -2.30). Homicide and suicide presented similar level drop in women, while the homicide reduction was 2.5 the size of the suicide reduction in men. The slope in homicide in men during the lock-down period increased by 6.66 deaths per million men per year (95% CI:3.18, 10.15). External deaths presented a sudden drop after the lockdown was implemented and an increase in homicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient.

Keywords: COVID-19; External deaths; Lockdown; Public policy; Suicides.

Fig. 1

Interrupted time-series analysis external deaths by type of death in Women. The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period and ligther grey to the relaxation of lockdown measures. The solid red lines correspond to the interrupted time-series linear regression model, the solid blue line corresponds to the LOESS smoother with 0.6 span and the blue shading corresponds to a 0.95 confidence interval around the LOESS smoother line. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Interrupted time-series analysis external deaths by type of death in Men. The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period and ligther grey to the relaxation of lockdown measures. The solid red lines correspond to the interrupted time-series linear regression model, the solid blue line corresponds to the LOESS smoother with 0.6 span and the blue shading corresponds to a 0.95 confidence interval around the LOESS smoother line. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Panel A: Interrupted time-series analysis the propotion of external deaths labeled as “unescpecified”. The solid red lines correspond to the interrupted time-series regression model. Panel B: Descriptive view of the percentage change in community mobility to transit stations before and after the lockdown period. The first vertical black dotted line corresponds to the firs case confirmation and the second the 40 day lockdown mark. Panel A and B: The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period and ligther grey to the relaxation of lockdown measures, the solid blue line corresponds to the LOESS smoother with 0.6 span and the blue shading corresponds to a 0.95 confidence interval around the LOESS smoother line. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Appendix Fig. 1

Non-external death trends before and during the lockdown by sex. The solid red line corresponds to the LOESS smoother with 0.6 span in men and the blue line to the LOESS smoother with 0.6 span in women. The vertical black dashed line corresponds to the beginning of the lockdown (March 16, 2020) and the grey shading to the lockdown period and ligther grey to the relaxation of lockdown measures.