The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health.

Methods: An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities.

Results: During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group.

Conclusion: The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

Keywords: Death rates; Premature mortality; Public health.

Figure 1.

Timeline of important events related to COVID-19 transmission in Sri Lanka from January 2020 to October 2021.

Figure 2.

Police areas covered in this study. The 6 police areas for which medicolegal services are provided by the Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo. Two police divisions each are located within 5-km, 10-km, and 25-km radii from the Colombo city limits, as depicted in the image.

Figure 3.

Monthly distribution of cases during 2019–2022. (A) Monthly autopsy load for each year compared with the monthly average during the previous 8 years (2010–2018). (B) Comparison of caseloads during the 3 periods of the study. Red represents the period of COVID-19 restrictions; Blue represents the period before and magenta represents the period after the restrictions. (C) Age distribution of deaths in males and females within each period.

Figure 4.

(A) Distribution of cases under each broad category of death in descending order. Cases that were unascertained or under investigation have been excluded. (B) Comparison of monthly frequencies for natural and unnatural categories of death across the 3 periods.