Temporal trends in and health conditions associated with "Deaths of Despair" (suicides, alcohol- and drug-related deaths): analysis of interlinked primary and secondary healthcare and mortality records

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Lay Summary

Research interest in ‘Deaths of Despair’, defined as deaths from suicide, drug poisoning, and alcohol-related conditions, is growing internationally. These deaths are assumed to reflect socioeconomic influences on psychological distress in a population. Studies up to 2017 in the UK found an increasing trend of Deaths of Despair and higher rates in men than women. However, the impact of the COVID-19 pandemic, poverty and ethnic differences on Deaths of Despair have not yet been investigated. It is critical to address this knowledge gap, as previous reports indicated that the pandemic’s impact has been more pronounced among socially disadvantaged groups. We aim to examine changes over time since 2000 in Deaths of Despair occurrence, overall and by each type separately in England. We will investigate these changes by the level of deprivation, urban versus rural neighbourhoods, ethnicity, and the effect of the pandemic and economic inflation (increase in prices) on these trends. We will also investigate changes in presentations to the healthcare system of health conditions likely to precede these deaths, such as self-harm and alcohol-induced liver disease. Finally, we will examine groups of health conditions associated with each cause of death. This approach will explore whether and how medically complex are Deaths of Despair and inform the development of interventions that aim to reduce their occurrence.

Technical Summary

We will utilise CPRD Aurum data for conducting individual-level research on Deaths of Despair (suicide, drug-related and alcohol-specific deaths) in England to supplement the existing ecological ONS reports. We will investigate all Deaths of Despair, and each type separately, during 2000-2022, estimating age- and sex-standardised annual incidence rates stratified by ethnicity, area-level deprivation, and urbanicity of residence. We will investigate changes in temporal trends using joinpoint regression and use the annual inflation rate as an indicator of national economic performance over the study period. We will examine the impact of the COVID-19 pandemic by focusing on the period 2013-2022 at a monthly (seasonal) level. We will use mean-dispersion negative binomial regression models to estimate expected incidence trends, March 2020 onwards, based on pre-pandemic data. The pandemic effect will be inferred from the difference between observed and predicted estimates. We will generate descriptive statistics on drug-related deaths, including substance type and recreational/prescribed use. The same analyses will be conducted for Diseases of Despair (suicidal ideation/behaviours, drug and alcohol misuse). These analyses will utilise interlinked primary and secondary healthcare data to provide evidence on the burden of morbidity and mortality. Finally, for each Death of Despair type, we will examine patients’ medical history (a year proceeding the death and at any time in the patient’s history), including primary and secondary healthcare contacts, diagnoses, and medication prescribing, using association network analysis to identify their co-occurrence patterns. These findings will determine if there are particularly vulnerable groups according to their health and socioeconomic descriptors. Ultimately, this research will provide clinicians with the health profile of these individuals and inform public health policies and initiatives. Understanding the impact of despair and its associated health and sociodemographic factors will inform national guidelines and contribute to developing effective preventive measures and interventions to mitigate premature mortality.

Health Outcomes to be Measured

Mortality, i.e., Deaths of Despair - suicides, drug-related deaths, and alcohol-specific deaths.
Morbidity, i.e., Diseases of Despair - suicide ideation, self-harm, depression, substance, and alcohol misuse.


Roger Webb - Chief Investigator - University of Manchester
Maja Radojcic - Corresponding Applicant - University of Manchester
Darren Ashcroft - Collaborator - University of Manchester
Matthew Carr - Collaborator - University of Manchester
Navneet Kapur - Collaborator - University of Manchester
Sarah Steeg - Collaborator - University of Manchester


HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification