The pandemic changed how Minnesotans die

As the medical examiner for nine rural counties in northwest Minnesota, Mary Ann Sens oversees hundreds of autopsies each year, involving everything from fatal car accidents to homicides. But she says there’s been one unmistakable shift in the way people here are dying: the drug overdoses.

“Methamphetamine is huge and fentanyl is huge,” she said at her office in the Red River Valley one recent fall day. “They are the worst, and it’s all new.” 

Those overdose deaths — as well as the lingering effects of the COVID-19 pandemic and the social upheaval it wrought — contributed to statewide mortality rates that remained significantly elevated in 2022, according to the latest data from the Centers for Disease Control.

More than 51,000 Minnesotans died of all causes last year for an overall age-adjusted mortality rate of about 750 deaths for every 100,000 residents, according to the provisional data. That represents a 15% increase over the age-adjusted death rate in 2019, before the pandemic.

Relative to 2019:

• Drug overdose deaths in 2022 were up 56%;
• Deaths caused by excessive drinking were up 40%;
• Homicide was up 22%;
• Suicides were roughly unchanged overall, although experts note suicide deaths are now trending younger than they used to.

Sens said that her office was one of the few that did not see an increase in overall mortality during the pandemic. But the composition of deaths changed. “Homicides went up,” she said. “And I think most homicides are in the home, and people were at home and domestic violence was huge.”

Statewide, the leading causes of death in 2022 were cancer and heart disease, which combined to take nearly 20,000 lives. Accidents (including falls, vehicle crashes and unintentional overdoses) took 3,553 lives; Alzheimer’s and Parkinsons’ diseases caused 3,162 deaths combined; and lower respiratory infections and strokes each caused more than 2,100 deaths. 

Suicide is also changing, Sens said. Years ago, suicides were almost exclusively among people with debilitating mental illnesses, terminal conditions or other “insurmountable difficulties” like pending criminal charges.

“Now sometimes a kid just gets a text and they kill themselves,” she said. She worries about the effects social media and ubiquitous internet access are having on teens and young adults.

COVID-19 killed an additional 2,302 Minnesotans in 2022, according to the CDC tally. The Minnesota Department of Health estimates COVID has killed about 15,000 people in the state since the start of the pandemic.

The CDC maintains a separate count of state-level “excess deaths” during the pandemic, intended to capture the true toll of COVID-19 on mortality rates. For most states the estimate of excess deaths is higher than the official COVID-19 count, but for Minnesota the excess death estimate is actually lower than the official tally. 

A CDC spokesman said that although that’s unusual, it is likely because COVID in Minnesota killed a disproportionately high number of senior citizens who would have died from other causes absent the pandemic. That aligns with what Mary Ann Sens saw at her office. 

Elizabeth Wrigley-Field, a University of Minnesota sociologist, also said that explanation seemed plausible.

“A relative lot of our COVID deaths have happened in nursing homes; that’s a sick, high-risk population where you’d expect a lot of deaths from other stuff over the course of a few years,” she said.

Overall, pandemic-era mortality increases driven largely by COVID and so-called deaths of despair set longevity gains back by about 20 years in Minnesota. Researchers from the Mayo Clinic, for instance, recently found that the first year of the pandemic saw significant increases in death by guns, overdoses, malnutrition and liver disease. Those deaths largely remained elevated in 2022, although the statewide homicide rate did fall by about 19% between 2021 and 2022, bringing numbers closer in line with the pre-pandemic trend.

Most other states saw similar patterns, as social isolation wrought by the pandemic drove up rates of substance abuse and interpersonal violence. 

“Emerging evidence suggests multiple potential drivers of this change,” the Mayo study concluded, “including economic stress and financial uncertainty, anxiety about a new infection affecting large segments of society, changes in the illicit drug supply observed at the national level and described by people who use drugs, as well as interruptions in access to mental health and substance disorder treatment.”

Minnesotans in their prime working years have been particularly hard-hit by these trends. Between 2019 and 2022, all-cause mortality rates increased 7% among Minnesotans age 65 and older, and 11% among those between the ages of 15 and 24. In the 25-54 age group, however, the mortality rate increased by 26%. 

The leading cause of death for this working age group was accidents, a broad category that includes drug overdoses. Fentanyl and other opioids are the chief drivers of those numbers.

The news isn’t all bad. Age-adjusted mortality rates for cancer and stroke continued on their longstanding downward trajectories, reflecting treatment advances and improvements in medical care. Intentional suicide rates have remained relatively stable, even as other deaths of despair rose. Homicides are returning to pre-pandemic trends, albeit slowly. 

Overall, Minnesota remains one of the healthiest states in the nation, with the eighth-lowest age-adjusted death rate in 2022. Residents of some Southern and Appalachian states like Mississippi, West Virginia and Kentucky were roughly 50% more likely to die of any cause in 2022 than were Minnesotans. Minnesotans live, on average, anywhere from five to seven years longer than people in those states.

Sens wishes more people understood how important her work is. Assigning a definitive cause of death “is sort of the final proof we can owe somebody,” she said. “You need to speak the truth for that person.”