Understanding data about deaths can shed light on what’s happening in our communities in terms of health. Changes in death rates, causes of death, and life expectancy are indicators of conditions within communities and the impact those conditions have on people. During the COVID-19 pandemic, Public Health – Seattle & King County started to track death data to compare to 2017-2019 as a way of understanding health under rapidly changing circumstances. The resulting report on Changes in Death Rates & Life Expectancy Associated with the COVID-19 Pandemic in King County provides this data to the public.
We sat down with Danny Colombara, an epidemiologist who crunched the data for this report, and Matias Valenzuela, director of Equity and Community Partnerships, to learn how the health department also uses these findings to analyze health disparities, set priorities, and develop the strategic plan.
What was most striking to you about the data about death in 2020-2022?
Danny: The thing that has lingered with me is the enormous burden borne by American Indian/Alaska Native and Native Hawaiian/Pacific Islander communities in King County. It’s literally off the charts compared to everyone else. There’s been more than a 40% increase in the death rates of both those communities. Life expectancy is years less than it was for the county as a whole. The fact that there were particular communities that were so powerfully affected so far beyond what others communally experienced—it troubles me.
Matias: It’s not always surprising, because we see this is how health inequities play out. The pandemic exacerbated some of the existing inequities and we see this pattern by race and also by geography in the impacts in south King County. Native Hawaiian/Pacific Islander and American Indians/Alaska Native populations had the highest death rates, and it’s also noteworthy that Black residents also had very high rates.
The data show that cancer-related deaths went down but diabetes-related deaths went up by almost 10% during the pandemic. What might explain that?
Danny: We have a few ideas. Those with cancer often have a reduced capacity to fight infections, especially those undergoing chemotherapy. They are at increased risk for severe COVID illness and associated death. It is possible that during the pandemic, some deaths that would have been attributed to cancer occurred due to COVID-19 instead. For example, a person might have been undergoing treatment for lung cancer for two or three years, and midway through, they contracted COVID. COVID initiated the cascade of conditions that led to death, although the person would have died with cancer at the same time. So that’s one possibility.
Ideally, no one should die of diabetes. It should be manageable with appropriate care, control of diet, exercise, and monitoring. But a lot of these things fell apart during the pandemic. I imagine there were a lot of people who weren’t able to access nutritious meals and who missed out on appointments for monitoring blood glucose and hypertension. There’s also some evidence that COVID may lead to poor blood sugar control. The infection could trigger biological processes that increase diabetes deaths.
The pandemic emergency was a tough time for everyone and took a mental health toll. But from 2020-2022, the rate of suicide deaths decreased by over 9% compared to 2017-2019. Did this surprise you?
Danny: Yes, definitely. It caused a lot of head scratching because obviously there were concerns that all the additional stresses and anxieties would lead to a spike in suicides. I was very thankful that we didn’t see that. In emergency department surveillance data, we saw that there were more attempts, but less actual suicide deaths. One potential reason could be that if someone is locked down at home when they attempt suicide, there’s a greater likelihood that someone would find them with time for intervention.
Were there other noteworthy changes within communities in King County?
Matias: We also noticed a significant increase in death rates among the Latinx community. For a couple of decades, the Latinx population nationally has tended to be healthier than their socioeconomic status would predict, often called the “Hispanic or Latino paradox.” There’s a hypothesis that the Latinx population has some protective factors that are contributing to better health, such as strong community bonds. Those who are newly arrived tend to have better health. But the large proportional increase in death rates among the Latino population that we see in this report is similar to worsening trends in the Latinx population at the national level. It’s saying that as a whole, relatively healthy Latinos who emigrate to the U.S. and their subsequent generations tend to get sicker the longer they are here in the United States.
Danny: I’m glad you brought that up! Based on what we saw in this report, I dug into data from the last 10 to 12 years. It was very clear that the average life expectancy in the Latino population was much higher than the rest of the county a number of years ago. During the pandemic, you see this big decrease, going down, down, down. It actually started before the pandemic, to some extent. There had been this exceptionally healthy community—that’s something that should be cherished and protected and not taken for granted. I really hope that resources and awareness can be brought to bear to nip this downward trend in the bud, and to make sure that a population that has been extraordinarily healthy will be able to retain that health.
How has the data from this first iteration of this report been used in the health department?
Danny: When I remember our daily calls where we shared this emerging data during the pandemic, initially there were only epidemiologists, statisticians, and medical people. Over time community members were able to participate and share what’s going on in their communities. This allowed us to better target limited resources. For example, through our partnership with the local housing authorities, we were able to identify specific housing developments for over 100 vaccination clinics. The pandemic caused us to get out of our silos. We were sharing data and able to work together more aggressively and quickly to adapt to the needs of the community. That gave me a lot of hope.
The emergency declaration for COVID-19 is over. What do these findings suggest about what most needs our attention now to improve health in in King County?
Matias: Addressing systemic racism continues to be an issue because it’s an underlying force, and that’s why we have declared racism a public health crisis. And when we think about emerging threats to our communities’ health, the themes that we see in this report are very well aligned with what we are pointing out in our Public Health Strategic Plan. Key emerging threats that we are focusing on include overdose prevention, gun violence prevention, health of people experiencing homelessness, and community well-being and youth mental health. At the same time, we need to continue to work on chronic conditions and diseases, like diabetes, that are major risk factors and also contribute to premature death. They’re also all disproportionately impacting specific communities of color, as highlighted in the report, especially the Native/Indigenous community, the Black community, and the Pacific Islander community. That’s why we need to think about this comprehensively and work on different levels. At the individual level, with drug overdose, we need access to naloxone, and with gun violence, we need things like expanded access to lock boxes. But most importantly at a broader level, how do we improve community conditions impacted by systemic racism – jobs, housing, education, food access? We need to work more upstream so that we can alleviate the impacts we see downstream.
We have so many community assets and strengths. In the same communities that are disproportionately impacted, community building and organizing is happening. We saw during the pandemic and still today all the work of so many community organizations, how they came together in a way that’s been extremely powerful and inspiring. This report is not always the place to find those pieces of good news and hope, but that work is happening.
Read the full report on Changes in Death Rates & Life Expectancy Associated with the COVID-19 Pandemic in King County, Washington (in English).
Learn more about how Public Health and community partners are working together to address systemic racism:
- Public Health – Seattle and King County 2024-2029 Strategic Plan – King County, Washington
- Racism as a Public Health Crisis in King County
- Black Community Equity Team
- Pacific Islander Priority Population Project
- Con Confianza y En Comunidad
Originally published August 30, 2024.