How we analyzed death records and found an increase in overdoses
While notification of infectious disease deaths is normally considered the responsibility of the medical examiner or coroner, most counties in California have assigned the tracking and reporting of COVID-19-related deaths to local health departments.
In Santa Clara County, all deaths from COVID-19 were reported and reviewed by the coroner’s office, regardless of whether a person lived in the county or elsewhere. This included deaths occurring at home and in hospitals, long-term care facilities, nursing homes, prisons and psychiatric care facilities.
County practices for post-death COVID-19 testing vary widely:
- The Santa Clara County medical examiner is performing COVID-19 post-mortem tests on deceased people received by this office and suspected of having the virus.
- The Alameda County Sheriff Coroner is testing all the dead brought to the county morgue for COVID-19.
- The San Francisco County Department of Public Health began requiring post-mortem testing of all people who have died in the county since June 2020.
In addition, mortality data is a snapshot in time in which there is always a portion of cases where the cause of death is pending results of tests or an investigation. For example, counties keep data if a person’s death is investigated as a felony. During the pandemic, many organizations were also late.
How we analyzed the data
Santa Clara: As of December 2020, members of the COVID-19 Documenting Project have filed multiple public records law requests with the Santa Clara County Medical Examiner’s Office to obtain data on all deaths in Santa Clara County. between January 1, 2018 and March 1, 2021.
We have reported all death records that mentioned the case insensitive words “fentanyl” or “tox” in any domain, as variations of the word “toxicity” are commonly mentioned in deaths attributed to drug overdose.
By plotting the ‘fentanyl’ and ‘tox’ death tally over time, we found peaks in 2019 and the first half of 2020, but a rather abnormal drop in the second half of 2020. This drop could be due to incomplete mortality data, for example due to cases the medical examiner is still investigating. County offices often take months to close pending cases and accurately record the cause of death.
We also found that the median age of people who died from the potent opioid fentanyl has decreased each year. We then extended our analysis to two neighboring counties to look for clues of a similar trend.
The unusual drop in fentanyl-related deaths in the second half of 2020 was also echoed in data from Alameda and San Francisco counties. So we contacted the Santa Clara County Medical Examiner’s Office to request an updated list of death records, specifically asking for all fentanyl-related deaths and the ages of those who died. This new record demand was met on April 29, 2021. After plotting the gross tally of fentanyl deaths over time, we no longer saw a sharp decline in deaths in the second half of 2020, which gives us a greater confidence that our data more accurately reflects the actual number of people who were dying of fentanyl overdoses in Santa Clara County. We used these updated data to corroborate our previous findings on decreasing trends in the median age of people who died on fentanyl.
We found 920 COVID-related deaths in Santa Clara County death records in 2020. A new data set on COVID deaths by county, compiled by the California Department of Public Health, has revealed that there are had 932 COVID-related deaths in total in Santa Clara County. These two counts are similar, underscoring the accuracy of fentanyl death records for 2018, 2019, and 2020 obtained from the Santa Clara County Medical Examiner’s Office at the end of April 2021.
Alameda County: Similar to Santa Clara, the COVID-19 documentation team received all mortality data from January 1, 2018 to February 27, 2020 from the Alameda County Sheriff’s Office Coroner’s Office before beginning the investigative process for this story. We realized that to accurately characterize trends in death registries – especially those related to fentanyl overdose – we needed to obtain up-to-date data. The Alameda County Sheriff’s Office Coroner’s Office responded to our last request on May 3, 2021. We found that the most recent data showed that six fewer people had died from a fentanyl overdose over the course of the year. the second half of 2020 than previous datasets from the same period.
San Francisco: Through case requests to the San Francisco Chief Medical Examiner’s Office, the COVID-19 documentation team had previously received death certificates from January 1, 2018 through November 2020. In March, we found that on of the 1365 total death certificates on that date range, 490 (35.9%) had the cause of death listed as “pending” or “unknown,” indicating that the chief medical examiner’s office had not closed these surveys. However, accidental overdose reports posted on the office’s website showed their office estimated more than twice the number of people who died from fentanyl overdoses in 2020 compared to the records provided to us. We requested updated data on fentanyl mortality for the period January 1, 2018 to March 31, 2021. The Medical Examiner’s Office responded to our request on April 29, 2021. These latest records show 396 deaths from fentanyl in 2020. However, the office says in a separate report that 515 people have died of fentanyl overdoses – an indication that our data, while much more comprehensive than before, still does not reflect all of the people who have died of fentanyl. overdosed on fentanyl in San Francisco. Additionally, the records provided did not show any overdose of fentanyl between January 2018 and July 2018. We seek further clarification on this potential data gap and have excluded this period from our analysis.
We cross our data with an analysis of California Health and Human Services Death Profiles for 2018, 2019 and 2020.
This analysis showed that deaths statewide increased by 30.3% (from 2018 and 2019 to 2020). The state includes data on deaths in the county where the person lived, not the county where they died.