The Impact of COVID-19 on New York's Poorest: An Analysis of Excess Mortality During the Pandemic Using Burial Records from Hart Island

We propose to investigate the impact of COVID-19 on mortality among poor New Yorkers using burial records from Hart Island, the city's potter's field. We will look at all-cause excess mortality during the first and second wave of the outbreak by sex, race/ethnicity, and location. Excess mortality is defined as the difference (or ratio) between the actual number of deaths observed and the number of deaths expected in the absence of the pandemic. It is a key metric to understand the full impact of the pandemic on mortality and population health. Studying excess mortality is important as the official COVID-19-related death count may understate the true number of deaths due to lack of testing, false negatives, and misclassification of cause-of-death. COVID-19 may also indirectly affect mortality from other causes. Individuals with acute or chronic health conditions, which are more prevalent among the poor, may be more likely to die because of these issues and the greater strain on the healthcare system. Social distancing and stay-at-home orders may decrease mortality from accidents but could raise mortality from other causes such as suicide and drug abuse. Understanding how COVID-19 affects socio-economically disadvantaged populations is an important public health priority, but no official statistics speak to its impact on the poor. Estimates of excess mortality among New Yorkers using Hart Island individual-level death records will help shed light on this important issue. These data provide a never-before-explored source to study the impact of the pandemic. Decedents on Hart Island constitute a particularly vulnerable population as they are among the poorest-of-poor New Yorkers. They are expected to be more likely to suffer from lack of timely access to healthcare, and may face greater risk of misclassification upon death, owing to a lack of social and material resources. Analysis of preliminary data shows as many as seven times the number of deaths during the height of the initial COVID-19 outbreak in April 2020 compared to the same period in 2019, confirming the feasibility and potential of the proposed research. This research will link place-of- death addresses with censuses blocks and nested geographies, facilitating estimation of individual and community characteristics to more fully describe inequality in COVID deaths. Further, while indigent burial is an ongoing tragedy found throughout the world during the COVID-19 pandemic, it remains almost completely unstudied in the scientific literature. The proposed research will provide much-needed analysis of a public health and social crisis by drawing on the expertise of faculty in demography, geography, and epidemiology.