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

我们建议调查COVID-19对纽约穷人死亡率的影响， 哈特岛的埋葬记录，这里是城市的陶工之地我们将研究全因过剩 按性别、种族/族裔和地点分列的第一波和第二波疫情期间的死亡率。 超额死亡率定义为实际死亡人数与实际死亡人数之差（或比率） 观察到的死亡人数以及在没有大流行的情况下预计的死亡人数。这是一个关键指标， 了解这一流行病对死亡率和人口健康的全面影响。 研究超额死亡率很重要，因为官方的COVID-19相关死亡人数可能 由于缺乏检测、假阴性和错误分类， 死亡原因COVID-19还可能间接影响其他原因导致的死亡率。个人 患有急性或慢性健康状况的人，在穷人中更为普遍， 可能会因为这些问题和医疗保健系统的更大压力而死亡。社会 保持距离和呆在家里的命令可能会降低事故的死亡率， 其他原因，如自杀和吸毒。 了解COVID-19如何影响社会经济弱势群体是一个 这是一个重要的公共卫生优先事项，但没有官方统计数据说明它对穷人的影响。 使用哈特岛个人水平死亡估计纽约人的超额死亡率 记录将有助于阐明这一重要问题。这些数据提供了一个前所未有的探索 研究大流行的影响。哈特岛上的死者 弱势群体，因为他们是穷人中最穷的纽约人。预计他们将 更有可能遭受缺乏及时获得医疗保健的痛苦，并可能面临更大的风险， 由于缺乏社会和物质资源，死亡后的分类错误。 对初步数据的分析显示， 与2019年同期相比，2020年4月首次COVID-19爆发的高峰期， 确认拟议研究的可行性和潜力。这项研究将连接的地方- 死亡地址与人口普查区块和嵌套的地理位置， 个人和社区特征，以更充分地描述COVID死亡的不平等。 此外，虽然贫穷的埋葬是一个持续的悲剧，在世界各地发现， 在COVID-19大流行期间，科学文献中几乎完全没有对其进行研究。的 拟议的研究将提供急需的公共卫生和社会危机分析， 利用教师在人口学、地理学和流行病学方面的专业知识。

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.