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

我们建议使用以下工具调查新冠肺炎对贫困纽约人死亡率的影响 哈特岛的墓葬记录，这座城市的波特之地。我们将研究各种原因造成的过度行为 按性别、种族/族裔和地点分列的第一波和第二波暴发期间的死亡率。 超额死亡率定义为实际死亡人数与实际死亡人数之间的差额(或比率)。 在没有大流行的情况下，观察到的死亡人数和预计的死亡人数。这是一个关键的指标 了解大流行对死亡率和人口健康的全面影响。 研究超额死亡很重要，因为官方新冠肺炎相关的死亡统计可能 低估了因缺乏检测、假阴性和错误分类而死亡的真实数字 死亡原因。新冠肺炎也可能间接影响其他原因的死亡率。个人 患有急性或慢性健康状况的人，这在穷人中更普遍，可能更多 可能会因为这些问题和医疗体系面临的更大压力而死亡。社交 疏远和居家订单可能会降低事故死亡率，但可能会增加 其他原因造成的死亡，如自杀和药物滥用。 了解新冠肺炎如何影响社会经济弱势群体是一个 这是重要的公共卫生优先事项，但没有官方统计数字说明其对穷人的影响。 使用哈特岛个体水平死亡对纽约人超额死亡率的估计 记录将有助于阐明这一重要问题。这些数据提供了前所未有的 来源：研究大流行的影响。哈特岛上的死者构成了一个特别的 弱势群体，因为他们是最贫穷的纽约人中的一员。预计他们将 更有可能得不到及时的医疗保健，并可能面临更大的风险 死亡时的错误分类，原因是缺乏社会和物质资源。 对初步数据的分析显示，这一时期的死亡人数是 与2019年同期相比，2020年4月首次新冠肺炎爆发的高峰， 确认了拟议研究的可行性和潜力。这项研究将把地点- 带有人口普查模块和嵌套地理位置的死亡地址，便于估计 个人和社区特征，以更全面地描述COVID死亡人数的不平等。 此外，虽然贫穷的埋葬是一种持续不断的悲剧，但在 在新冠肺炎大流行期间，科学文献中几乎完全没有对它进行研究。这个 拟议的研究将通过以下方式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.