key: cord-0784217-chmmxehj authors: Calderon-Anyosa, R. J.; Kaufman, J. S. title: Impact of COVID-19 Lockdown Policy on Homicide, Suicide, and Motor Vehicle Deaths in Peru date: 2020-07-14 journal: nan DOI: 10.1101/2020.07.11.20150193 sha: c2b258c6c7195159abec7a69a30174b2aa3caff2 doc_id: 784217 cord_uid: chmmxehj Introduction: Although lockdown measures to stop COVID-19 have direct effects on disease transmission, their impact on violent and accidental deaths remains unknown. Our study aims to assess the early impact of COVID-19 lockdown on violent and accidental deaths in Peru. Methods: Based on data from the Peruvian National Death Information System, an interrupted time series analysis was performed to assess the immediate impact and change in the trend of COVID-19 lockdown on external causes of death including homicide, suicide, and traffic accidents. The analysis was stratified by sex and the time unit was every 15 days. Results: All forms of deaths examined presented a sudden drop after the lockdown. The biggest drop was in deaths related to traffic accidents, with a reduction of 12.66 deaths per million men per month (95% CI: -15.56, -9.76) and 3.64 deaths per million women per month (95% CI:-5.25, -2.03). Homicide and suicide presented similar level drop in women, while the homicide reduction was twice the size of the suicide reduction in men. The slope in suicide in men during the lock-down period increased by 3.62 deaths per million men per year (95% CI:0.06, 7.18). No other change in slope was detected. Conclusions: Violent and accidental deaths presented a sudden drop after the lockdown was implemented and an increase in suicide in men was observed. Falls in mobility have a natural impact on traffic accidents, however, the patterns for suicide and homicide are less intuitive and reveal important characteristics of these events, although we expect all of these changes to be transient. COVID-19 has had a serious impact on population health worldwide 1 , not only as a direct 3 consequence of the infection but also due to the measures taken to reduce its transmission. These 4 unprecedented changes in the lifestyles of millions have also impacted mental health, society and Study population regression model was fitted to the violent deaths rates with a time variable (every 15 days), a 9 6 variable to indicate post-lockdown, which was defined since March 16, 2020 , and an interaction 9 7 term between the post-lockdown indicator and the time variable, to evaluate a change in the slope 9 8 of the outcome trend after lockdown. Stratified analysis was performed for women and men 9 9 because of known differences in violent deaths by sex. Autocorrelation of the time series was analysis was conducted using R 3.6.1. The time slope in the pre-lockdown period was positive for all types of violent deaths in both sex the post-lockdown period was in deaths related to traffic accidents, with a reduction of 12.66 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint presented a similar level drop in women with around 1 fewer death per million women per 1 2 0 month, while the homicide reduction was twice the suicide reduction in men with 6 and 3 drops presented a reduction of 2 deaths per million women per month, being the second-highest drop in 1 2 3 this group (Table 1) . We detected an increase in the slope of suicides in men in the post- In this nationwide time series analysis, we found that lockdown implementation was associated . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint detected change in the post-lockdown trend of suicides in men. Nonetheless, we do expect rates 1 4 4 to return to their pre-pandemic levels at some future point. The biggest immediate absolute 1 4 5 reduction was seen in traffic accidents and the smallest in suicides, but of course this also reflects 1 4 6 the higher absolute burden of traffic accidents as a cause of death. These results are consistent with both the theoretical rationale behind lockdown and various early 1 4 9 reports in other parts of the world. The change in lifestyle and behaviors associated with limited traffic accidents, since people staying at home are at no risk for these events. The decreases in 1 5 3 suicide and homicide are less obvious. Suicide might be expected to increase from economic and Expectations about homicide are also not so clear. As lockdown measures began, conventional 1 5 7 crimes began to slow down around the world. Studies that evaluated the short-term effects of 1 5 8 lockdown on different types of crime reports in Los Angeles and Indianapolis in the USA found a 1 5 9 marked decrease in the robbery, burglary, and aggravated assault after the stay-at-home measures Most homicides in men in Latin-America and around the world are associated with crime 43,44 , and since lockdown, both murder and crime decreased in the region 45 . In Mexico, murder rates, which 1 6 4 started at a historic high in 2020, dropped dramatically almost halfway from the national average 1 6 5 of 81 per day to 54 after social distancing measures were put in place 46 and a similar pattern has 1 6 6 been seen in other countries in the region. Although there is an initial drop and sustained low 1 6 7 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . crime rate while in lockdown, a greater change is expected once lifted due to economic 1 6 8 uncertainty. In our time series analysis, we also found a marked dropped in homicides after 1 6 9 lockdown. Although this aligns with most reports in the region, this decrease in homicides 1 7 0 contrasts with what is happening in some cities in the USA where crime is down, but murder is Most homicides in men are associated with crime, however, most homicides in women are hate 1 7 5 crimes or feminicides. In Peru, the first cause of homicide in women is intimate partner violence, situations of domestic violence 23, 24, 49 . Although we found a reduction in women's homicides 1 7 9 overall, this does not exclude the increase in other forms of intimate partner violence, rather, it Mental health during lockdown has also been a constant concern 13,15,16,51,52 . Some initial reports 1 8 7 show the increase in suicides rate during this pandemic as a consequence of lockdown, financial is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint 1 3 This initial drop should not be considered as encouraging, since just as there was a marked drop 2 3 9 at the beginning, it is likely to be an equally sharp increase after the lockdown is lifted and the should take into consideration other aspects of health that might be overlooked during this . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted July 14, 2020. . https://doi.org/10.1101/2020.07.11.20150193 doi: medRxiv preprint World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19) Impact of lockdown following COVID-19 on the gaming behavior of college students Economic impacts of Wuhan 2019-nCoV on China and the world Isolation, quarantine, social distancing and community containment: pivotal role for old-style public health measures in the novel coronavirus (2019-nCoV) outbreak Evaluating the Effectiveness of Social Distancing Interventions to Delay or Flatten the Epidemic Curve of Coronavirus Disease Covid-19 hot spots appear across Latin America Decreto Supremo N° 116-2020-PCM The Peru Approach against the COVID-19 Infodemic: Insights and Strategies COVID-19 mortality rates in the European Union, Switzerland, and the UK: effect of timeliness, lockdown rigidity, and population density The Efficacy of Lockdown Against COVID-19: A Cross-Country Panel Analysis. Appl Health Econ Health Policy Is Lockdown Bad for Social Anxiety in COVID-19 Regions?: A National Study in The SOR Perspective COVID 2019-suicides: A global psychological pandemic Violence against women, children, and adolescents during the COVID-19 pandemic: overview, contributing factors, and mitigating measures Impact of social distancing during COVID-19 pandemic on crime in Los Angeles and Indianapolis Initial evidence on the relationship between the coronavirus pandemic and crime in the United States Crime Rates in a Pandemic: the Largest Criminological Experiment in History Staying Home Saves Lives, Really! Rochester, NY: Social Science Research Network The increase in domestic violence during the social isolation: what does it reveals? The impact of the Covid-19 pandemic on domestic violence: The dark side of home isolation during quarantine COVID-19 and Ending Violence against Women and Girls Alarming trends in US domestic violence during the COVID-19 pandemic Assessing air quality changes in large cities during COVID-19 lockdowns: The impacts of traffic-free urban conditions in Almaty Impact of lockdown measures implemented during the Covid-19 pandemic on the burden of trauma presentations to a regional emergency department in Kwa-Zulu Natal, South Africa Impact of the COVID-19 Pandemic on an Emergency Traumatology Service: Experience at a Tertiary Trauma Centre in Spain A revisit on older adults suicides and Severe Acute Respiratory Syndrome (SARS) epidemic in Hong Kong The Impact of Epidemic, War, Prohibition and Media on Suicide: United States, 1910-1920 Plataforma Nacional de Datos Abiertos Resultados preliminares del fortalecimiento del sistema informático nacional de defunciones Perú: Resultados Definitivos de los Censos Nacionales Mortality and Morbidity: The Measure of a Pandemic COVID-19: a need for real-time monitoring of weekly excess deaths Google COVID-19 Community Mobility Reports Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: a review Sample size and power considerations for ordinary least squares interrupted time series analysis: a simulation study REUNIS :. Repositorio Único Nacional de Información en Salud -Ministerio de Salud Suicide risk and prevention during the COVID-19 pandemic COVID-19, anxiety, sleep disturbances and suicide Exploring the Effect of 2019-nCoV Containment Policies on Crime: The Case of Los Angeles. ArXiv200311021 Econ Q-Fin Stat Calidad de los datos de homicidio en América Latina. Bras Lab Análisis Violencia-Universidad Estado Rio Global Study on Homicide 2019: Executive Summary. United Nations Office on Drugs and Crime Crimen cae en calles de Latinoamérica en tiempos de COVID-19 Crime and Contagion: The Impact of a Pandemic on Organized Crime. Global Initiative Against Transnational Organized Crime That's Also Reflected in Crime Statistics. The New York Times Lima Perú: La Siniestra Ensayos Domestic violence and COVID-19: Our hidden epidemic Características de la muerte de mujeres por violencia según las necropsias realizadas en la morgue del Callao The outbreak of COVID-19 coronavirus and its impact on global mental health COVID-19 and suicides: The urban poor in Bangladesh Factors associated with COVID-19 outbreak-related suicides in India Projected increases in suicide in Canada as a consequence of COVID-19 Avances hacia la igualdad de hombres y mujeres Situación del mercado laboral en Lima Metropolitana Impact of Covid-19 lockdown on characteristics of autopsy cases in Greece. Comparison between 2019 and 2020