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Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health.Methods: An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities.Results: During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group.Conclusion: The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, health-seeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.<\/jats:p>","DOI":"10.24171\/j.phrp.2023.0175","type":"journal-article","created":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T04:30:42Z","timestamp":1700713842000},"page":"468-482","update-policy":"https:\/\/doi.org\/10.24171\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022"],"prefix":"10.24171","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9562-0533","authenticated-orcid":true,"given":"Sameera Anuruddha","family":"Gunawardena","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2677-236X","authenticated-orcid":true,"given":"Nishani","family":"Dassanayake","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1515-075X","authenticated-orcid":true,"given":"Buddhika Indeewarie","family":"Keerawelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9903-3771","authenticated-orcid":true,"given":"Shivasankarie","family":"Kanthasamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4242-0687","authenticated-orcid":true,"given":"Hasini","family":"Ranganatha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0773-6507","authenticated-orcid":true,"given":"Jayani Wathsala","family":"Gunawardana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"31909","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2008-3"},{"key":"ref2","first-page":"270","volume-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","author":"Zhou","year":"2020"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa316"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.25757"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9020575"},{"volume-title":"WHO coronavirus (COVID-19) dashboard [Internet]","year":"2023","key":"ref6"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12743"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1016\/j.chaos.2020.110173"},{"volume-title":"World Health Organization declared a pandemic public health menace: a systematic review of the coronavirus disease 2019 \u201cCOVID-19\u201d [Internet]","year":"2020","author":"Jebril","key":"ref9"},{"volume-title":"National Action Committee on President\u2019s Advice to prevent spread of deadly coronavirus [Internet]","year":"2020","key":"ref10"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1007\/s41649-020-00153-z"},{"volume-title":"Press release 2020.03.20: Declaration of police curfew islandwide [Internet]","year":"2020","key":"ref12"},{"volume-title":"First coronavirus patient dies in Sri Lanka, total COVID-19 count 113 [Internet]","year":"2020","key":"ref13"},{"volume-title":"Press release 2020.05.25. 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