Covariates

Demographic and clinical factors were abstracted from the Maryland OCME electronic database at the time of death. We assessed age at death (10-year categories), homelessness at the time of death (yes, no), sex at birth (male, female), and race/ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, or other/unknown [including Asian, other, unknown]). Sex and race/ethnicity groups are presented due to the differences in seroprevalence in these groups. Manner of death was determined by the medical examiner and can include the following categories: natural, homicide, suicide, accidental, and undetermined. Undetermined is a classification used by the medical examiner when the cause of death is unknown or there is insufficient information per investigation and/or autopsy examination to definitively determine the manner of death. At the time of publication, 1 case was still under investigation and was classified as undetermined. For this study we defined overdose death as an overdose due to illicit drug intoxication irrespective of manner of death. Manner of death was categorized as natural, homicide, suicide, accidental (due to motor vehicle trauma), accidental (all other, excluding overdose), illicit drug overdose, or undetermined (excluding overdose).