Background The COVID-19 pandemic significantly changed society. The effect of pandemic-related behavior changes on injury burden has not been systematically assessed.

Methods We compared injury age-standardized mortality/morbidity rate ratio (MtRR/MbRR) with 95% confidence interval (95% CI) of 2020 vs. 2019 to those of 2019 vs. 2018 to demonstrate the influence of the COVID-19 pandemic on fatal and nonfatal injury burden. The ratio of MtRRs (RMtRR) and the ratio of MbRRs (RMbRR) with 95% CI between 2020 vs. 2019 and 2019 vs. 2018 were also calculated, separately.

Results The COVID-19 pandemic was associated with substantial injury mortality increases but significant injury morbidity decreases from 2019 to 2020 compared to from 2018 to 2019. Mortality disparities between the two time periods were primarily driven by greater mortality during the COVID-influenced 2020 versus 2019 from road traffic crashes, drug poisoning, and homicide by firearm. Similar patterns were not present from 2019 versus 2018. There were morbidity reductions from road traffic crashes, unintentional falls, and self-harm by suffocation from 2019 to 2020 compared to the previous period. Change patterns in sex and age groups were generally similar, but exceptions were observed.

Conclusion The COVID-19 pandemic significantly changed injury burden in the United States. The increased injury burden from injury mortality among specific populations merits attention of injury researchers and policymakers.

Learning outcomes The results call for continued effort to tailor injury prevention strategies to particular sex- and age-groups as well as the environmental context that citizens face.