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Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic
Scott E Janus1, Mohamed Makhlouf1, Nicole Chahine2
1Department of Medicine, University Hospitals, Cleveland, OH; Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, OH.
Insights
Cardiovascular disease (CVD) mortality, including myocardial infarction (MI) and stroke, significantly increased during the COVID-19 pandemic. This excess mortality disproportionately impacted Black individuals compared to White individuals.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Medicine
Background:
- The COVID-19 pandemic has had profound global health implications, necessitating an examination of its impact on non-communicable diseases.
- Cardiovascular diseases (CVD) remain a leading cause of mortality worldwide, with subtypes including myocardial infarction (MI), stroke, and heart failure.
Purpose of the Study:
- To investigate the changes in cardiovascular disease (CVD) mortality patterns and demographic features during the COVID-19 pandemic compared to the pre-pandemic era in the United States.
- To analyze excess mortality rates for CVD and its major subtypes (MI, stroke, heart failure) between 2018-2019 and 2020-2021.
- To examine demographic disparities, specifically race, in CVD mortality trends during the pandemic.
Main Methods:
- A cross-sectional study utilizing US Multiple Cause of Death files from 2018 to 2021.
- International Classification of Diseases, Tenth Revision (ICD-10) codes were used to identify deaths related to CVD (I00-I99), MI (I21-I22), stroke (I60-I69), and heart failure (I42, I50).
- Excess mortality was calculated by comparing the pandemic period (2020-2021) with the prepandemic period (2018-2019), with subgroup analyses performed for race and temporal variations.
Main Results:
- A total of 3,598,352 CVD deaths were analyzed. The pandemic period saw a 6.7% excess in overall CVD mortality, 2.5% for MI, and 8.5% for stroke compared to the prepandemic era.
- Black individuals experienced significantly higher excess CVD mortality (13.8%) compared to White individuals (5.1%; P<.001).
- This racial disparity was consistent across CVD subtypes: MI (9.6% vs 1.0%), stroke (14.5% vs 6.9%), and heart failure (5.1% vs -1.2%), all with P<.001.
Conclusions:
- The COVID-19 pandemic has led to a significant and persistent increase in cardiovascular disease and subtype-specific mortality.
- Excess cardiovascular mortality disproportionately affected Black individuals, highlighting critical healthcare disparities.
- Further research and targeted interventions are essential to address and eliminate these health inequities.
Objective:
To investigate the patterns and demographic features of cardiovascular disease (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure in the pre-COVID-19 era (2018-2019) vs during the COVID-19 pandemic (2020-2021) in the United States.
Methods:
In this cross-sectional study, we used the US Multiple Cause of Death files for 2018 to 2021 to examine the trend of excess cause-specific deaths using International Classification of Diseases, Tenth Revision codes for CVD (I00 to I99), MI (I21 and I22), stroke (I60 to I69), and heart failure (I42 and I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and heart failure) between prepandemic (2018-2019) and pandemic (2020-2021) years. We performed a subgroup analysis on race and month-to-month and year-to-year variation using χ2 analysis to test statistical significance.
Results:
Overall, 3,598,352 CVD deaths were analyzed during the study period. There was a 6.7% excess CVD mortality, 2.5% MI mortality, and 8.5% stroke mortality during the COVID-19 pandemic (2020-2021) compared with the prepandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) than White individuals (5.1%; P<.001). This remained consistent across subtypes of CVD, including MI (9.6% vs 1.0%; P<.001), stroke (14.5% vs 6.9%; P<.001), and heart failure (5.1% vs -1.2%; P<.001).
Conclusion:
There has been a significant rise in CVD and subtype-specific mortality during the COVID-19 pandemic that has been persistent despite 2 years since the onset of the pandemic. Excess CVD mortality has disproportionately affected Black compared with White individuals. Further studies targeting and eliminating health care disparities are necessary.
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