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Shifting Burdens: U.S. Cardiovascular Mortality Trends during the COVID-19 Pandemic
Param Darpan Sheth1, M C Prasad1, Chandana Srinath1
1Department of General Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India.
Insights
The COVID-19 pandemic increased U.S. cardiovascular mortality, especially pulmonary embolism (PE) and arrhythmias. Racial minorities faced disproportionately higher increases, emphasizing the need for equitable healthcare access.
Area of Science:
- Cardiovascular epidemiology
- Public health surveillance
- Infectious disease impact
Background:
- Cardiovascular diseases (CVDs) are leading causes of mortality.
- The COVID-19 pandemic presented direct and indirect risks to cardiovascular health.
- Understanding pandemic-era CVD mortality trends is crucial.
Purpose of the Study:
- To analyze changes in U.S. mortality from major cardiovascular conditions pre- and post-COVID-19.
- To investigate sex- and race-specific disparities in these mortality shifts.
Main Methods:
- Utilized national death certificate data (2015-2023) from CDC WONDER.
- Examined mortality rates for cardiac arrest, arrhythmias, myocarditis, pericarditis, and pulmonary embolism (PE).
- Calculated age-standardized rates and rate ratios, stratified by sex and race.
Main Results:
- All studied cardiovascular conditions showed increased mortality post-pandemic.
- Pulmonary embolism (PE) had the largest relative increase (+31.4%).
- Black and American Indian/Alaska Native populations experienced the steepest relative mortality increases.
Conclusions:
- The COVID-19 era correlated with persistent rises in U.S. cardiovascular mortality, notably PE and arrhythmias.
- Significant racial disparities in mortality increases were observed.
- Equitable access to preventive and acute cardiovascular care is urgently needed.
Background:
Cardiovascular conditions such as cardiac arrest, arrhythmias, myocarditis, pericarditis, and pulmonary embolism (PE) contribute substantially to mortality. The COVID-19 pandemic introduced both direct (infection-related) and indirect (healthcare disruption) risks, potentially altering these trends.
Objective:
To assess the shifts in U.S. mortality from major cardiovascular causes before and after the COVID-19 pandemic, with emphasis on sex- and race-specific disparities.
Methodology:
We analyzed national death certificate data from the Centers for Disease Control and Prevention-Wide Ranging Online Data for Epidemiologic Research Multiple Cause of Death database (2015-2023). Outcomes included cardiac arrest (I46), arrhythmias (I47-I49), myocarditis (I40-I41, I51.4), pericarditis (I30-I32), and PE (I26). Age-standardized mortality rates (ASRs) were calculated using the 2000 U.S. standard population. Rate ratios (RRs) for the post- versus prepandemic periods were estimated using Poisson regression, stratified by sex and race.
Results:
Mortality increased across all outcomes in the postpandemic period. PE showed the largest relative rise (ASR: +31.4%; RR: 1.31, 95% confidence interval [CI]: 1.30-1.32), followed by myocarditis (+25.1%; RR: 1.25, 95% CI: 1.19-1.30), pericarditis (+21.4%; RR: 1.21, 95% CI: 1.19-1.24), and arrhythmias (+23.0%; RR: 1.23, 95% CI: 1.23-1.23). Cardiac arrest increased more modestly (+9.8%; RR: 1.09, 95% CI: 1.09-1.09). Men had consistently higher absolute rates, while Black and American Indian/Alaska Native populations experienced the steepest relative increases.
Conclusion:
The COVID-19 era was associated with sustained increases in U.S. cardiovascular mortality, particularly PE and arrhythmias. Disproportionate impacts among racial minorities highlight the urgent need for equitable access to preventive care, acute cardiovascular services, and long-term surveillance.
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