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Bereavement and Risk of Cardiovascular Disease Before and During the COVID-19 Pandemic
Fen Yang1, Shiyu Li1, Mary M Barker1
1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Insights
Bereavement increases cardiovascular disease (CVD) risk. This risk was higher during the COVID-19 pandemic, especially after losing a partner or sibling, highlighting the need for targeted care for bereaved individuals.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Grief research
Background:
- Bereavement is a recognized risk factor for cardiovascular disease (CVD).
- The COVID-19 pandemic's impact on the bereavement-CVD association, due to healthcare disruptions and social isolation, was previously unclear.
Purpose of the Study:
- To compare the association between bereavement and incident CVD before and during the COVID-19 pandemic.
- To investigate how different types of loss and age influence this association across pandemic periods.
Main Methods:
- A Swedish national cohort study analyzed individuals aged 30+ using health registries from pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods.
- Cox regression models estimated hazard ratios for incident CVD following bereavement (loss of partner, child, parent, or sibling), comparing the two periods and considering age.
Main Results:
- Bereavement was linked to increased CVD risk in both periods. The association was stronger during the COVID-19 pandemic for partner loss (HR 1.46 vs 1.30) and sibling loss (HR 1.23 vs 1.16).
- No significant period difference was observed for child or parent loss. Age modified the risk, with partner/parent loss risk increasing with age, and child/sibling loss risk decreasing with age.
Conclusions:
- Bereavement is consistently associated with elevated CVD risk, with a notably stronger association for partner and sibling loss during the COVID-19 pandemic.
- Bereaved individuals may experience heightened cardiovascular vulnerability, emphasizing the need for enhanced clinical monitoring and preventive strategies.
Importance:
Bereavement is a known risk factor for cardiovascular disease (CVD), but it remains unclear whether the COVID-19 pandemic-which disrupted health care and increased social isolation-altered this association.
Objective:
To compare the association between bereavement and incident CVD before and during the pandemic.
Design, Setting, And Participants:
This cohort study of Swedish national health registries included individuals aged 30 years or older in Sweden during the pre-COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. Analyses were performed between September 2024 and August 2025.
Exposures:
Bereavement exposure was defined as the loss of a partner, child, parent, or sibling.
Main Outcomes And Measures:
The first diagnosis of any CVD event, identified from an outpatient hospital visit or hospitalization via the Swedish Patient Register or death via the Swedish Cause of Death Register. Cox regression was used to estimate hazard ratios (HRs) of incident CVD after bereavement by study period, type of loss, and age.
Results:
Analysis included a total of 5 365 829 study participants (51.4% female; median [IQR] age, 51.6 [40.4-64.6] years) during the pre-COVID-19 period and 5 522 898 study participants (51.4% female; median [IQR] age, 49.8 [38.2-62.8] years) during the COVID-19 period. Overall, 372 477 (6.94%) and 368 902 (6.68%) incident CVD cases were identified during the pre-COVID-19 and COVID-19 periods, respectively. Bereavement was associated with increased CVD risk regardless of period or type of loss. However, the risk increment was greater during the COVID-19 period compared with the pre-COVID-19 period for loss of a partner (HR, 1.46 [95% CI, 1.41-1.51] vs 1.30 [95% CI, 1.26-1.35]; P for difference < .001) and sibling (HR, 1.23 [95% CI, 1.20-1.27] vs 1.16 [95% CI, 1.13-1.19]; P for difference = .003). No period difference was noted for the loss of a child or parent. The risk increment after loss of a partner or parent increased with age, while the risk after loss of a child or sibling decreased with age.
Conclusions And Relevance:
In this cohort study, bereavement was associated with increased CVD risk both before and during the COVID-19 pandemic; however, a stronger association for partner or sibling loss was noted during the pandemic. These findings suggest that bereavement may be a period of heightened cardiovascular vulnerability, underscoring the importance of targeted clinical monitoring and preventive care for bereaved individuals.
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