Racial and Ethnic Disparities in Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic in the United States

Abstract

Background: Cardiovascular deaths increased during the early phase of the COVID-19 pandemic in the United States. However, it is unclear whether diverse racial/ethnic populations have experienced a disproportionate rise in heart disease and cerebrovascular disease deaths.

Methods: We used the National Center for Health Statistics to identify heart disease and cerebrovascular disease deaths for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic individuals from March to August 2020 (pandemic period), as well as for the corresponding months in 2019 (historical control). We determined the age- and sex-standardized deaths per million by race/ethnicity for each year. We then fit a modified Poisson model with robust SEs to compare change in deaths by race/ethnicity for each condition in 2020 versus 2019.

Results: There were a total of 339 076 heart disease and 76 767 cerebrovascular disease deaths from March through August 2020, compared with 321 218 and 72 190 deaths during the same months in 2019. Heart disease deaths increased during the pandemic in 2020, compared with the corresponding period in 2019, for non-Hispanic White (age-sex standardized deaths per million, 1234.2 versus 1208.7; risk ratio for death [RR], 1.02 [95% CI, 1.02-1.03]), non-Hispanic Black (1783.7 versus 1503.8; RR, 1.19 [95% CI, 1.17-1.20]), non-Hispanic Asian (685.7 versus 577.4; RR, 1.19 [95% CI, 1.15-1.22]), and Hispanic (968.5 versus 820.4; RR, 1.18 [95% CI, 1.16-1.20]) populations. Cerebrovascular disease deaths also increased for non-Hispanic White (268.7 versus 258.2; RR, 1.04 [95% CI, 1.03-1.05]), non-Hispanic Black (430.7 versus 379.7; RR, 1.13 [95% CI, 1.10-1.17]), non-Hispanic Asian (236.5 versus 207.4; RR, 1.15 [95% CI, 1.09-1.21]), and Hispanic (264.4 versus 235.9; RR, 1.12 [95% CI, 1.08-1.16]) populations. For both heart disease and cerebrovascular disease deaths, Black, Asian, and Hispanic populations experienced a larger relative increase in deaths than the non-Hispanic White population (interaction term, P<0.001).

Conclusions: During the COVID-19 pandemic in the United States, Black, Hispanic, and Asian populations experienced a disproportionate rise in deaths caused by heart disease and cerebrovascular disease, suggesting that these groups have been most impacted by the indirect effects of the pandemic. Public health and policy strategies are needed to mitigate the short- and long-term adverse effects of the pandemic on the cardiovascular health of diverse populations.

Keywords: COVID-19; cardiovascular disease; cerebrovascular disease; health disparities; mortality; pandemic; race/ethnicity.

Figure 1.

Monthly age–sex standardized heart disease and cerebrovascular disease deaths per million by race and ethnicity, 2020 vs 2019. Age–sex standardized heart disease (A) and cerebrovascular disease (B) deaths per million from March through August 2020 (dashed lines) compared with corresponding months in 2019 (solid lines) for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic populations.

Figure 2.

Relative monthly change in age–sex standardized heart disease and cerebrovascular disease deaths per million by race and ethnicity, 2020 vs 2019. Relative (%) change in age–sex standardized heart disease (A) and cerebrovascular disease (B) deaths per million from March through August (2020 vs 2019) for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic populations.

Figure 3.

Absolute monthly differences in age–sex standardized heart disease and cerebrovascular disease deaths per million by race and ethnicity, 2020 vs 2019. Absolute differences in age–sex standardized heart disease (A) and cerebrovascular disease (B) deaths per million from March through August (2020 vs 2019) for non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic populations.