Prevalence of cardiovascular diseases in COVID-19 related mortality in the United States

Abstract

Background: Several cardiovascular disease (CVD) risk factors and sequelae have been associated with COVID-19. Little is known about the distribution of CVD conditions in COVID-19 related deaths in the US population.

Methods: The public-use dataset by CDC, "Conditions Contributing to COVID-19 Deaths, by State and Age, Provisional 2020-2021", was abstracted as of August 1, 2021. A descriptive analysis was conducted to explore the overall and age-specific prevalence of various CVD and risk factors grouped by pre-specified ICD-10 codes amongst COVID-19 patient deaths. Respective trends over the duration of the pandemic were analyzed using the Mann-Kendall method, including time-periods before and after the introduction of vaccines in January 2021. All time-related analysis was conducted between March 2020 and June 2021.

Results: A total of 600,241 COVID-19 related deaths were reported between March 2020 and June 2021. Hypertensive diseases were the most prevalent (19.6%), followed by diabetes (15.9%), ischemic heart disease (IHD;10.9%), heart failure (7.7%), cardiac arrhythmias (7.5%), other diseases of the circulatory system (6.6%), cerebrovascular diseases (5%), and obesity (4.1%). While a significant downward trend was noted for hypertensive diseases over the course of the pandemic, cardiac arrhythmias, heart failure (HF), obesity, and other circulatory system diseases demonstrated a significant upward trend. Since the introduction of vaccines, the trends for heart failure and cardiac arrhythmias remained steady while having demonstrated a significant rise in the pre-vaccination time-period. While obesity and other diseases of the circulatory system predominated (>50%) amongst the CVD burden in the younger population (0-24 years and 25-34 years), the percentage occurrence of cardiac arrhythmias, hypertensive diseases, HF, and IHD increased with age.

Conclusion: Hypertensive diseases, diabetes, and IHD were the most prevalent cardiovascular conditions amongst COVID-19 related deaths. These patterns varied by age. While the trend for hypertensive diseases declined over the course of the pandemic, cardiac arrhythmias, HF, obesity, and other diseases of the circulatory system demonstrated an upward trend. An important limitation is the source of the data being limited to death certificates.

Keywords: Burden; COVID; Cardiovascular; Mortality; Prevalence.

Fig. 1

Cardiovascular conditions contributing to overall COVID-19-related deaths for the duration of the pandemic across all ages, United States.

Fig. 2

Trends of cardiovascular diseases contributing to COVID-19 mortality, March 2020 – June 2021, United States. The respective p-values for trend are presented next to the legend (a = overall p-value for trend, b = p-value for trend in the pre-vaccination period, c = p-value for trend in the post-vaccination period). The dashed vertical line roughly estimates the time vaccines against COVID-19 became publicly available in a graduated fashion. ^⁎Other diseases of the circulatory system.

Fig. 3

Contribution of specific conditions amongst total cardiovascular diseases described in COVID-19-related mortality by age over the duration of the pandemic, United States.