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. 2022 Dec;97(12):2206-2214.
doi: 10.1016/j.mayocp.2022.07.008. Epub 2022 Jul 21.

Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic

Scott E Janus  1 , Mohamed Makhlouf  1 , Nicole Chahine  2 , Issam Motairek  1 , Sadeer G Al-Kindi  3
Affiliations

Examining Disparities and Excess Cardiovascular Mortality Before and During the COVID-19 Pandemic

Scott E Janus et al. Mayo Clin Proc. 2022 Dec.

Abstract

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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Figures

Figure 1
Figure 1
Overall mortality comparing pandemic years (2020-2021) with prepandemic years (2018-2019). CHF, congestive heart failure; CVD, cardiovascular disease; MI, myocardial infarction.
Figure 2
Figure 2
Excess cardiovascular disease (CVD) mortality by year compared with 2018 overall and by race.
Figure 3
Figure 3
Excess myocardial infarction (MI) mortality by year compared with 2018 overall and by race.
Figure 4
Figure 4
Excess stroke mortality by year compared with 2018 overall and by race.
Figure 5
Figure 5
Excess heart failure (HF) mortality by year compared with 2018 overall and by race. CHF, congestive heart failure.
Figure 6
Figure 6
Heatmap of United States by percentage excess mortality comparing 2020-2021 with 2018-2019.
See this image and copyright information in PMC

Comment in

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