Although an increase in cardiovascular disease (CVD) and subtype-specific mortality has been reported during the COVID-19 pandemic, an unequal distribution has been observed, with Black and African American patients experiencing a larger burden of mortality compared with White patients. These are the findings of a retrospective, cross-sectional study published in Mayo Clinic Proceedings.
Researchers sought to explore the patterns, demographics, and changes in CVD death and its 3 subtypes — myocardial infarction (MI), stroke, and heart failure (HF) —between January 1, 2018, and December 31, 2021. They used multiple cause-of-death files maintained by the National Center for Health Statistics through the US Centers for Disease and Prevention Wide-Ranging Online Data for Epidemiologic Research.
The primary study outcome was excess mortality from CVD and its 3 subtypes, in which 3 consecutive years (2019, 2020, and 2021) were compared with 2018. The year 2018 was selected as the referent year, as it permitted the assessment and comparison of preexisting trends in mortality in the year 2019 (ie, the prepandemic era).
Total mortality from the 2018 to 2019 prepandemic era was compared with mortality during the COVID-19 pandemic years of 2020 and 2021. Trends in excessive cause-specific death caused by CVD, according to the International Disease Classification (ICD), version 10, were examined. A subgroup analysis was performed on race, as well as month-to-month and year-to-year variation, with chi-squared analysis used to examine statistical significance.
A total of 3,598,352 deaths from CVD were analyzed in the current study. During the COVID-19 pandemic (2020 to 2021) compared with the prepandemic era (2018 to 2019), a 6.7% excess in CVD mortality, as well as a 2.5% excess in MI mortality and an 8.5% excess in stroke mortality, was reported.
A significantly higher excess in CVD mortality was reported among Black and African American patients compared with White patients (13.8% vs 5.1%; P <.001). This higher excess remained consistent across the 3 subtypes of CVD, which included MI (9.6% vs 1.0%, respectively), stroke (14.5% v 6.9%, respectively), and HF (5.1% vs –1.2%, respectively; P <.001 for all).
Limitations of the current study warrant mention. The analysis was based on provisional ICD codes, which may be incomplete because of delays in reporting. Further, since the study was based on the inclusion of only underlying causes of death associated with CVD, it may be possible that undiagnosed cases of COVID-19 partially contributed to the excess death observed as well.
According to the researchers, “Further studies targeting and eliminating health care disparities are necessary.”
Janus SE, Makhlouf M, Chahine N, Motairek I, Al-Kindi SG. Examining disparities and excess cardiovascular mortality before and during the COVID-19 pandemic. Mayo Clin Proc. Published online July 20, 2022. doi:10.1016/j.mayocp.2022.07.008