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

  • Scott E. Janus
    Affiliations
    Department of Medicine, University Hospitals, Cleveland, Ohio

    Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio
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  • Mohamed Makhlouf
    Affiliations
    Department of Medicine, University Hospitals, Cleveland, Ohio

    Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio
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  • Nicole Chahine
    Affiliations
    Loyola University Medical Center, Maywood, Illinois
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  • Issam Motairek
    Affiliations
    Department of Medicine, University Hospitals, Cleveland, Ohio

    Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio
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  • Sadeer G. Al-Kindi
    Correspondence
    Corresponding Author: Sadeer G Al-Kindi, Assistant Professor of Medicine, Case Western Reserve University, Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH, 44106,
    Affiliations
    Department of Medicine, University Hospitals, Cleveland, Ohio

    Harrington Heart and Vascular Institute, University Hospitals and School of Medicine, Case Western Reserve University, Cleveland, Ohio
    Search for articles by this author
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      Abstract:

      Objective

      To investigate the patterns and demographics of cardiovascular (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure (HF) in the pre-COVID-19 era (2018-2019) vs during COVID-19 pandemic (2020-2021) in the United States.

      Methods

      In this cross-sectional study, we utilized the US multiple cause of death files 2018-2021 to examine trend of excess cause-specific deaths due to CVD (International Classification Disease, version 10 [ICD10]: I00-I99), MI (ICD10: I21-I22), stroke (ICD10: I60-I69) and HF (ICD10: I42, I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and HF) between pre-pandemic (2018-2019) and pandemic years (2020-21). We performed a subgroup analysis on race and month to month and year to year variation, using chi-squared 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 COVID-19 pandemic (2020-2021) compared to pre-pandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) compared with 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 HF (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 which has been persistent despite two 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.

      Key Words

      Abbreviations:

      CVD (cardiovascular disease), COVID-19 (severe acute respiratory syndrome coronavirus 2 2019), MI (myocardial infarction), HF (heart failure)