Rise in heart disease, stroke deaths seen during first year of pandemic
CDC data show heart disease and stroke deaths increased during the first year of the COVID-19 pandemic due to factors other than an aging population, reversing prior trends and widening race disparities.
From 2019 to 2020, researchers also found Black adults had both the greatest increase and the highest overall rate of heart disease and stroke deaths compared with adults from other races and ethnicities. “We had been making progress in reducing deaths from heart disease and stroke, primarily due to preventive measures and timely interventions,” Stephen Sidney, MD, MPH, director of research clinics and senior research scientist with Kaiser Permanente Northern California Division of Research, told Healio. “Our study showed the pandemic didn’t just stop these gains, it reversed them, with Black, Latino and Asian adults hit hardest. This tells us we are not doing enough nationwide to make health care equally accessible to all and to optimize the preventive measures we know can improve CV health.”
Sidney and colleagues analyzed CDC data collected from 2011 to 2020 to assess age-adjusted mortality rates for heart disease and stroke, age-specific numbers of deaths and population estimates, using the WONDER database. Researchers estimated year-to-year change in age-associated deaths by multiplying the age-specific death rate for 1 year by the age-specific population of the next year. Risk-associated mortality was calculated as change in total deaths minus age-associated change in deaths, representing deaths associated with underlying changes in disease risk.
The findings were published in JAMA Network Open.
Higher risk by race
From 2011 to 2019, deaths attributed to heart disease increased by 10.4% and deaths attributed to stroke rose by 16.3%. The total age-associated increase in heart disease deaths from 2019 to 2020 was 17.6%, whereas the risk-associated decrease was 7.1%. For stroke, the total age-associated increase in deaths from 2019 to 2020 was 18.1%, whereas the total risk-associated decrease was 1.8%.
During the first year of the COVID-19 pandemic, heart disease and stroke deaths increased by 5.8% and 6.8%, respectively. However, the age-associated increases were 1.6% and 1.7% for heart disease and stroke, respectively, whereas risk-associated increases were 4.1% for heart disease and 5.2% for stroke.
Comparing 2011 to 2019 with 2019 to 2020, researchers observed a less than 1.5% change in the mean annual percent change in the number of age-associated deaths attributed to heart disease and stroke for all race groups. However, for all race groups, mean annual percent change in risk-associated heart disease and stroke deaths rose sharply from 2019 to 2020 compared with 2011 to 2019. The mean annual percent change in deaths from heart disease and stroke due to risk factors other than an aging population grew by 11.9% in Black adults, 11.2% in Hispanic adults, 9.9% in Asian-Pacific Islanders and 2.3% in white adults.
Black adults experienced a concerning more than fivefold higher percentage increase for heart disease and a twofold higher percent increase for stroke compared with white adults, the researchers wrote.
Impact of COVID-19
The researchers noted that the COVID-19 pandemic was associated with conditions that likely contributed to risk-associated increased heart disease and stroke mortality, including periods of overcrowding of hospitals with patients who had COVID-19, resulting in fewer hospitalizations for acute CV events, fewer visits for medical care, poorer medication adherence and increased barriers to healthy lifestyle behaviors.
“Nationwide, we were seeing overcrowded hospitals due to COVID-19. We also know that COVID-19 itself can have a deleterious effect on heart disease and strokes,” Jamal S. Rana, MD, PhD, chief of cardiology with the Permanente Medical Group and adjunct investigator Kaiser Permanente Northern California Division of Research, told Healio. “What is alarming is the disproportionate impact. It is as if the pandemic melted the tip of the iceberg to reveal how precarious the health care situation is for Black, Latino and Asian adults in the U.S. These data are more evidence pointing to the underlying structural racism, systemic inequities and social determinants of health that create different outcomes in communities of color.”
The researchers noted that the findings, along with the emergence of new virus strains associated with high COVID-19 rates, suggest more emphasis is needed on maintenance of optimal CV risk factor levels and “vigilance toward equity in access to health care.”