Infectious Disease
CV mortality rates in US rose during first year of pandemic; racial disparities persist
December 24, 2022
2 min read
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Reversing a trend of improvement from 1999 to 2019, CV mortality rates increased in the US during the first year of the COVID-19 pandemic, with the highest increases among Black and Hispanic adults, according to researchers.
“Given the significant population burden of CV disease and the ongoing COVID pandemic, these results have important implications for the understanding of disease-specific increases in CV mortality and consideration for targeted intervention, including targeting racial disparities, that may reduce CV mortality risk,” Ofer KoboMD, clinical professor at Israel Institute of Technology, and colleagues wrote in European Heart Journal – Quality of Care & Clinical Outcomes.
Reversing a trend of improvement from 1999 to 2019, CV mortality rates increased in the US during the first year of the COVID-19 pandemic, with the highest increases among Black and Hispanic adults.
Source: Adobe Stock
To evaluate changes in age-adjusted CV mortality trends between 1999 and 2019 and the first year of the pandemic in 2020, Kobo and colleagues analyzed data from 18,783,701 death certificates (51% women; 85.4% white; 12.1% Black) of US residents aged 18 years or older with CV as the cause of mortality with data collected from the CDC WONDER database.
The CDC WONDER database provided researchers with age-adjusted mortality rates (AAMRs) for 1999 to 2019, from which an average annual percent change (AAPC) was calculated for the period. Kobo and colleagues then utilized the AAPC for the 1999-2019 period to estimate an AAMR for 2020. Excess mortality rate was calculated by subtracting projected AAMR from actual AAMR.
Individuals were grouped by sex, race/ethnicity (white, Black, Hispanic or Latino, Asian or Pacific Islander, American Indian or Alaska Native) and age (< 55 years, 55 to 74 years, 75 years). CVD was subcategorized into ischemic heart disease, HF, hypertensive diseases and cerebrovascular diseases.
The overall excess CV mortality in 2020 compared with 2019 was 4.6%, translating to an absolute excess of 62,802 deaths, according to the researchers.
The relative CV mortality increase between 2019 and 2020 was highest in adults younger than 55 years (11.9%). It was 7.9% in adults aged 55 to 74 years and 2.2% in adults aged 75 years or older, Kobo and colleagues wrote.
The relative CV mortality increase between 2019 and 2020 was higher in Hispanic adults compared with non-Hispanic adults (9.4% vs. 4.3%) and in Black adults compared with white adults (10.6% vs. 3.5%), according to the researchers.
The relative increase of CV mortality related to hypertensive disease from 2019 to 2020 was 15.9%, representing 13,800 excess deaths, whereas the increase was 4.3% for ischemic heart disease, representing 32,293 excess deaths, and 4.9% for cerebrovascular disease, representing 11,218 excess deaths , Kobo and colleagues wrote, noting relative mortality for HF declined 1.4% from 2019 to 2020.
“These findings demonstrate that racial disparities in CV care became more prominent in 2020 after previously showing evidence of improvement in the current as well as prior cohorts,” Kobo and colleagues wrote. “Comorbidity burden of CV risk factors is higher in minority populations and general avoidance of medical care during the early phase of the COVID pandemic may have therefore had greater impact on minority populations. Minority and lower socioeconomic status adults had lower utilization of telemedicine and video medicine during that time, which may also have increased risks for adverse CV events. Additionally, multiple social determinants of health including psychosocial stress, food insecurity and poverty which contributed to racial disparities prior to the pandemic were worsened during the pandemic, with effects felt more prominently by members of racial/ethnic minority groups in the United States.”
The researchers also acknowledged the need for future research and evaluation on the impact of social determinants of health on racial and ethnic disparities in CV mortality.
“Whether these trends in social determinants of health and mortality will continue with the ongoing COVID pandemic deserves further evaluation, and efforts to improve social determinants of health may play an important role in reversing the racial and ethnic disparities in CV mortality seen in 2020,” Kobo and colleagues wrote.
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