Abstract WMP41: Changes In Stroke Mortality Among Black And White Persons Before And During Covid-19 Pandemic, United States 2015-2021

Abstract

Introduction: Although stroke death rates declined since 1950s, age-adjusted rates remained higher among non-Hispanic Black (NHB) than among non-Hispanic White (NHW) persons. No study has examined changes in disparities of stroke mortality among NHB and NHW before and during the COVID-19 pandemic. Methods: We calculated age-adjusted (US 2000 population) stroke death rates per 100,000 people among NHB and NHW ages ≥35 years from 2015-2021 using CDC WONDER. We compared NHB and NHW stroke death rates from 2015-2019 (before pandemic) to 2020-2021 (during pandemic) with respect to changes in rates, rate ratios (RR) and difference-in-difference in rates. Results: Trends and disparities of overall stroke death rates before the pandemic remained consistent between NHB (100.9 to 101.6 per 100,000 people) and NHW (69.1 to 70.6 per 100,000 people), with an average difference in rates of 31.3/100,000 and RR of 1.45. During the pandemic, stroke death rates increased but with different magnitudes among NHB (110.0 and 113.4 per 100,000) and NHW (72.0 and 73.1 per 100,000). Between pre-pandemic and pandemic periods, the absolute difference in rates increased 25% from 31.3 (95% confidence interval 30.8-31.7) to 39.1 (38.3-39.8) per 100,000 and the relative difference measured by RR increased from 1.45 (1.44-1.46) to 1.54 (1.53-1.55) (p<0.001). The difference-in-difference in rates and RR comparing before to during pandemic were 7.8 per 100,000 and 1.06, respectively, indicating widened disparities in stroke death rates (p<0.001) (Figure). During the pandemic (2020-2021), estimated excess stroke deaths was 4,030 among NHB (9.9% more than expected deaths) and 11,790 among NHW (5.3% more than expected deaths). Conclusion: Disparities in stroke death rates between NHB and NHW widened during the COVID-19 pandemic in the United States. Identifying factors associated with the widened disparities and providing the targeted interventions may be necessary to reduce the disparities.