Has the first year of the COVID-19 pandemic reversed the trends in CV mortality between 1999 and 2019 in the United States?

Abstract

Although cardiovascular (CV) mortality increased during the COVID-19 pandemic, little is known about how these patterns varied across key subgroups, including age, sex, and race and ethnicity, as well as by specific cause of CV death. The Centers for Disease Control WONDER database was used to evaluate trends in age-adjusted CV mortality between 1999 and 2020 among US adults aged 18 and older. Overall, there was a 4.6% excess CV mortality in 2020 compared to 2019, which represents an absolute excess of 62802 deaths. The relative CV mortality increase between 2019 and 2020 was higher for adults under 55 years of age (11.9% relative increase), vs. adults aged 55-74 (7.9% increase), and adults 75 and older (2.2% increase). Hispanic adults experienced a 9.4% increase in CV mortality (7400 excess deaths) vs. 4.3% for non-Hispanic adults (56760 excess deaths). Black adults experienced the largest % increase in CV mortality at 10.6% (15477 excess deaths) vs. 3.5% increase (42907 excess deaths) for White adults. Among individual causes of CV mortality, there was an increase between 2019 and 2020 of 4.3% for ischaemic heart disease (32293 excess deaths), 15.9% for hypertensive disease (13800 excess deaths), 4.9% for cerebrovascular disease (11218 excess deaths), but a decline of 1.4% for heart failure mortality. The first year of the COVID pandemic in the United States was associated with a reversal in prior trends of improved CV mortality. Increases in CV mortality were most pronounced among Black and Hispanic adults.