Post-pandemic, US cardiovascular death rate continues upward trajectory

New research confirms what public health leaders have been fearing: The significant uptick in the cardiovascular disease (CVD) death rate that began in 2020 has continued. The continuing trend reverses improvements achieved in the decade before the COVID-19 pandemic to reduce mortalities from heart disease and stroke, the leading causes of death in the United States. The findings are reported in the American Journal of Preventive Medicine.

Investigators from the US Centers for Disease Control and Prevention (CDC) and Northwestern University Feinberg School of Medicine analyzed information from more than 10 million death certificates of US adults (aged 35+ years) whose deaths occurred between 2010 and 2022.

Rebecca C. Woodruff, Ph.D., MPH, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention in Chamblee, GA, explained, "We were concerned about the emerging evidence that chronic disease outcomes worsened during the first two years of the COVID-19 pandemic. This was unfortunately the case with heart disease and stroke, which had been improving before the pandemic. We wanted to understand whether the concerning trends were temporary or whether they continued through 2022."

Looking at trends each year from 2010 to 2022, the researchers' findings show that the death rates from cardiovascular disease rose by 9.3% from 2020 through 2022, in contrast to a decline of 8.9% from 2010 to 2019. There were more than 228,000 more CVD deaths from 2020-2022 than would be expected had the pre-2020 trends continued. The reversal was evident across many ages, both sexes, and several race and ethnicity groups.

Dr. Woodruff characterized the results as an enduring setback in population health, evident after the public health emergency had largely stabilized. She pointed to several possible explanations for the increases:

• The pandemic disrupted access to health care for many people, which may have resulted in delays in detecting and treating chronic or acute heart disease.
• The crisis also disrupted many aspects of daily life that may have made it harder for people to do the things that prevent heart disease, including managing blood pressure, eating well, being physically active, quitting tobacco, getting healthy sleep, managing weight, controlling cholesterol, and managing blood sugar.
• An emerging body of evidence also suggests that people who have had COVID-19 are at increased risk for new or worsening heart disease, which may have contributed to the subsequent increase in cardiovascular death rates.

Dr. Woodruff noted, "Research to understand the drivers of these increases in CVD mortality rates can help guide clinical and public health approaches to prevent, detect, and treat CVD. Reprioritizing prevention and management of CVD is an essential first step."

She also highlighted several federal initiatives that focus on decreasing the burden of CVD: WISE WOMAN (Well-integrated Screening and Evaluation for Women Across the Nation, Paul Coverdell National Acute Stroke Program, and Million Hearts, adding that "the magnitude of the setbacks in CVD mortality and the range of affected subgroups speak to the need for broader prevention efforts moving forward."