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(opens in new tab/window) are reported in the American Journal of Preventive Medicine(opens in new tab/window), published by Elsevier.

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, PhD, MPH, Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 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 resultsas an enduring setback in population health, evident after the public health emergency had largely stabilized. She pointed to several possible explanations for the increases:

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  The pandemic disrupted access to healthcare for many people, which may have resulted in delays in detecting and treating chronic or acute heart disease.

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  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.

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  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 clinicaland public health approaches to prevent, detect, and treat CVD. Reprioritizing prevention and management of CVD is an essential first step.”

She 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.”

Notes for editors

The article is“Trends in Cardiovascular Disease Mortality Rates and Excess Deaths, 2010–2022,” by Rebecca C. Woodruff, PhD, MPH, Xin Tong, MPH, Sadiya S. Khan, MD, Nilay S. Shah, MD, Sandra L. Jackson, PhD, Fleetwood Loustalot, PhD, and Adam S. Vaughan, PhD, MPH (https://doi.org/10.1016/j.amepre.2023.11.009(opens in new tab/window)).It appears online in advance of the American Journal of Preventive Medicine, volume 66, issue 4 (April 2024), published by Elsevier.

Full text of this article is available to credentialed journalists upon request; contact Jillian B. Morgan at +1 734 936 1590 or [email protected](opens in new tab/window). Journalists wishing to interview the authors should contact Trayce Leak at [email protected](opens in new tab/window).

Co-author Nilay Shah, MD, receives research support from the NHLBI (K23HL157766).

The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

About the American Journal of Preventive Medicine

The American Journal of Preventive Medicine(opens in new tab/window) is the official journal of the American College of Preventive Medicine(opens in new tab/window) and the Association for Prevention Teaching and Research(opens in new tab/window). It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. www.ajpmonline.org(opens in new tab/window)

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