Decline in Heart Disease Deaths Reversed at Onset of COVID-19 Pandemic in US

Rebecca C. Woodruff, PhD, MPH

New research presented at the American Heart Association Scientific Sessions 2022 reported deaths from heart disease in the United States spiked at the start of the COVID-19 pandemic in 2020, after a recorded steady decline from 2010 to 2019.

Although deaths from heart disease have been declining among adults since the 1990s, a 2020 review of data observed these rates increased among adults in all age groups, sex, and race and ethnicity groups. It was particularly observed among younger adults and non-Hispanic Black adults.

“Prior to 2020, death rates from heart disease had been declining among adults for decades, which has been recognized by the Centers for Disease Control and Prevention [CDC] as one of the ten greatest public health achievements of the last century,” said lead author Rebecca C. Woodruff, PhD, MPH, Epidemiologist, CDC. “The increases in death rates from heart disease in 2020 represented about 5 years of lost progress among adults nationwide and about 10 years of lost progress among younger adults and non-Hispanic Black adults.”

The spread of COVID-19 in the United States led to school and workplace closings and was declared a global pandemic by the World Health Organization in March 2020, with widespread stay-at-home orders. The first COVID-19 vaccinations for adults and teens were available in December 2020.

Woodruff and colleagues noted that while investigators expected to see an increase in heart disease rates among adults, the magnitude of the increase was “striking.” They analyzed 2010 to 2020 information from the CDC’s Wide-Ranging ONLine Data for Epidemiologic Research (WONDER) database. The database aggregated death certificate data across the US from the National Vital Statistics System.

From 2010 to 2019, data show the national heart disease death rate dropped by 9.8%. But, in 2020, the rate increased by 4.1%. Investigators reported the setback in rates represented nearly 5 years of lost progress in reducing heart disease death rates among adults.

The increases in heart disease rates were reported to be particularly high among younger adults, associated with approximately 10 years of lost progress. Among 35- to 54-year-old adults, deaths from heart disease fell by 5.5% from 2010 to 2019, but then increased by 12% in 2020.

The database indicated that among 55- to 74-year-old adults, heart disease death rates were down by 2.3% between 2010 to 2019 but increased by 7.8% in 2020.

Increases in death rates were high among non-Hispanic Black adults, who experienced approximately 10 years of lost progress. For non-Hispanic Black adults, heart disease death rates declined by 10.4% from 2010 to 2019, then jumped by 11.2% in 2020.

The investigators indicated that growing evidence suggest people who have had COVID-19 infection may be at an increased risk for new or worsening cardiovascular disease, which may have been a factor in the rising rates from 2019 to 2020.

Factors associated with the pandemic lockdown, including a lack of physical activity and increased smoking and alcohol use, all contributed to the higher cardiovascular death rates, according to Michelle A. Albert, MD, MPH, President, American Heart Association and Walter A. Haas-Lucie Stern Endowed Chair in Cardiology, University of California at San Francisco.

“These social determinants of health have a larger effect on people who are economically disadvantaged, Black people, Hispanic people and indigenous and native individuals, so then you have a domino effect resulting in higher death rates and more disease among these populations,” Albert said.

Woodruff noted that the CDC is actively researching heart disease trends after 2020 to see the evolution of trends.

The virtual poster, “Trends in National Death Rates From Heart Disease in the United States, 2010‒2020,” was presented at AHA 2022.