Increase in Heart Disease, Stroke Risk-Associated Death Observed From 2019 - 2020

Stephen Sidney, MD, MPH

New research found an increase in age-associated heart disease and stroke deaths from 2011 - 2019, while the risk-associated number of heart disease and stroke deaths decreased.

In comparison, data show a several-fold increase in risk-associated deaths from heart disease and stroke from 2019 - 2020, with greater increases among members of racial and ethnic minority groups.

“The COVID-19 pandemic was associated with conditions that likely contributed to risk associated increased HD and stroke mortality,” wrote study author Stephen Sidney, MD, MPH, Division of Research, Kaiser Permanete Northern California. 

Investigators examined the relative contributions of aging versus underlying disease risk in the total population and major race and ethnicity groups. They determined age-adjusted mortality rates for heart disease and stroke, age-specific numbers of death, and population estimates from 2011 - 2020 from the Centers for Disease Control and Prevention WONDER database.

The year-to-year change in age-associated deaths was estimated by multiplying the age-specific death rate for 1 year by the age-specific population of the following year. The sum of the products was noted to represent age-associated change in death.

Then, risk-associated mortality was calculated as change in total deaths minus age-associated change in deaths, representing deaths associated with underlying changes in disease risk.

From 2011 - 2019, the number of heart disease deaths increased from 596,577 to 659,041 deaths (10.4%) and stroke deaths increased from 128,932 to 150,005 deaths (16.3%).

The total age-associated increase in heart disease deaths from 2019 - 2020 was 104,784 deaths (17.6%), while the risk-associated decrease was 42,326 deaths (7.1%). Further, for stroke, the total age-associated increase was 23,371 deaths (18.1%), while the total risk-associated decrease was 2301 deaths (1.8%).

The numbers from 2019 - 2020 show heart disease and stroke deaths increased by 37,934 deaths and 10,262 deaths (6.8%), respectively. Age-associated increases were 10,599 deaths (1.6%) and 2502 deaths (1.7%) for heart disease and stroke, respectively. The risk-associated increases were 27,335 deaths (4.1%) for heart disease and 7760 deaths (5.2%) for stroke.

Investigators observed for all race and ethnicity groups, the mean annual percent change in risk-associated heart disease and stroke deaths from 2011 - 2019 varied from -1.5% to 0.7%, compared with 2019 - 2020 increases ranging from 2.3% to 11.9%.

Data show risk-associated increases were highest in non-Hispanic Black individuals, while more than a 5-fold higher percentage increase was observed compared to non-Hispanic White individuals for heart disease and a 2-fold higher percent increase for stroke.

Sidney and colleagues noted that the findings in combination with new virus strains associated with high COVID-19 rates suggest that “increased emphasis on the maintenance of optimal risk factor levels specified in the American Heart Association’s Life’s Simple 7 guideline and vigilance toward equity in access to health care are warranted more than ever.”

The research letter, “Age-Adjusted Mortality Rates and Age and Risk–Associated Contributions to Change in Heart Disease and Stroke Mortality, 2011-2019 and 2019-2020,” was published in JAMA Network Open.