Excess cardiovascular mortality across multiple COVID-19 waves in the United States from March 2020 to March 2022

Abstract

The COVID-19 pandemic has limited the access of patients with cardiovascular diseases to healthcare services, causing excess deaths. However, a detailed analysis of temporal variations of excess cardiovascular mortality during the COVID-19 pandemic has been lacking. Here we estimate time-varied excess cardiovascular deaths (observed deaths versus expected deaths predicted by the negative binomial log-linear regression model) in the United States. From March 2020 to March 2022 there were 90,160 excess cardiovascular deaths, or 4.9% more cardiovascular deaths than expected. Two large peaks of national excess cardiovascular mortality were observed during the periods of March–June 2020 and June–November 2021, coinciding with two peaks of COVID-19 deaths, but the temporal patterns varied by state, age, sex and race and ethnicity. The excess cardiovascular death percentages were 5.7% and 4.0% in men and women, respectively, and 3.6%, 8.8%, 7.5% and 7.7% in non-Hispanic White, Black, Asian and Hispanic people, respectively. Our data highlight an urgent need for healthcare services optimization for patients with cardiovascular diseases in the COVID-19 era.