Pandemic Dramatically Worsens Racial Disparities in Heart Disease Deaths, UH Study Finds

UH Clinical Update | January 2023

Deaths from cardiovascular disease have risen substantially during the COVID-19 pandemic, with the burden disproportionately falling on Black Americans, according to a new large study from University Hospitals Harrington Heart & Vascular Institute, recently published in the journal Mayo Clinic Proceedings. In fact, study data shows that the pandemic may have erased about 20 years of gains in narrowing racial disparities in American deaths from heart disease.

How the Study Was Done

UH cardiologist Sadeer Al-Kindi, MD, and colleagues analyzed data from the Multiple Cause of Death files maintained by the National Center for Health Statistics through the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER). This database contains the death certificates for all U.S. residents, in which the underlying cause of death is ascertained by the treating physician.

Sadeer Al-Kindi, MD

The research team looked at changes in deaths due to cardiovascular disease in 2018 and 2019 – before the pandemic -- with deaths in 2020 and 2021. The team also then looked specifically at deaths due to heart attack (myocardial infarction), stroke and heart failure. Overall, 3,598,352 deaths from cardiovascular disease were analyzed during the study period.

Startling Results

Results show that cardiovascular disease deaths during the pandemic years increased by 6.7 percent over pre-pandemic years, with a spike specifically occurring in deaths from stroke.

These results are not especially surprising, Dr. Al-Kindi says. Pandemic-era avoidance of hospitals and medical care on the part of patients, plus access issues because of paused services and staffing shortages, likely both contributed to an increased number of deaths from heart disease. But what is surprising, he says, is just how great the gap is between Black patients and white patients. Study results show that while deaths from heart disease for white patients increased by 5.1 percent during the pandemic years, they increased by 13.8 percent for Black patients. The gap was most stark in 2020, when cardiovascular disease deaths for white patients increased by 5.1 percent and the increase in deaths for Black patients was more than three times that – at 15.8 percent.

“I expected them to be maybe 5 percent or 10 percent different, but not a three-fold difference between Black and white,” Dr. Al-Kindi says. “The size of that effect is really stark. Although underlying disparities are known to exist in society, including structural racism, and in the U.S. healthcare system, the COVID-19 pandemic seems to have exacerbated these inequalities not just in healthcare but in all facets of society.”

Why is This Happening?

One explanation for these findings, Dr. Al-Kindi says, is that Black individuals have higher rates of the comorbidities to heart disease that lead to adverse outcomes, such as hypertension, obesity and chronic kidney disease. Another is that resource limitation and transportation difficulties that disproportionately affect Black individuals make them more vulnerable to even small limits in access to the healthcare system – such as when services are limited in a pandemic.

“Regardless of the underlying cause, our data highlight the critical need to address and to improve access and distribution of health resources and care,” Dr. Al-Kindi says.

The Way Forward

One solution to reversing the pandemic’s damage in terms of racial disparities and heart disease may lie in more fully embracing telehealth, Dr. Al-Kindi says. However, there, too, access can be difficult.

“Some people don’t have Internet access or smartphone access,” he says. “So it comes with some caveats, but there is at least some emerging evidence that telemedicine in certain situations is improving health outcomes in a variety of different racial groups.”

For their part, Dr. Al-Kindi says, physicians and other providers can combat these worrying trends by being extra-vigilant to any disruptions in care faced by their Black patients, during COVID or any other type of disaster situation. He also calls on them to work creatively in their communities to create more opportunities for people of color to access the healthcare system.

He points to ACHIEVE GreatER, an effort between University Hospitals, Case Western Reserve University and Wayne State University, as a model. Supported by an $18.2 million grant from the National Institutes of Health, it involves deploying community health workers to the Black community in Cleveland and Detroit to work to create better heart health outcomes for residents. Specifically, the new grant funds this innovative program so that the study team can identify residents at risk of heart disease and provide personalized, adaptable approach to lifestyle and life circumstance.

Given the damage the pandemic has done, Dr. Al-Kindi says, more creative solutions like this are needed to begin closing the gap again when it comes to disparities in heart disease deaths.

“Policy-level changes must occur at a patient, provider, and system level,” he says.

A Complex Problem

Sanjay Rajagopalan, MD, Chief of Cardiovascular Medicine and Chief Academic and Scientific Officer for UH Harrington Heart & Vascular Institute and the Herman K. Hellerstein, MD, Professor of Cardiovascular Research, highlights the importance of this new study.

“These findings from Dr. Al-Kindi are enormously important in not only focusing our attention on the stark difference in health outcomes between Blacks and whites, but also to highlight the scale and scope of work that needs to undertaken to solve disparities in health,” he says.

Solutions will require a focus on the complexity of the issue, he says.

“A core challenge in proposing solutions for complex societal problems, such as racial disparities in health, is that intimate knowledge of multiple variables and how their component parts are related is required. Better understanding of the drivers of heightened risk would need to take into consideration unsuspected factors in the social and physical fabric of Black lives, healthcare access, delivery and finally the lived experience, to propose solutions that ultimately can move us towards closing some of the gaps.”