Objective:

We sought to determine whether COVID19 altered rates of cerebrovascular disease related deaths in the United States

Background:

COVID19 can trigger cerebrovascular complications through multiple mechanisms related to immune dysregulation.  In addition, due to the strain on health care systems during the COVID19 pandemic, acute care for patients with cerebrovascular disease may have been compromised. Due to these factors, COVID19 has likely markedly impacted the incidence of cerebrovascular disease related deaths.  However, the magnitude of this impact in the United States is unknown.

Design/Methods:

We queried the National Vital Statistics System (NVSS), which catalogs all death certificates in the United States, for adult deaths where cerebrovascular disease was either the underlying or contributing cause over a 10 year period (2011-2020).  For each year we tallied the total number of cerebrovascular deaths and then calculated the distribution of deaths across age groups, sex, and race.  For 2020, we identified cerebrovascular disease related deaths where COVID19 was either the underlying or contributing cause.  

Results:

Cerebrovascular disease related deaths were largely stable from 2011-2019 (Annual Percentage Change, APC 0.4, 95% CI -0.17 to 0.96).  In contrast, there was a marked increase in cerebrovascular disease related deaths from 2019-2020 (APC 12.2, 95% CI 7.5-15.63).  This increase was consistently seen across all age deciles as well as across sex and race categories. The increase in cerebrovascular related deaths was largely driven by COVID19 (underlying cause death in 42.2% of cases).

Conclusions:

Cerebrovascular disease related deaths markedly increased in the United States in 2020.  This increase was largely driven by COVID19 as the underlying cause of death, suggesting that etiologies directly related to COVID19 immune dysregulation mediated a significant fraction of increased deaths.  However, the increase in non-COVID19 related underlying causes of death suggests that other factors, such as access to health care, also contributed to the abrupt rise.