Excess cerebrovascular mortality in the u.s. during the COVID-19 pandemic

ABSTRACT

Introduction: The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus-19 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related death and characterize its association with psychosocial factors and emerging COVID-19 related mortality. Methods: U.S. and state-level excess cerebrovascular deaths from January-May 2020 were quantified by Poisson regression models built using National Center for Health Statistic (NCHS) data. Weekly excess cerebrovascular deaths in the U.S. were analyzed as functions of time-varying, weekly stroke-related EMS calls and weekly COVID-19 deaths by univariable linear regression. A state-level negative binomial regression analysis was performed to determine the association between excess cerebrovascular deaths and social distancing (degree of change in mobility per Google COVID-19 Community Mobility Reports) during the height of the pandemic after the first COVID-19 death (February 29, 2020), adjusting for cumulative COVID-19 related deaths and completeness of deaths attributable to COVID-19 in NCHS. Findings: There were 918 more cerebrovascular deaths than expected from January 1-May 16 , 2020 in the U.S. Excess cerebrovascular mortality occurred during every week between March 28- May 2 , 2020, up to 7.8% during the week of April 18 . Decreased stroke-related EMS calls were associated with excess stroke deaths one (β -0.06, 95% CI -0.11, -0.02) and two weeks (β -0.08, 95% CI -0.12, -0.04) later. There was no significant association between weekly excess stroke death and COVID-19 death. Twenty-three states and NYC experienced excess cerebrovascular mortality during the pandemic height. At the state level, a 10% increase in social distancing was associated with a 4.3% increase in stroke deaths (IRR 1.043, 95% CI 1.001-1.085) after adjusting for COVID- 19 mortality. Conclusions: Excess U.S. cerebrovascular deaths during the COVID-19 pandemic were observedwith decreases in stroke-related EMS calls nationally and less mobility at the state level. Publichealth measures are needed to identify and counter the reticence to seeking medical care for acutestroke during the COVID-19 pandemic.