Applying a Bayesian spatiotemporal model to examine excess county-level cardiovascular disease death rates during the COVID-19 pandemic

Amid the COVID-19 pandemic, national cardiovascular disease (CVD) death rates increased, especially among younger adults. County-level variation has not been documented. Using county-level CVD deaths (ICD-10 codes: I00-I99) from the US National Vital Statistics System, we developed a Bayesian multivariate spatiotemporal model to estimate excess CVD death rates in 2020 based on trends from 2010 to 2019 for adults aged 35-64 and ≥ 65 years. Among adults aged 35-64 years, 64.7% of counties experienced significant excess CVD death rates. The median county-level CVD death rate in 2020 was 150 per 100 000 persons, which exceeded the predicted rate for 2020 (median excess death rate, 11 per 100 000; median excess rate ratio, 1.08). Among adults aged ≥65 years, 15.2% of counties experienced significant excess CVD death rates. The median county-level CVD death rate was 1546 per 100 000 in 2020, which exceeded the predicted rate in 2020 (median excess death rate, 48 per 100 000; median excess rate ratio, 1.03). Counties with significant excess death rates in 2020 were geographically dispersed. In 2020, disruptions of county-level CVD death rates were widespread, especially among younger adults, suggesting the continued importance of CVD prevention and treatment in younger adults in communities across the country.