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

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