The Black–White Gap in Stroke Deaths Widened During COVID-19

Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. Stroke death rates have fallen since the 1950s, but they've stayed higher among Black adults than White adults. Despite efforts to cut risk factors, raise awareness of symptoms and improve access to care, Black adults were 45% more likely to die of stroke in 2018. CDC compared age-adjusted stroke death rates among Black and White adults 35 and older before (2015–2019) and during (2020–2021) the COVID-19 pandemic.

Findings

• Before the pandemic, rates were steady for both groups, and Black adults' rate was about 1.4 times White adults'; during it, about 1.5 times.
• The widening was similar for men and women and grew with age: the gap rose 10.9% (16.6 to 18.4) among ages 35–64 and 19.4% (89.8 to 107.2) among ages 65–84.
• Among people 85 and older, Black adults had lower stroke death rates than White adults before the pandemic — a gap of −23.7 — which reversed to 30.3 per 100,000 during it.
• Excess stroke deaths in 2020–2021: an estimated 3,835 among Black adults (9.4% more than expected) and 15,125 among White adults (6.9%). Excess deaths were higher among women and fell with age.

Why the gap may have grown

• Black–White differences in stroke deaths mainly reflect differences in how often strokes happen — driven by higher rates of high blood pressure and diabetes — more than differences in survival.
• The pandemic disrupted blood pressure care, possibly worsening inequities in treatment and control.
• Fewer ED visits and hospitalizations for stroke, partly from fear of COVID-19, may have delayed care and worsened outcomes.
• Mental health, activity, diet and sleep suffered during the pandemic, perhaps more among people of color.
• COVID-19 itself raises stroke risk, and Black people had higher COVID-19 rates.

What's needed

Identifying the factors behind the wider gap — including economic strain, mental health and social determinants — and tailored efforts to prevent and control hypertension, high cholesterol and diabetes, strengthen stroke care systems and address structural racial disparities in health care.

Know the warning signs — sudden face drooping, arm weakness and speech difficulty — and call 9-1-1 immediately.

Limitations: death records can't show how much of the increase was directly caused by the pandemic, and the study covered only Black and White adults.

Sources

Based on "Stroke Mortality Among Black and White Adults Aged ≥35 Years Before and During the COVID-19 Pandemic — United States, 2015–2021," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The imported copy was cut off in one place; the missing text was taken from the same report's full text in PubMed Central (PMC10121266).