Crisis within a crisis: A CDC WONDER analysis of the pandemic's impact on cancer and cardiovascular mortality.

e23336 Background: Cancer and cardiovascular disease (CVD) are leading global causes of mortality, often coexisting and worsening outcomes. This study examines how the pandemic impacted mortality rates in individuals with cancer and CVD, comparing pre- and post-COVID-19 periods. By analyzing mortality patterns, we explore the interplay of these diseases during the global health crisis. Methods: Using CDC WONDER data (2018–2023), we analyzed adults ≥25 with cancers (ICD-10: C00-D48) and CVD (ICD-10: I00-99). Age-adjusted mortality rates (AAMRs) were calculated for pre-COVID (2018–2019), during COVID (2020–2021), and post-COVID (2022–2023), with percent changes stratified by demographics and geography. Results: We observed a 12.1% rise in CVD mortality in adults with cancer during COVID, followed by a 2.3% increase post-COVID, resulting in a 14.6% net rise from pre-COVID levels. Females (16.5%) had a higher mortality increase than males (13%). Non-Hispanic (NH) American Indians experienced the largest increase during COVID (14.8%), followed by NH Whites (12.6%), NH Blacks (12.6%), NH Asians (12.4%), and Hispanics (11.7%). Post-COVID, NH American Indians saw a decline (-6.4%), while NH Asians (-0.9%) and Hispanics (-0.6%) were stable; NH Blacks (2.4%) and NH Whites (3%) had a modest increase. Adults ≥65 years were most impacted, with a 15.5% rise in mortality compared to 45–64 years (11%) and <45 years age groups (10.8%). All census regions experienced increases during COVID (Northeast: 7.6%, West: 11.1%, South: 14.1%, Midwest: 14.4%). Post-COVID, mortality declined in the Northeast (-0.1%) and Midwest (-0.2%) but rose in the South (5.7%) and West (1.3%). States with the highest AAMRs before, during, and post-COVID remained consistent: Oklahoma, Nebraska, and Mississippi. Conclusions: The COVID-19 pandemic contributed to rising cancer and CVD mortality rates, especially among females, NH Whites, older adults, and the South. These trends emphasize the need to address disparities, strengthen preventive care, and build resilient healthcare. COVID-19 and changes in cancer and cardiovascular AAMRs. Variable Pre-COVID AAMR (95% CI) During COVID AAMR (95% CI) Post-COVID AAMR (95% CI) % change (Pre-COVID to During COVID) % change (During COVID to Post-COVID) % change (Pre-COVID to Post-COVID) Overall 79.4 (79.1 - 79.6) 89 (88.8 - 89.3) 91 (90.7 - 91.2) 12.1 2.3 14.6 Male 103.1 (102.6 - 103.5) 114.8 (114.4 - 115.3) 116.5 (116.1 - 117.0) 11.4 1.5 13 Female 62 (61.7 - 62.3) 70 (69.7 - 70.3) 72.2 (71.9 - 72.5) 12.9 3.1 16.4 Hispanic 61.4 (60.7 - 62.1) 68.6 (67.9 - 69.4) 68.2 (67.5 - 68.9) 11.7 -0.6 11.1 NH White 80.9 (80.6 - 81.2) 91.1 (90.8 - 91.4) 93.8 (93.5 - 94.1) 12.6 2.9 15.9 NH Black 96.5 (95.6 - 97.4) 108.7 (107.8 - 109.6) 111.3 (110.4 - 112.2) 12.6 2.4 15.3 NH Asian 50.2 (49.3 - 51.1) 56.4 (55.5 - 57.4) 55.9 (55.1 - 56.8) 12.4 -0.9 11.4 NH American Indian 71 (67.8 - 74.1) 81.5 (78.3 - 84.8) 76.3 (73.3 - 79.3) 14.8 -6.4 7.5