Impact of the COVID-19 pandemic on incidence of myocardial infarction, heart failure and stroke, by mental disorder diagnosis, in England, 2019-2023: a cohort study.

backgroundWe aimed to estimate mental disorder disparities in cardiovascular disease (CVD) incidence and determine whether these disparities were worsened by the COVID-19 pandemic.

methodsFor each outcome (myocardial infarction (MI), heart failure and stroke), we created a population-based cohort of people without a prior diagnosis of the outcome using linked electronic health records, with follow-up from November 2019 until December 2023. We ascertained pre-existing schizophrenia, bipolar disorder and depression, and each CVD outcome from primary care and hospital admission records and (for CVD outcomes) mortality records. We calculated sex-stratified age-standardised incidence rates by mental disorder diagnosis and used quasi-Poisson modelling to obtain rate ratios (RRs) of CVD among people with each of schizophrenia, bipolar disorder or depression versus those without any of these disorders, adjusting for sociodemographic factors and time period. We investigated whether mental disorder disparities changed as a consequence of the COVID-19 pandemic by including an interaction term between mental disorder and time.

resultsDuring follow-up, 383 365 people had incident MI, 868 590 had incident heart failure and 455 300 had incident stroke. Age-standardised incidence of each CVD outcome decreased markedly between February and April 2020, with incidence levels returning to, but not exceeding, prepandemic levels in subsequent years. Mental disorder was associated with a higher incidence of each CVD outcome, with RRs ranging from 1.31 (95% CI 1.25 to 1.38) to 2.15 (95% CI 2.05 to 2.24). There was generally no evidence of interaction between mental disorder and time, with mental disorder disparities in CVD incidence stable over time.

conclusionWe found no clear evidence that the mental disorder disparities in CVD incidence widened during the acute period of the pandemic or during the subsequent years. Continued monitoring of the CVD burden in the general population and among marginalised groups is critical to identifying longer-term impacts on CVD and worsening disparities.