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Contributed by David R. Williams, August 25, 2020 (sent for review June 16, 2020; reviewed by Susan Everson-Rose, Jay S. Kaufman, and Herman Taylor)
Significance
Previous studies have shown a transiently higher risk of acute cardiovascular disease (CVD) events within minutes to hours after behavioral, psychosocial, and environmental triggers. Research is limited examining acute CVD surrounding sociopolitical events. We compared hospitalization rates for acute CVD before and immediately after the date of the 2016 presidential election among patients in an integrated healthcare delivery system. The rate of CVD hospitalizations in the 2 d after the 2016 presidential election was 1.62 times higher compared to the rate in the same 2 d the week prior. Transiently heightened cardiovascular risk around the 2016 election may be attributable to sociopolitical stress. Further research is needed to understand the intersection between major sociopolitical events, perceived stress, and acute CVD.
Abstract
Previous research suggests that stressors may trigger the onset of acute cardiovascular disease (CVD) events within hours to days, but there has been limited research around sociopolitical events such as presidential elections. Among adults ≥18 y of age in Kaiser Permanente Southern California, hospitalization rates for acute CVD were compared in the time period immediately prior to and following the 2016 presidential election date. Hospitalization for CVD was defined as an inpatient or emergency department discharge diagnosis of acute myocardial infarction (AMI) or stroke using International Classification of Diseases, 10th revision codes. Rate ratios (RR) and 95% confidence intervals (CIs) were calculated comparing CVD rates in the 2 d following the 2016 election to rates in the same 2 d of the prior week. In a secondary analysis, AMI and stroke were analyzed separately. The rate of CVD events in the 2 d after the 2016 presidential election (573.14 per 100,000 person-years [PY]) compared to the rate in the window prior to the 2016 election (353.75 per 100,000 PY) was 1.62 times higher (95% CI 1.17, 2.25). Results were similar across sex, age, and race/ethnicity groups. The RRs were similar for AMI (RR 1.67, 95% CI 1.00, 2.76) and stroke (RR 1.59, 95% CI 1.03, 2.44) separately. Transiently heightened cardiovascular risk around the 2016 election may be attributable to sociopolitical stress. Further research is needed to understand the intersection between major sociopolitical events, perceived stress, and acute CVD events.
Footnotes
- ↵1To whom correspondence may be addressed. Email: dwilliam{at}hsph.harvard.edu.
Author contributions: M.T.M., M.A.M., L.X.Q., K.R., T.N.H., A.C.G., S.S., R.P.S., E.M., and D.R.W. designed research; M.T.M., B.H.L., L.X.Q., K.R., and T.N.H. performed research; B.H.L., L.X.Q., and H.Z. analyzed data; B.H.L. provided data acquisition/programming; M.A.M., B.H.L., L.X.Q., K.R., H.Z., T.N.H., A.C.G., S.S., R.P.S., E.M., and D.R.W. revised the manuscript for important intellectual content; and M.T.M. wrote the paper.
Reviewers: S.E.-R., University of Minnesota Medical School; J.S.K., McGill University; and H.T., Morehouse School of Medicine.
The authors declare no competing interest.
This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2012096117/-/DCSupplemental.
Data Availability.
Anonymized data that support the findings of this study may be made available from the investigative team in the following conditions: 1) agreement to collaborate with the study team on all publications, 2) provision of external funding for administrative and investigator time necessary for this collaboration, 3) demonstration that the external investigative team is qualified and has documented evidence of training for human subjects protections, and 4) agreement to abide by the terms outlined in data use agreements between institutions.
Published under the PNAS license.
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Sociopolitical stress and acute cardiovascular disease hospitalizations around the 2016 presidential election
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