PANDEMIC PRESSURES AND CHRONIC DISEASE OUTCOMES: CARDIOVASCULAR MORTALITY IN BULGARIA DURING COVID-19
DOI:
https://doi.org/10.15547/tjs.2026.03.009Keywords:
cardiovascular diseases, mortality, Covid-19, Bulgaria, health services accessibility, pandemics, regional health planningAbstract
Purpose: Cardiovascular disease (CVD) is Bulgaria's leading cause of death. The Covid-19 pandemic disrupted global health services, likely worsening CVD mortality. This study examined CVD mortality trends in Bulgaria during 2020–2022 versus pre-pandemic years and assessed the pandemic's impact.
Material and Methods: CVD mortality data (ICD-10: I00–I99) came from the National Center of Public Health and Analyses. An ARIMA model forecast expected rates for 2020–2022 using 2000–2019 trends. Observed rates were compared to predictions. Regional disparities across Bulgaria's six planning regions were analyzed via one-way ANOVA with Tukey post-hoc tests.
Results: Observed CVD mortality exceeded ARIMA forecasts throughout the pandemic. In 2020, it was 8.8% above expected; 2021 peaked at 1,163.2 per 100,000—the highest in two decades. Rates dipped slightly in 2022 but stayed elevated. Significant regional differences emerged (F = 12.826, p < 0.001), with the North West Region highest.
Conclusions: Covid-19 substantially increased CVD mortality in Bulgaria, exceeding trends and predictions, with northern regions hardest hit. Findings highlight needs for resilient systems, chronic care continuity, and targeted regional planning in crises.
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