{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T16:17:18Z","timestamp":1777047438154,"version":"3.51.4"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Bereavement is a known risk factor for cardiovascular disease (CVD), but it remains unclear whether the COVID-19 pandemic\u2014which disrupted health care and increased social isolation\u2014altered this association.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the association between bereavement and incident CVD before and during the pandemic.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study of Swedish national health registries included individuals aged 30 years or older in Sweden during the pre\u2013COVID-19 (2018-2019) and COVID-19 (2020-2021) periods. Analyses were performed between September 2024 and August 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Bereavement exposure was defined as the loss of a partner, child, parent, or sibling.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The first diagnosis of any CVD event, identified from an outpatient hospital visit or hospitalization via the Swedish Patient Register or death via the Swedish Cause of Death Register. Cox regression was used to estimate hazard ratios (HRs) of incident CVD after bereavement by study period, type of loss, and age.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Analysis included a total of 5\u202f365\u202f829 study participants (51.4% female; median [IQR] age, 51.6 [40.4-64.6] years) during the pre\u2013COVID-19 period and 5\u202f522\u202f898 study participants (51.4% female; median [IQR] age, 49.8 [38.2-62.8] years) during the COVID-19 period. Overall, 372\u202f477 (6.94%) and 368\u202f902 (6.68%) incident CVD cases were identified during the pre\u2013COVID-19 and COVID-19 periods, respectively. Bereavement was associated with increased CVD risk regardless of period or type of loss. However, the risk increment was greater during the COVID-19 period compared with the pre\u2013COVID-19 period for loss of a partner (HR, 1.46 [95% CI, 1.41-1.51] vs 1.30 [95% CI, 1.26-1.35];\n P<\/jats:italic>\n for difference\u2009&amp;lt;\u2009.001) and sibling (HR, 1.23 [95% CI, 1.20-1.27] vs 1.16 [95% CI, 1.13-1.19];\n P<\/jats:italic>\n for difference\u2009=\u2009.003). No period difference was noted for the loss of a child or parent. The risk increment after loss of a partner or parent increased with age, while the risk after loss of a child or sibling decreased with age.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, bereavement was associated with increased CVD risk both before and during the COVID-19 pandemic; however, a stronger association for partner or sibling loss was noted during the pandemic. These findings suggest that bereavement may be a period of heightened cardiovascular vulnerability, underscoring the importance of targeted clinical monitoring and preventive care for bereaved individuals.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.9102","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:30:25Z","timestamp":1777044625000},"page":"e269102","source":"Crossref","is-referenced-by-count":0,"title":["Bereavement and Risk of Cardiovascular Disease Before and During the COVID-19 Pandemic"],"prefix":"10.1001","volume":"9","author":[{"given":"Fen","family":"Yang","sequence":"first","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiyu","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary M.","family":"Barker","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huiqi","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krisztina D.","family":"L\u00e1szl\u00f3","sequence":"additional","affiliation":[{"name":"Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikael","family":"Rostila","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Stockholm University, Stockholm, Sweden"},{"name":"Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Rogne","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Stockholm University, Stockholm, Sweden"},{"name":"Centre for Health Equity Studies, Stockholm University and Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Feychting","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Unnur A.","family":"Valdimarsd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"},{"name":"Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland"},{"name":"Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fredrik","family":"Nyberg","sequence":"additional","affiliation":[{"name":"School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fang","family":"Fang","sequence":"additional","affiliation":[{"name":"Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"issue":"9603","key":"zoi260283r1","doi-asserted-by":"publisher","first-page":"1960","DOI":"10.1016\/S0140-6736(07)61816-9","article-title":"Health outcomes of bereavement.","volume":"370","author":"Stroebe","year":"2007","journal-title":"Lancet"},{"issue":"8","key":"zoi260283r2","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1097\/PSY.0000000000000717","article-title":"Grief: a brief history of research on how body, mind, and brain adapt.","volume":"81","author":"O\u2019Connor","year":"2019","journal-title":"Psychosom Med"},{"issue":"1","key":"zoi260283r3","doi-asserted-by":"publisher","first-page":"6240","DOI":"10.1038\/s41598-025-90657-1","article-title":"Cause-specific mortality after spousal bereavement in a Danish register-based cohort.","volume":"15","author":"Sloth","year":"2025","journal-title":"Sci Rep"},{"issue":"12","key":"zoi260283r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.49463","article-title":"Prenatal exposure to severe stress and risks of ischemic heart disease and stroke in offspring.","volume":"6","author":"Yang","year":"2023","journal-title":"JAMA Netw Open"},{"issue":"8","key":"zoi260283r7","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1016\/j.jchf.2024.01.009","article-title":"Prenatal exposure to severe stress and the risk of heart failure up to middle-age.","volume":"12","author":"Yang","year":"2024","journal-title":"JACC Heart Fail"},{"issue":"1","key":"zoi260283r8","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.50814","article-title":"Sibling death in childhood and early adulthood and risk of early-onset cardiovascular disease.","volume":"7","author":"Huang","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"3","key":"zoi260283r9","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1161\/CIRCULATIONAHA.111.061770","article-title":"Risk of acute myocardial infarction after the death of a significant person in one\u2019s life: the Determinants of Myocardial Infarction Onset Study.","volume":"125","author":"Mostofsky","year":"2012","journal-title":"Circulation"},{"issue":"4","key":"zoi260283r10","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1001\/jamainternmed.2013.14558","article-title":"Increased risk of acute cardiovascular events after partner bereavement: a matched cohort study.","volume":"174","author":"Carey","year":"2014","journal-title":"JAMA Intern Med"},{"issue":"4","key":"zoi260283r11","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/ane.12736","article-title":"Risk of stroke after bereavement-a systematic literature review.","volume":"136","author":"Aalbaek","year":"2017","journal-title":"Acta Neurol Scand"},{"issue":"2","key":"zoi260283r12","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1177\/00221465241273870","article-title":"Death of a parent, racial inequities, and cardiovascular disease risk in early to mid-adulthood.","volume":"66","author":"Garcia","year":"2025","journal-title":"J Health Soc Behav"},{"issue":"4-5","key":"zoi260283r13","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1080\/08959420.2020.1764320","article-title":"Bereavement in the time of coronavirus: unprecedented challenges demand novel interventions.","volume":"32","author":"Carr","year":"2020","journal-title":"J Aging Soc Policy"},{"issue":"4","key":"zoi260283r14","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1080\/00332747.2022.2051141","article-title":"Bereavement during the COVID-19 pandemic: impact on coping strategies and mental health.","volume":"85","author":"Fisher","year":"2022","journal-title":"Psychiatry"},{"issue":"6","key":"zoi260283r15","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1016\/j.jacc.2022.06.008","article-title":"Impact of the COVID-19 pandemic on cardiovascular health in 2020: JACC state-of-the-art review.","volume":"80","author":"Roth","year":"2022","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"zoi260283r16","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1038\/s41591-022-02158-7","article-title":"The impact of the COVID-19 pandemic on cardiovascular disease prevention and management.","volume":"29","author":"Dale","year":"2023","journal-title":"Nat Med"},{"key":"zoi260283r17","doi-asserted-by":"publisher","first-page":"649","DOI":"10.2147\/CLEP.S312742","article-title":"Swedish COVID-19 investigation for future insights\u2014a population epidemiology approach using register linkage (SCIFI-PEARL).","volume":"13","author":"Nyberg","year":"2021","journal-title":"Clin Epidemiol"},{"issue":"2","key":"zoi260283r18","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1007\/s10654-016-0117-y","article-title":"Registers of the Swedish total population and their use in medical research.","volume":"31","author":"Ludvigsson","year":"2016","journal-title":"Eur J Epidemiol"},{"key":"zoi260283r19","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1007\/978-1-59745-423-0","article-title":"The Swedish Multi-generation Register.","volume":"675","author":"Ekbom","year":"2011","journal-title":"Methods Mol Biol"},{"issue":"9","key":"zoi260283r20","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1007\/s10654-017-0316-1","article-title":"The Swedish cause of death register.","volume":"32","author":"Brooke","year":"2017","journal-title":"Eur J Epidemiol"},{"issue":"10","key":"zoi260283r22","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.1176\/ajp.145.10.1300","article-title":"Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised (DSM-III-R).","volume":"145","author":"Cooper","year":"1988","journal-title":"Am J Psychiatry"},{"key":"zoi260283r23","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.jad.2020.09.049","article-title":"Acute grief after deaths due to COVID-19, natural causes and unnatural causes: an empirical comparison.","volume":"278","author":"Eisma","year":"2021","journal-title":"J Affect Disord"},{"key":"zoi260283r24","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register.","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"issue":"3","key":"zoi260283r25","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s10654-025-01221-0","article-title":"Diagnostic accuracy in the Swedish national patient register: a review including diagnoses in the outpatient register.","volume":"40","author":"Everhov","year":"2025","journal-title":"Eur J Epidemiol"},{"issue":"1","key":"zoi260283r26","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1093\/ehjqcco\/qcaa084","article-title":"The impact of the COVID-19 pandemic on the care and management of patients with acute cardiovascular disease: a systematic review.","volume":"7","author":"Kiss","year":"2021","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"issue":"42","key":"zoi260283r27","doi-asserted-by":"publisher","first-page":"2936","DOI":"10.1093\/eurheartj\/ehu131","article-title":"Competing risks analyses: objectives and approaches.","volume":"35","author":"Wolbers","year":"2014","journal-title":"Eur Heart J"},{"issue":"12","key":"zoi260283r28","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.1111\/apa.15582","article-title":"The first eight months of Sweden\u2019s COVID-19 strategy and the key actions and actors that were involved.","volume":"109","author":"Ludvigsson","year":"2020","journal-title":"Acta Paediatr"},{"issue":"1","key":"zoi260283r29","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1111\/apa.16535","article-title":"How Sweden approached the COVID-19 pandemic: summary and commentary on the National Commission Inquiry.","volume":"112","author":"Ludvigsson","year":"2023","journal-title":"Acta Paediatr"},{"key":"zoi260283r4","unstructured":"Wei? D. Bereavement In Adulthood and Risks of Incident and Recurrent Cardiovascular Diseases. Doctoral Thesis. Karolinska Institutet; 2022."},{"key":"zoi260283r5","unstructured":"Chen? H. Bereavement and Risks of Cardiovascular Diseases and Mortality. Doctoral Thesis. Karolinska Institutet; 2022."},{"key":"zoi260283r21","unstructured":"Socialstyrelsen. National Patient Register. 2019. Accessed March 12, 2026. https:\/\/www.socialstyrelsen.se\/en\/statistics-and-data\/registers\/national-patient-register"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2848139\/yang_2026_oi_260283_1776441263.3425.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T15:30:27Z","timestamp":1777044627000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2848139"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.9102","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}