SAT-580 - Mortality Trends and Disparities in Diabetes and Co-occurring Macrovascular Morbidity in the United States, 1999–2023

Background:
Hyperglycemia and insulin resistance in Diabetes Mellitus (DM) significantly contribute to atherosclerotic changes by increasing systemic inflammation and endothelial dysfunction, thereby increasing the risk of macrovascular diseases. These include ischemic heart disease (IHD), cerebrovascular disease (CeVD) encompassing both ischemic and hemorrhagic stroke, and peripheral arterial disease (PAD)-specifically atherosclerosis of the arteries of the extremities. This study examines mortality trends and disparities in diabetes patients with co- occurring IHD, CeVD, or PAD from 1999 to 2023.

Methods:
A retrospective analysis using the CDC WONDER database (1999–2023) was conducted for individuals aged 25 and older. Deaths were identified using ICD-10 codes E10-E14 (DM) as the underlying cause of death and ICD codes I20-I25 (IHD), I60-I69 (CeVD), or I70.2 (PAD) as contributing causes. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated, and demographic trends (gender and race) were analyzed using Joinpoint regression to determine the Annual Percent Change (APC).

Results:
A total of 928,026 deaths were attributed to DM with IHD, CeVD, or PAD. The overall AAMR decreased from 21.11 to 14.30 between 1999 and 2019, followed by a sharp increase to 16.13 in 2020 and 16.30 in 2021, respectively, before declining to 13.92 in 2023. Males consistently exhibited higher AAMRs than females (AAMR of 14.95 for men vs. 10.82 for women from 2018–2023; male-to-female ratio of 1.3). Joinpoint regression showed a significant long-term decline until 2018, a sharp increase between 2018 and 2021 (APC: 5.68 for males, 5.86 for females), and a subsequent rapid decline from 2021–2023. This recent decline was more pronounced in females (APC = -9.74) than in males (APC = -7.13). Blacks or African Americans had consistently higher AAMRs across all racial groups, followed by Hispanics and Whites (2018- 2023 AAMR of 23.86, 17.26, and 14.1 respectively).

Conclusion:
Mortality from diabetes and co-occurring macrovascular disease declined substantially for two decades but was reversed sharply during the COVID-19 pandemic (2020–2021). The downward trajectory resumed through 2023 with females experiencing more rapid recent declines than males. Despite overall improvements, disparities persist across racial groups with Blacks or African Americans having the highest AAMRs. Targeted and equity-focused interventions are required to ensure fair healthcare access across different groups.

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