EXPRESS: Temporal Trends and Disparities in Acute Ischemic Event Mortality Among U.S. Adults With Coexisting Atherosclerotic Heart Disease and Diabetes Mellitus: A National Analysis

Abstract

BACKGROUND: Although ischemic heart disease (IHD) mortality has declined overall due to advances in prevention and acute care, adults with both chronic atherosclerotic heart disease and diabetes mellitus-who face a twofold increased risk of coronary events-may not have benefited equally. National trends and disparities in acute ischemic event mortality within this dual-risk population remain underexamined. OBJECTIVE: To quantify age-adjusted mortality trends and identify demographic and geographic disparities in acute ischemic event mortality among U.S. adults with both diabetes and chronic atherosclerotic heart disease from 1999 to 2020. METHODS: We conducted a retrospective analysis using CDC WONDER (1999-2020). Adults aged ≥25 years were included if the underlying cause of death was an acute ischemic event, with both diabetes and chronic atherosclerotic heart disease listed as contributing causes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression was used to assess trends. RESULTS: Among 201,980 deaths identified, AAMRs declined from 1999 to 2009 (-6.15% per year), slowed from 2009 to 2018 (-3.16%), and rose slightly from 2018 to 2020 (+4.39%; not statistically significant). Men, Black and Hispanic individuals, older adults, and residents of micropolitan counties had the highest mortality. State-level AAMRs varied nearly fourfold. Women had steeper declines than men; Black adults bore the highest burden throughout. CONCLUSION: While mortality declined overall in this high-risk group, progress has slowed and significant disparities persist. Targeted, equity-focused interventions are urgently needed.