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

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.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, we conducted a cross-sectional analysis using CDC Wide-ranging Online Data for Epidemiologic Research (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. 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. While mortality declined overall in this high-risk group, progress has slowed and significant disparities persist. Targeted, equity-focused interventions are urgently needed.