Abstract Body (Do not enter title and authors here): Background and Purpose
Older adults in the United States face worsening trends in the incidence and prevalence of comorbid diabetes mellitus (DM) and heart failure (HF). This study aimed to examine the trends in DM and HF-related mortality among adults ≥65 years in the United States.
Methods
The Multiple Cause-of-Death data using CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) were analyzed for DM and HF-related deaths from 1999 to 2019 in adults ≥65 years. Age-adjusted mortality rates (AAMRs) per 100,000 population were determined and stratified by year, sex, race/ethnicity, and geographic region. Joinpoint regression was used to analyze trends in AAMRs using annual percent change (APC).
Results
A total of 842,785 deaths occurred among older adults in the United States related to comorbid HF and DM. The overall AAMR for deaths due to comorbid DM and HF in older adults was 97.4. The AAMRs remained stable between 1999 and 2005. From 2005 to 2009, AAMRs steadily declined at an APC of -3.41 (95% CI: -4.75 to -0.52). Following a period of stability from 2009 to 2014, AAMRs increased at an APC of 2.80 (95% CI: 1.97 to 4.68) till 2019. Men (116.2) had consistently higher AAMRs than older women (84.8) throughout the study period. Upon stratification by race and ethnicity, AAMRs were observed to be highest in non-Hispanic (NH) American Indian or Alaska Native (144.1), followed by NH Black or African American (124.4), Hispanic or Latino (100.5), NH White (95.3), and NH Asian or Pacific Islander (62.0) populations. Non-metropolitan areas had higher AAMRs for comorbid HF and DM than metropolitan areas, with overall AAMRs of 126.9 and 90.9, respectively. States that fell into the top 90^th percentile included Kentucky, Mississippi, Oklahoma, Oregon, Vermont, and West Virginia, which had twice the AAMRs than states that fell into the bottom 10^th percentile, including Arizona, Florida, Hawaii, Massachusetts, Nevada, and New York.
Conclusion
Our analysis revealed a concerning rise in mortality related to comorbid DM and HF in U.S. adults ≥ 65 years old since 2014. Men, NH American Indian and Alaska Native populations, and residents of non-metropolitan areas displayed the highest AAMRs. Future efforts focusing on improved risk assessment and the adoption of therapeutic therapies are needed for the effective management of patients with comorbid DM and HF to help alleviate the mortality burden.