Abstract Body (Do not enter title and authors here): Introduction:
Diabetes mellitus type II is among the nine leading causes of mortality. All-cause mortality hikes by folds in those affected. Heart failure (HF) is a common cause; however, patient demographics and other factors impact the trends. Identifying these can help direct relevant healthcare agendas.

Research Question:
What are the trends in HF-associated mortality in individuals with diabetes mellitus type II in the USA?

Goals:
Identifying trends stratified by age, gender, race, and geographical location in HF-associated mortality in diabetic individuals.

Methodology:
Crude mortality rate (CMR) and age-adjusted mortality rate (AAMR) per 100,000 population were extracted from the National Vital Statistics System from 1999 to 2020 using the CDC Wonder database, with diabetes mellitus type II as the underlying cause and heart failure as a contributing cause. Changes over time, as annual percentage change (APC), were analyzed with Joinpoint regression analysis.

Results:
The overall AAMR increased from 1999-2004 (APC: 6.054), followed by a decrease during 2004-2014 (APC: -0.139) and a final incline till 2020 (APC: 11.52). Older adults (aged 85+) had the highest CMR of 97.08. Men had a higher AAMR than women (5.61 versus 3.87). Ethnicity-wise, the highest AAMR was observed in Non-Hispanic (NH) American Indians or Alaska Natives (7.13), followed by the Hispanic or Latino (5.26), NH Black or African American (4.90), NH White (4.57), and NH Asian or Pacific Islander (3.20) populations. Among states, the lowest AAMR was observed in the District of Columbia (1.63) while the highest was in Oregon (8.51). Stratified by census regions, the highest mortality rate was in the Western region (AAMR: 5.81), followed by the Midwestern, Southern, and Northeastern regions; 5.50, 4.17, and 2.97, respectively.

Conclusions:
Our study found substantially rising trends in HF-related mortality in type II diabetics. In different strata, the highest rates were observed in individuals over 85 years, males, NH American Indian or Alaska Natives, and those residing in the Western region, especially Oregon. Such results call for directive policy introduction in relevant areas of healthcare that can help limit fatal outcomes.