Abstract Body (Do not enter title and authors here):
Background: The COVID-19 pandemic disrupted healthcare systems and significantly impacted individuals with chronic conditions.
Research Question: What was the impact of the pandemic on diabetes mellitus (DM) as a contributing condition on cardiovascular disease (CVD) mortality trends and place of death?
Methods: Using the CDC WONDER database (2018–2023), we identified deaths due to CVD (ICD-10 codes: I00–I99) in individuals with DM (ICD-10 codes: E10-E14) in the United States. The study was divided into pre-COVID (2018-2019), during COVID (2020-2021), and post-COVID (2022-2023) periods. Age-adjusted mortality rates (AAMRs) per 100,000 population were stratified by age, sex, race/ethnicity, and regions. Places of death were classified as inpatient, outpatient/ER, home, hospice, or nursing home/long-term care.
Results: There were a total of 617,414 deaths due to CVD in patients with DM and the AAMR increased from 22.18 per 100,000 pre-COVID to 26.24 during COVID and remained high at 25.84 post-COVID. AAMR increased across all age groups during the pandemic, with the most increase among adults aged 25-44 (+29.8%), followed by 45-64 (+20.8%) and ≥65 (+17.3%) which decreased by 4.68%, 4.02% and 0.73% post-COVID respectively (Table 1).
Home deaths increased considerably from 40.6% (69,344 of 170,777) pre-COVID to 46.2% (94,512 of 204,566) during COVID-19, with a slight decline to 45.1% (94,020 of 208,388) post-COVID. In contrast, deaths in nursing homes (−2.67%), outpatient/ER settings (−1.07%), and inpatient (−1.68%) declined during COVID.
Regionally, the South had greatest increase in AAMR (+21.3%) which increased to (+23.2%) post-COVID, followed by the West (+16.2% to +13.3%), Midwest (+16.6% to 12.6%), and Northeast (+15.8% to +9.4). Males and females had a comparable mortality increase during the pandemic (+18% and 17.9%) while non-Hispanic individuals had a higher increase in AAMR (+17.1%) as compared to Hispanics (+10.6%). Among races, Black individuals had the highest AAMR increase (+23.6%), followed by Asian (+21%), White (+17%), and American Indian or Alaska Native (+6.2%).
Conclusion: The COVID-19 pandemic was associated with considerable rise in CVD mortality in patients with DM, especially younger adults. This trend continued post-COVID and a considerable and lasting shift in place of death toward home settings was observed. These disparities underscore systemic gaps in prevention and chronic disease management that were magnified during the pandemic.