Abstract Body: Objective: Diabetes mellitus (DM) continues to be a major contributor to acute myocardial infarction (AMI)-related mortality. Both Type 1 diabetes mellitus (T1DM) and Type 2 diabetes mellitus (T2DM) are associated with AMI; however, mortality data on the regional and demographic disparities among patients with concomitant AMI and T1DM remain understudied.
Methods: We utilized publicly available, deidentified data from the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) database. Using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), we identified diabetic patients with AMI (codes I21.0-I21.1, I21.3-I21.4, I21.9, I22.0-I22.1, I22.8-I22.9). T2DM was defined using codes E11.0–E11.9, and T1DM using codes E10.0–E10.9. Age-adjusted mortality rates (AAMRs), standardized per 100,000 population, were stratified by year, sex, ethnicity, urbanization, geographic region, and state. Analyses were conducted using Joinpoint Regression Software version 5.0.2.
Results: Between 1999 and 2020, a total of 203,068 AMI-related deaths occurred among individuals with diabetes. Of these, 169,973 were in patients with T2DM and 33,095 in those with T1DM, with overall AAMRs substantially higher in T2DM (4.5) than in T1DM (0.4). Mortality was consistently greater among males (T2DM: 5.0; T1DM: 1.0) when compared to females (T2DM: 3.4; T1DM: 0.7). Among T2DM patients, the AAMR was highest in Hispanics (5.9), while in T1DM, it was greatest in non-Hispanics (0.9). Across both cohorts, non-metropolitan areas demonstrated higher mortality (T2DM: 5.9; T1DM: 1.3). T2DM-related mortality peaked in the Western region (AAMR: 5.3), whereas T1DM-related mortality was highest in the Midwest region (AAMR: 1.1). West Virginia showed the highest T2DM mortality (AAMR: 7.9), followed by Iowa, California, Ohio, and Tennessee. For T1DM, Rhode Island reported the highest mortality (AAMR: 1.8), with Tennessee, West Virginia, Arkansas, and North Dakota also ranking in the 90th percentile.
Conclusion: AMI imposes a substantial mortality burden among individuals with DM, especially those with T2DM. Marked disparities by sex, ethnicity, region, and urbanization emphasize the need for targeted preventive and healthcare strategies to reduce inequities.