Abstract 270: Disparities In Cardiovascular Mortality Associated With Diabetes Prevalence In United States: County Level Analysis From 2011 To 2019

Abstract

Introduction: A significant rise in the rates of Diabetes Mellitus (DM) amongst U.S. adults has been observed in recent decades. Although associations between DM and cardiovascular mortality (CVM) are well-known, disparities in related CVM are unclear. Hypothesis: We sought to study the independent impact of DM on CVM among age, sex, and race/ethnic subgroups. Methods: County-level age adjusted CVM rates (ACVM) were obtained from the CDC WONDER database. DM prevalence, demographics, socioeconomic, environmental, and other cardiovascular risk factors obtained from the County Health Rankings project database. Multivariate generalized linear mixed models were used to investigate the independent association between ACVM and DM amongst different subgroups using incidence rate ratios (IRRs) to evaluate the relative impact and additional yearly deaths (AYD) to evaluate the absolute impact of DM. Results: Among 309,886,995 residents (50% women, 11.7% non-Hispanic blacks, 23.8% [45-64 age group]) lived at 2900 US counties in 2011, total 7,381,448 (2.4%) CV deaths occurred between 2011-2019. In fully adjusted model*, DM significantly associated with ACVM (IRR: 1.013; 95% CI: 1.006 to 1.020; AYD: 3). This association remained robust amongst those aged 45 to 64 (IRR: 1.023; 95% CI: 1.013 to 1.033; AYD: 3.4), those aged ≥65 (IRR: 1.010; 95% CI: 1.003 to 1.017; AYD: 14.5), males (IRR: 1.023; 95% CI: 1.014 to 1.031; AYD: 6.2), females (IRR: 1.010; 95% CI: 1.001 to 1.018; AYD: 1.8), non-Hispanic Whites (IRR: 1.011; 95% CI: 1.003 to 1.018; AYD: 2.5); and 45-64 age group of non-Hispanic blacks (IRR: 1.033; 95% CI: 1.001 to 1.066; AYD: 9.2); Figure. Conclusion: Increased DM prevalence is independently associated with high ACVM among different age, sex, and race/ethnic groups, and this impact is most pronounced in the middle-aged group of males, non-Hispanic whites, and non-Hispanic blacks. Population-level interventions are imperative to effectively combat this ongoing epidemic.