Annual Change Research Articles

Projected epidemiological trends and burden of liver cancer by 2040 based on GBD, CI5plus, and WHO data.

Incidence of liver cancer as one of the most common cancers worldwide and become the significant contributor for the mortality among cancer patients. The disease burden, risk factors, and trends in incidence and mortality of liver cancer globally was described subsequently estimated the projections of liver cancer incidence or mortality by 2040. Data regarding age-standardized incidence and mortality rates for liver cancer was obtained from multiple databases, including GLOBOCAN 2020, CI5 volumes I-XI, WHO mortality database, and Global Burden of Disease (GBD)-2019. Concentrating on worldwide variations, this thorough analysis offers insights into patterns of incidence and mortality based on gender and age. Our findings encompass significant indicators, including age-standardized rates (ASRs), average annual percentage change (AAPC), and future projections extending up to the year 2040. Liver cancer holds the sixth position in terms of most frequently diagnosed cancers and stands as the sixth leading cause of cancer-related deaths worldwide in 2020, accounting for 905,677 new cases and 782,000 fatalities. Additionally, liver cancer contributed to 12,528,421 age-standardized disability-adjusted life years (DALYs), with an age-standardized DALYs rate of 161.92 in 2019 worldwide. The age-specific incidence rates exhibited significant variations across different regions, showing a fivefold difference in males and females. A significant increase in incidence was observed in North Europe and Asia, while North African countries reported a higher mortality burden (ASR, 10 per 100,000) compared to developed countries. Since last few years, the incidence and mortality rates have increased and attained Annual Average Percentage Change (AAPC) incidence rate of 7.7 (95% CI 3.9-11.6) for men and the highest AAPC mortality rate of 12.2 (95% CI 9.5-15.0) for women. In 2019, Western Europe emerged as the high-risk region for DALYs related to smoking and alcohol consumption, while high-income North America carried a high risk for DALYs associated with a high body-mass index. The projected trend indicates a surge in new liver cancer incident cases, expected to rise from around 905,347 to an estimated 1,392,474 by 2040. This study described the evidence pertinent to higher incidence trends in liver cancer, particularly among both young and older adults, encompassing males and females, as well as those who are HIV-infected and HBsAg positive. A significant rise in the young population poses a significant public health concern that warrants attention from healthcare professionals to prioritize the promotion of health awareness and the development of effective cancer prevention strategies, particularly in many developing countries.

Long-Term Blood Pressure Variability and Visual Field Progression in Glaucoma.

Long-term variability of blood pressure may be associated with visual field (VF) progression in patients with glaucoma. To investigate the association between blood pressure parameters and VF progression over time in patients with glaucoma. This retrospective cohort study of longitudinal data included patients with suspected or confirmed glaucoma who were selected from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study. Patients underwent blood pressure and VF testing from November 2000 to December 2022, and data were analyzed in October 2023. Suspected or confirmed glaucoma. Mean and SD values of blood pressure variables were calculated for systolic and diastolic arterial pressures. These parameters were incorporated into multivariable mixed-effect models to investigate the association between blood pressure parameters and mean intraocular pressure with rates of VF mean deviation loss. Interaction terms between blood pressure parameters and mean intraocular pressure were also included in the models. A total of 1674 eyes from 985 patients were assessed (mean [SD] age, 61.2 [0.4] years; 563 female [57.2%]). The mean rate of VF mean deviation change was -0.13 (95% CI, -0.16 to -0.10) dB/y over a mean follow-up of 8.0 (95% CI, 7.7-8.2) years. The interaction terms of higher mean blood pressure and higher SD of blood pressure were associated with faster annual mean deviation changes for both mean arterial pressure (0.02 [95% CI, 0.01-0.04] dB/y per 1-mm Hg higher; P = .001) and diastolic arterial pressure (0.02 [95% CI, 0.01-0.03] dB/y per 1-mm Hg higher; P < .001). The interaction term of higher SD of blood pressure and higher mean intraocular pressure was associated with faster annual mean deviation changes for both mean arterial pressure (0.01 [95% CI, 0.00-0.02] μm per 1-mm Hg higher; P = .003) and diastolic arterial pressure (0.01 [95% CI, 0.00-0.01] μm per 1-mm Hg higher; P = .001). In this cohort study, higher mean blood pressure and higher SD of blood pressure were associated with faster VF progression. These findings suggest that long-term variability of blood pressure may be a modifier of the association between intraocular pressure and VF progression in glaucoma.

Investigating Microperimetric Features in Bietti Crystalline Dystrophy Patients: A Cross-Sectional Longitudinal Study in a Large Cohort.

To assess the clinical and genetic characteristics of patients with Bietti crystalline dystrophy (BCD) with a focus on potential of microperimetry in monitoring macular function. A total of 208 genetically-confirmed BCD patients were enrolled in this retrospective study. The patients were categorized into subgroups based on their fundus characteristics (fovea sparing and fovea involved), optical coherence tomography (OCT) findings (presence/absence of retinal pigment epithelium [RPE] or ellipsoid zone [EZ] line at the fovea/parafovea), and genetic profiles (Mis/Mis, Tru/Mis, Tru/Tru). Fixation patterns were analyzed, and macular sensitivity (MS) parameters were compared among different groups. Longitudinal analysis was performed to calculate the annual changes in MS parameters. Correlation between genotype and phenotype were further investigated by analyzing cumulative incidence of vision impairment among different genotypic groups. Patients with well-preserved RPE or EZ at the foveal/parafoveal region exhibited higher MS. Notably, there was a decline in sensitivity parameters, with a decrease of -2.193dB/year (95% confidence interval [CI] -4.292 to -0.095, P = 0.041) at the fovea and -1.353dB/year (95% CI -2.047 to -0.659, P < 0.001) in average sensitivity. An age-adjusted comparison of sensitivity among genotypic groups and cumulative incidence analyses showed no association between genotypic groups and vision loss. Microperimetry proves to be one of a credible tool for detecting macular functional changes in BCD patients. BCD patients with different genotypes may have similar disease progression.

Trends of extreme hyperbilirubinemia related infant mortality in select European countries (1990-2019).

Limited data exist on population-level mortality outcomes related to extreme neonatal hyperbilirubinemia (EHB) and this study examines trends in annual infant mortality rate (IMR) attributed to hemolytic and perinatal jaundice among Germany, France, Italy, Portugal, Greece and Spain from 1990 to 2019. Data on annual incident cases and disability-adjusted life years were collected from the 2019 Global Burden of Disease study. Live birth cohort data were sourced from UN World Population Prospects. We quantified temporal trends, with relative percent changes. Average annual percent changes (AAPCs) were evaluated using the Joinpoint Regression Program. EHB-related infant mortality decreased from 21.4 (95%CI: 16.1, 27.1) in 1990 to 4.2 (95%CI: 1.9, 7.6) per million live births in 2019. Germany demonstrated lowest AAPC of -3.2% (95% CI: -3.8, -2.5), while Portugal had the highest AAPC of -8.6% (95% CI -11.9, -5.1) in reducing infant mortality due to EHB. There were distinct divergences in the trajectories of declining EHB mortality among the studied countries. This study highlights a significant decline in infant mortality due to extreme hyperbilirubinemia, emphasizing the need for national surveillance and tailored guidelines to prevent bilirubin induced neurological damage. This cross-sectional analysis revealed a marked decline in infant mortality rates attributed to extreme hyperbilirubinemia across the selected European countries. The rates of decline varied significantly between countries, demonstrating notable heterogeneity in mortality trends when stratified by age at death. Implementing data-driven surveillance systems can optimize the alignment of equitable healthcare services, strengthen accountability measures, and identify critical operational inefficiencies. In the European Union, country-specific hyperbilirubinemia guidelines should be reinforced to ensure effective screening and post-discharge follow-up protocols that are tailored to risk burden and available healthcare resources.

Global, regional and country-specific burden of patella, tibia or fibula, or ankle fractures and its prediction to 2035: findings from global burden of disease study 2019.

Bone fractures are a global public health issue and a major source of significant illness and financial hardship. However, to date, there is limited research on patella, tibia or fibula, or ankle fractures (FPTFA) disease burden. Using the framework of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we conducted temporal trends of disease burden, effects of sex and socio-demographic index (SDI) on age standardized prevalence rate (ASPR) and age-period-cohort model. Machine learning models were built to predict the ASPR of FPTFA in 2035. In 1990 and 2019, the top three of all fractures with the highest ASPR was FPTFA. Globally, in 2019, there were 13529.45million (95%UI: 11811.02, 15642.25), 9198.67million (95%UI: 8518.9, 10009.91) and 77.54million (95%UI: 34.09, 149.9) prevalent cases of fracture attributable to fall, transport injury and mechanical external force, respectively. The number of fracture prevalence and years lived with disability (YLDs), and ASPR were higher in males than in females. From 1990 to 2019, most of GBD regions showed a downward trend in average annual percent change (AAPC) of ASPR attributable to transport injuries, High-income Asia Pacific had the highest decline (AAPC= -1.81%, 95%CI: -1.89% to -1.74%). However, an upward trend in East Asia was observed (AAPC = 1.60%, 95%CI: 1.48-1.73%). With increasing SDI, the ASPR for FPTFA attributed to the fall and mechanical external force slowly increased and then turned downward, especially in high-income and high-SDI countries. The longitudinal age curve suggested that the attributed rate was increased for the three sites of lower limb fractures. The best predictive models for FPTFA caused by falls, transport injuries and mechanical external force were autoregressive integrated moving average model (ARIMA) (0,2,1), ARIMA (2,0,1) and ARIMA (0,2,2), with R2 of 0.96, 0.78 and 0.94, respectively. By 2035, ASPR for the fall-related FPTFA will continue to rise rapidly, whereas the ASPR of the transport injury-related FPTFA will gradually decrease. FPTFA attributed to the falls is the dominant type and the burden and trends of the fall-related FPTFA are substantial. Fall prevention and access to treatment are crucial for reducing FPTFA burden.

Trends of genetic contributions on epigenetic clocks and related methylation sites with aging: A population-based adult twin study.

Several crucial acceleration periods exist during aging process. Epigenetic clocks, serving as indicators of aging, are influenced by genetic factors. Investigating how the genetic contributions on these clocks change with age may provide novel insights into the aging process. In this study, based on 1084 adult twins from the Chinese National Twin Registry (CNTR), we established structural equation models (SEMs) to evaluate the trends in genetic influence with aging for epigenetic clocks, which include PC-Horvath, PC-Hannum, PC-PhenoAge, PC-GrimAge, and DunedinPACE. A decline in overall heritability was observed for all five clocks from ages 31 to 70, with a relatively stable trend at first. Subsequently, apart from PC-GrimAge, the other four clocks displayed a more evident drop in heritability: DunedinPACE and PC-PhenoAge experienced a clear decline between 55 and 65 years, while PC-Horvath and PC-Hannum showed a similar decrease between 60 and 70 years. In contrast, the heritability of PC-GrimAge remained stable throughout. An analysis of methylation sites (CpGs) from these clocks identified 41, 26, 4, and 36 CpG sites potentially underlying heritability changes in DunedinPACE, PC-Horvath, PC-Hannum, and PC-PhenoAge, respectively. Data from the CNTR were collected through two surveys in 2013 and 2018. Based on 308 twins with longitudinal data, declines in genetic components were observed at follow-up compared to baseline, with significant decreases in the four PC-clocks. DunedinPACE peaked in 5-year longitudinal genetic contribution changes at age 55-60, while PC-clocks consistently peaked at age 50-55. These findings may offer novel insights into the role of genetic variations in aging.

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency.

Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture. To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD. We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5. At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002). Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

Effect of 3-year changes in adiposity measures on the pre-diabetes regression and progression: a community-based cohort study.

We assessed the impact of a 3-year change-percent in adiposity measures on regression and pre-diabetes (Pre-DM) progression among Iranian adults. Three-year change-percent in body weight (BW), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and visceral adiposity index (VAI) were calculated for 1458 Pre-DM subjects (mean age of 53.0 ± 13.7, 46.8% men), participated in the third examination of the Tehran Lipid and Glucose Study (2006-2008). Multinomial logistic regression models were used to estimate relative risk ratios (RRRs) of the outcomes [i.e., regression to normal glucose regulation (NGR), persistence in Pre-DM, and progression to newly diagnosed type 2 diabetes (T2D)] across 3-year change categories of adiposity measures (i.e., ≥ 5% decrease, 0-5% decrease, increase). Over nine years of follow-up, 37.7 and 39.0% returned to NGR and progressed to T2D, respectively. Decreased BW (0-5 and ≥ 5%) was associated with regression to NGR (RRRs = 1.44, 95% CIs = 1.05-1.98, and 2.64, 1.63-4.28, respectively). Decreased BMI and WC ≥ 5% were also associated with regression to NGR (RRRs = 1.63, 95% CI = 1.01-2.64; 1.69, 1.20-2.37, respectively). Changes in WHR and VAI were not associated with Pre-DM regression or progression. Pre-DM subjects with ≥ 5% BW loss had a constant FSG level overtime and a lower overall mean of FSG (116 vs. 111 and 112mg/dL, P = 0.023 and 0.009, respectively) and 2h-SG (154 vs. 165 and 168mg/dL) compared to those had 0-5% BW loss or BW gain. Short-term management of adiposity measures increases the regression probability to NGR. Targeting BW loss seems a more potent predictor of Pre-DM reversion among the adiposity measures.

Total Gastrectomy for Gastric Malignancy: Trends Over 15 Years in Major Morbidity, Mortality, and Patient Selection From The National Surgical Quality Improvement Program.

We examined trends in major morbidity and mortality following total gastrectomy for malignancy in a national cohort. The National Surgical Quality Improvement Program was used to identify patients who underwent total gastrectomy for malignancy from 2007 to 2021. Joinpoint regression was used to determine annual percent changes (APCs) in thirty-day postoperative major morbidity, mortality, and length of stay (LOS). Major morbidity included deep and organ space surgical site infection, venous thromboembolism, cardiac event, pneumonia, acute renal failure, sepsis, and respiratory failure. Of 3515 patients, the median age was 65 years (IQR = 55-73), 59% were male, and 57.9% were White. Major morbidity was 23%, which did not change over time (APC = -1.4, 95% CI = -3.4 to 0.58), nor were there changes in individual morbidities with time. The most common morbidities were organ space surgical site infection (9.2%) and pneumonia (8.5%). Mortality rate in the study cohort was 2.7% and did not change (APC = -6.2, 95% CI = -13.0 to 1.1). LOS (median 9 days) also did not vary with time (APC = -2.3, 95% CI = -7.8 to 3.9). There was an increase in patients with diabetes (21.6% vs. 11.2%, p < 0.05), BMI ≥ 30 (31.1% vs. 18.2%, p < 0.05), and ASA IV-V status (11.6% vs. 3.5%, p < 0.05). Morbidity and mortality following total gastrectomy for malignancy have not significantly changed over the last fifteen years. While this may in part be explained by increased patient comorbidity, efforts should be made to improve patient selection and mitigate postoperative complications to allow for timely adjuvant therapies.

Global burden associated with rare infectious diseases of poverty in 2021: findings from the Global Burden of Disease Study 2021.

Rare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally. Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050. In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15years being the most predominant. Females aged 15-49years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050. There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere.

Trends in extreme rainfall over the past 55 years suggest springtime subhourly rainfall extremes have intensified in Mahantango Creek, Pennsylvania.

Extreme short-duration rainfall is intensifying with climate warming, and growing evidence suggests that subhourly rainfall extremes are increasing faster than more widely studied durations at hourly and daily timescales. In this case study, we used 55 years (1968-2022) of 5-min precipitation data from Mahantango Creek, a long-term experimental agricultural watershed in east-central Pennsylvania, United States, to examine annual and seasonal changes in subhourly (15-min), hourly, and daily rainfall extremes. Specifically, we evaluated temporal trends in the magnitude and frequency of subhourly, hourly, and daily rainfall extremes. We then estimated apparent scaling rates between rainfall extremes and dew point temperature (Td) and compared these rates to the Clausius-Clapeyron (CC) rate (∼ 7% per °C). We also determined the coincidence of extreme rainfall trends with indicators of atmospheric instability and convective-type precipitation. Overall, we found the most significant changes in rainfall extremes at 15-min durations during the spring, with magnitudes of these subhourly extremes increasing by 0.6 to 0.9% per year, and frequencies rising by 3.4% per year. Apparent scaling rates in the spring showed that 15-min rainfall extremes transitioned from sub-CC scaling to greater than 2CC scaling when Td reached 11° C, implying a possible shift from stratiform rains to more intense convective rains above this Td threshold. Notably, trends in maximum hourly convective available potential energy (CAPE) increased during spring, as did the ratio of 15-min rainfall extremes to their corresponding daily rainfall totals. Findings indicate that convective-type precipitation may be playing an increasing role in the intensification of springtime 15-min rainfall extremes in Mahantango Creek.

Burden of Parkinson's disease in Central Asia from 1990 to 2021: findings from the Global Burden of Disease study.

Central Asia is known to face various ecological challenges that constitutes major risk factors for Parkinson's disease (PD). This study examines the burden of PD in Central Asia, a region where data on neurological disorders is notably sparse. Building on the latest Global Burden of Disease Study (GBD 2021), this study investigates the Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability-Adjusted Life Years (DALYs) associated with PD in Central Asia and its countries from 1990 to 2021. The authors calculated average annual percent change (AAPC) to analyze trends, and compared individual country estimates to global figures. Additionally, incorporating data from the World Bank, both Bayesian hierarchical and non-hierarchical frequentist regression models were employed to assess their impact on DALYs. The DALYs varied across the study period, primarily driven by YLLs. While YLLs showed a uniform trend, YLDs were mostly incremental. Kazakhstan had the highest estimates across all metrics and was the only country aligned with global patterns. Age- and sex-specific estimates revealed substantial variations, with notably high figures found in male subjects from Tajikistan. The YLLs, YLDs, and DALYs for Kazakhstan, Uzbekistan, and Turkmenistan saw a significant increase in AAPCs. In contrast, Kyrgyzstan and Tajikistan saw declines, likely attributable to civic conflict and inter-country differences in population structure. Further comparison of DALY trends revealed significant deviations for all countries from the global pattern. This study showed an overall increase in PD burden from 1990 to 2021. These findings underscore the need for targeted strategies to reduce PD burden, with a particular focus on Kazakhstan. Integrating historical information is crucial for discussing the plausible mechanisms in studies sourced from the GBD.

Abstract 4144573: Cardiac biomarkers, intensive lifestyle intervention, and risk of heart failure subtypes in type 2 diabetes – a post-hoc analysis of the Look AHEAD trial

Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) identify subclinical heart failure (HF) in type 2 diabetes (T2D). The contribution of changes in cardiac biomarkers to HF risk, particularly HF subtypes, is unclear. Whether HF risk associated with cardiac biomarkers is modifiable with an intensive lifestyle intervention (ILI) targeting weight loss is unknown. Methods: Adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial without prevalent HF were included. NT-proBNP and hs-cTnT were measured at baseline, 1- and 4-years (Roche Diagnostics). Adjusted Cox models were created to evaluate the associations of baseline, 1- and 4-year change in NT-proBNP and hs-cTnT with risk of HF with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). Interaction testing was performed to evaluate heterogeneous effects of the ILI vs diabetes support and education (DSE) across baseline cardiac biomarkers. Results: Of the 3,959 participants included, 212 had incident HF (108 HFpEF, 84 HFrEF) over 12 years. Higher baseline NT-proBNP and hs-cTnT were each significantly associated with higher risk of HFpEF and HFrEF ( Table) . Increases in NT-proBNP over 1- and 4-years were significantly associated with higher risk of HFpEF and HFrEF with a similar pattern of association for hs-cTnT and HF subtypes. After accounting for risk factor changes, the association of 1- and 4-year changes in NT-proBNP, but not hs-cTnT, with risk of HF subtypes remained significant. There was a significant interaction between NT-proBNP and ILI for risk of HFpEF but not HFrEF (p-int = 0.001). The ILI reduced HFpEF risk among participants with elevated (≥125 pg/mL) but not non-elevated NT-proBNP (&lt;125 pg/mL) (ILI vs DSE HR [95% CI]: 0.48 [0.25-0.93] and 1.67 [0.94-2.94], respectively). No significant treatment group by hs-cTnT interactions were identified. Conclusions: In T2D, longitudinal changes in cardiac biomarkers, particularly NT-proBNP, are significantly associated with HF risk, independent of risk factor changes. In Look AHEAD, elevated NT-proBNP may identify individuals who are more likely to benefit from the ILI for HFpEF prevention.

Abstract 4134912: Geographic, Gender,&amp;Racial Trends in Mortality Due to Coronary Artery Disease in Diabetes among Adults Aged 25 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis

Background: Coronary artery disease (CAD) is a significant contributor to mortality among adults with diabetes mellitus (DM) in the United States. This study examines the patterns of CAD-related mortality in individuals aged 25 and above with DM, with a particular focus on geographic, gender, and racial/ethnic discrepancies from 1999 to 2020. Methods: The study analyzed death certificate information from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were computed per 100,000 individuals, categorized by year, gender, race/ethnicity, and geographic areas. Results: Between 1999 and 2020, CAD in individuals with DM resulted in 1,462,279 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (44.2%) and at home (29.3%). The overall age-AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95% CI: -1.29 to -0.77 p &lt; 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p &lt; 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p &lt; 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in urban areas (AAPC: -1.22, p &lt; 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629). Conclusion: The decrease in AAMRs for CAD among individuals with DM from 1999 to 2020 indicates improvements in healthcare management. However, the ongoing disparities based on race, gender, and geography call for targeted public health interventions to guarantee fair access to cardiovascular care. Additional endeavors are necessary to comprehend and alleviate the root causes of these inequalities.

Abstract 4134768: Geographic, Gender,&amp;Racial Trends in Mortality Due to Heart Failure in Coronary Artery Disease Among Adults Aged 65 and Older in the United States, 1999-2020: A CDC WONDER Database Analysis

Backgrounds: Heart failure (HF) associated with coronary artery disease (CAD) is a significant contributor to mortality in the elderly population of the United States. This study examines trends in HF in CAD-related mortality among adults aged 65 and older, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020. Methods: A retrospective analysis was performed using the CDC WONDER database death certificates from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: Between 1999 and 2020, there were 6,571,263 deaths attributed to coronary artery disease (CAD) and 6,135,540 deaths related to Heart Failure (HF) in the US. Among adults aged 65 and older, HF in CAD caused 1,597,451 deaths, with 37.1% occurring in medical facilities and 30.3% in nursing homes. The AAMRs for HF in CAD decreased from 241.7 in 1999 to 156.2 in 2020 (AAPC: -2.23, p &lt; 0.000001). This reduction was significant from 1999 to 2014, followed by a slight increase from 2014 to 2020. Men consistently had higher AAMRs than women (227.4 vs. 137.1), with women experiencing a more significant decline in rates (AAPC: -3.23, p &lt; 0.000001). Racial disparities revealed the highest AAMRs among Whites (183.0), followed by American Indians/Alaska Natives (153.7), Blacks (134.6), Hispanics (123.7), and Asians/Pacific Islanders (81.6). The most significant reductions were observed in Hispanics (AAPC: -2.68, p &lt; 0.000001). Geographically, AAMRs varied, ranging from 92.1 in Hawaii to 257.3 in West Virginia, with the Midwest showing the highest mortality (191.0). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (202.6 vs. 166.1), although both showed moderate declines over time, more pronounced in urban areas (AAPC: -2.41, p &lt; 0.000001). Conclusion: The study uncovers notable variances in HF in CAD-related mortality among elderly individuals in the United States based on race, gender, and geographic location. While the decrease in AAMRs from 1999 to 2014 indicates progress in cardiovascular care, the subsequent rise from 2014 to 2020 and enduring disparities call for specific public health measures to tackle these inequalities.

Abstract 4134922: Trends in Coronary Artery Disease-Related Mortality in Adults with Hyperlipidemia in the United States: A CDC WONDER Database Analysis

Background: Coronary artery disease (CAD), related to high blood lipid levels, is a significant contributor to adult mortality in the United States. This study examines the patterns of CAD-related deaths associated with high lipid levels in adults aged 25 and above, with a specific focus on variations related to geography, gender, and race/ethnicity from 1999 to 2020. Methods: This study employed a comprehensive retrospective analysis using death certificate data from the CDC WONDER database, covering 21 years from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons, categorized by year, gender, race/ethnicity, and geographic regions. This approach ensured a robust and reliable analysis of the trends in CAD-related deaths associated with high lipid levels. Results: Between 1999 and 2020, CAD in individuals with high levels of lipids resulted in 407,667 deaths among adults aged 25 and above in the United States. The majority of these deaths occurred in medical facilities (40.1%) and at home (37.3%). The AAMR for CAD in individuals with high lipid levels increased from 4.1 in 1999 to 12.1 in 2020, showing an AAPC of 4.44 (95% CI: 3.69 to 5.48, p &lt; 0.000001). Men had a higher AAMR (12.4) than women (5.6), and both sexes experienced significant increases over time. Disparities in AAMRs by race/ethnicity revealed the highest rates among Whites (8.9), followed by American Indians/Alaska Natives (8.6), Blacks (7.3), Hispanics (6.5), and Asians/Pacific Islanders (5.9). The most significant increase was observed in Blacks (AAPC: 5.07, p &lt; 0.000001). This detailed breakdown of the disparities in CAD mortality rates among different racial and ethnic groups provides a clear picture of the health inequalities that need to be addressed. Conclusion: This study emphasizes the discrepancies in CAD mortality related to high lipid levels among adults in the United States based on race, gender, and geographic location. The consistent rise in AAMRs between 1999 and 2020 emphasizes the necessity for specific public health interventions to tackle these increasing inequalities.

Abstract 4147639: Trends in Atherosclerosis-related mortality in the United States from 1999 to 2020; A Retrospective Analysis

Background and Aims: Atherosclerotic diseases, including but not limited to myocardial infarction and stroke, are the leading cause of morbidity and mortality worldwide. Here we aim to identify and quantify temporal trends of atherosclerotic disease mortality among adults in the United States from 1999 to 2020, and pinpoint racial, local, regional, age and gender-wise variations in this trend. Methods: Data was sourced from the CDC WONDER database, with atherosclerosis identification based on ICD-10 Codes I70. We determined the crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals from 1999-2020. JointPoint regression was employed to examine the changes in AAMR across the years through annual percent change (APC) and the average annual percent change (AAPC). Results: The AAMR for atherosclerosis shows a uniformly declining trend from 1999 to 2020 with AAPC= -7.25; 95% CI -6.34 to -8.14. The analysis revealed significant disparities in mortality rates among different demographic groups. Mortality was significantly higher among female patients (AAPC=-7.09%; 95% CI -6.48 to -8.58), American Indian patients (AAPC=-7.88%; 95% CI -.6.58 to -9.11), and rural populations (AAPC=-7.62%; 95% CI -6.53 to -8.70). Most deaths occurred in the southern region of the US (AAPC: -7.62%; 95% CI -7.45 to -9.19). A notable exception to this was California which accounted for the highest mortality in the US. Conclusion: Our nationwide analysis showed an overall decreasing mortality trend due to atherosclerosis among adults in the US. However, the higher mortality rate among females, American Indians, and rural populations is concerning and requires further investigation that can explain and expand on the findings of our study and explain this variation in mortality rates.

Abstract 4138715: Disparities in Aortic Dissection and Aortic Aneurysm-Related Mortality in The United States From 1999-2020

Background: Aortic dissection (AD) and aneurysm (AA) have a low incidence but are severe health risks associated with high mortality rates, and based on location, can have a mortality rate of over 80%. We aim to highlight disparities in mortality based on gender, race, age and demographic background. Methods: This retrospective study analyzed death certificate data for AD and AA (ICD-10 code I71) from 1999 to 2020 using the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 100,000 were assessed for adults aged 25 and older by gender, race, year, state, and place of death, while crude mortality rates (CMR) per 100,000 were used for age groups. Joinpoint regression calculated the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Results: From 1999 to 2020, AD and AA resulted in 400,748 deaths in the US. During this period, AAMR for men (12.19) was approximately double that for women (5.77). Overall, the AAMR decreased from 12.40 to 6.71 (AAPC: -2.93; 95% CI: -3.06 to -2.79; p-value&lt;0.000001). NH whites had the highest AAMR at 8.93, while Hispanic and Latino populations had the lowest at 4.20. Approximately 52.3% of the deaths occurred in inpatient medical facilities, whereas 18.4% occurred at home. Vermont, West Virginia, and Wyoming had the highest AAMRs, at 11.60, 11.47, and 11.30, respectively. Among racial groups, both males and females experienced a decrease in AAMR except for NH black men. For this group, there was an increase in AAMR from 9.42 in 2012 to 10.43 in 2020 (APC:1.03; 95% CI: 0.15 to 2.22; p-value:0.028). The CMR for young adults rose significantly from 0.62 in 2014 to 0.73 in 2020 (APC:2.55; 95% CI 1.11 to 6.74; p-value:0.02), and for middle-aged adults from 3.09 in 2010 to 3.61 in 2020 (APC: 1.57; 95% CI 1.04 to 2.25; p-value&lt;0.000001). Conversely, a steep decline in CMR was observed for older adults from 27.93 in 2014 to 25.4 in 2020 (APC:-1.34; 95% CI -1.9 to -0.69; p-value:0.0004). Conclusion: Although AD and AA mortality rates have declined over time, significant disparities persist for NH Black men and young/middle-aged adults. This highlights the need for early screening programs and equitable healthcare provision for all populations.

Abstract 4138617: Temporal and Regional Trends in Cardiovascular Mortality Associated with Parkinson's Disease from 1999 to 2020: A Retrospective Study in the United States

Introduction: Parkinson’s disease (PD) is a common neurodegenerative disorder, and existing evidence links it to cardiovascular (CVD) mortality. Research Question: Is the CVD-related mortality higher in PD patients compared to that in the general population? Goals: We aim to identify CVD-related mortality trends in patients with PD in the US stratified by age, sex, race, and region, and compare them to CVD-related mortality trends in the general population. Methods: Death certificates from the CDC-WONDER database were examined for adults aged ≥65 years. Crude rates (CR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and change in AAMR was estimated via annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint regression. Results: From 1999 to 2020, a total of 138,151 CVD-related deaths occurred in individuals with PD. The AAMRs decreased moderately till 2002 (APC: -3.25), then sharply till 2014 (APC: -5.43), but increased thereafter till 2020 (APC: 1.77). Males had higher AAMR than females, and the AAPC for CVD-related deaths in PD differed significantly from those in the general population. NH Whites displayed the highest AAMR (16.14) while NH Blacks or African Americans displayed the lowest (9.65). Hispanics or Latinos showed an AAMR of 11.22, followed by NH Asians or Pacific Islanders (10.24) and NH American Indians or Alaska Natives (9.70). AAMRs also varied substantially by region (West: 16.64; Midwest: 16.40; Northeast: 15.59; South: 13.12). States with the highest AAMRs were Nebraska, California, and Oklahoma. Rural regions exhibited a higher AAMR (16.34) than Urban regions (14.88). The AAPC for CVD-related deaths in PD differed significantly from those in the West and in urban regions. Most deaths occurred at nursing homes or long-term care (43.85%). The adults aged ≥85 years exhibited an alarmingly high CR (53.04), and the AAPC differed significantly from the general population due to CVD. Conclusions: We observed overall decreasing trends in CVD-related deaths in adults with PD from 1999 to 2014, which increased thereafter till 2020. Highest mortality was exhibited by males and NH Whites, residents of the West and the Midwest, and adults ≥85 years.

Abstract 4137243: Dynamic changes of pericoronary fat attenuation index predicting changes of coronary plaque burden

Background: Percent atheroma volume (PAV) is a validated index of coronary plaque burden, linking to adverse cardiac events. Meanwhile, pericoronary fat attenuation index (FAI) on coronary computed tomography angiography (CCTA) image is a novel prognostic marker of coronary inflammation. Research Questions: It is unknown the impact of coronary inflammation (i.e., FAI) on the progression of coronary PAV in patients at an increased risk of adverse cardiac events. Methods: Patients with type 2 diabetes mellitus (T2DM) who underwent at least two clinically indicated CCTA examinations (time interval &gt; 1 year) at our center were potentially eligible for enrollment. Eligible patients presented with more than one study plaque, defined as non-obstructive stenosis at baseline and not being intervened during serial CCTA. Longitudinal CCTA images were assessed for FAI and compositional plaque characteristics (e.g., PAV) using dedicated post-processing softwares. The relationships between changes in FAI and progression of compositional PAV were examined using the logistic and linear regression analysis. Results: A total of 204 T2DM patients (mean age, 61.2 ± 9.3 years; male, 68.1%) with 366 study plaques were enrolled. All patients were treated with statins, and their time interval between longitudinal CCTAs was 14.1 (12.9, 17.6) months. Compared with patients with improved coronary inflammation (ΔFAI ≤ 0), those with deteriorated coronary inflammation (ΔFAI &gt; 0) had lower high density lipoprotein cholesterol and baseline FAI, whereas higher blood pressure (all p &lt; 0.05). Meanwhile, compared to patients with ΔFAI ≤ 0, those with ΔFAI &gt; 0 had more Δoverall and Δnon-calcified PAV (all p &lt; 0.05). Importantly, these findings were consistent in a dedicated propensity score matching analysis. In logistic regression analysis, ΔFAI &gt; 0 was associated with annual progression of overall PAV and non-calcified PAV, whereas ΔFAI ≤ 0 associated with annual regression of overall PAV and non-calcified PAV after adjusting for cardiac risk factors, baseline PAV and medications (all p &lt; 0.05). Similarly, in linear regression analysis, changes of FAI were independently positively associated with annual changes of overall PAV (β=0.545, p&lt; 0.001) and non-calcified PAV (β=0.461, p&lt; 0.001) (Figure 1). Conclusion: In this longitudinal CCTA study, changes of coronary inflammation are closely correlated with changes of overall and non-calcified PAV among T2DM patients treated with statins.