EXPRESS: Temporal trends and disparities in acute ischemic event mortality among U.S. adults with coexisting atherosclerotic heart disease and diabetes mellitus: A national analysis

Authors

• Abdalhakim Shubietah, Advocate Health - MidwestFollow
• Mohammad Bdair, Department of Medicine, An-Najah National University, Nablus, West Bank, Palestine.
• Anwar Zahran, Department of Medicine, An-Najah National University, Nablus, West Bank, Palestine.
• Mohammed AbuBaha, Department of Medicine, An-Najah National University, Nablus, Palestine.
• Maisam Tobeh, Al Qassimi Women's and Children's Hospital, Sharjah, United Arab Emirates.
• Abubakar Nazir, Oli Health Magazine Organization Kigali, Kigali, Rwanda.
• Mohamed S. Elgendy, Faculty of Medicine, Tanta University, Tanta, Egypt.
• Ameer Awashra, Department of Medicine, An-Najah National University, Nablus, West Bank, Palestine.
• Jehad Zeidalkilani, Department of Internal Medicine, MercyOne Siouxland Medical Center, Sioux City, IA, USA.
• Hosam I. Taha, Faculty of Medicine, Tanta University, Tanta, Egypt.
• Fathi Milhem, Department of Medicine, An-Najah National University, Nablus, Palestine.
• Ahmed Emara, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.

Recommended Citation

Shubietah A, Bdair M, Zahran A, et al. EXPRESS: Temporal Trends and Disparities in Acute Ischemic Event Mortality Among U.S. Adults With Coexisting Atherosclerotic Heart Disease and Diabetes Mellitus: A National Analysis. J Investig Med. Published online April 28, 2026. doi:10.1177/10815589261448845

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Background: Although ischemic heart disease (IHD) mortality has declined overall due to advances in prevention and acute care, adults with both chronic atherosclerotic heart disease and diabetes mellitus-who face a twofold increased risk of coronary events-may not have benefited equally. National trends and disparities in acute ischemic event mortality within this dual-risk population remain underexamined.

Objective: To quantify age-adjusted mortality trends and identify demographic and geographic disparities in acute ischemic event mortality among U.S. adults with both diabetes and chronic atherosclerotic heart disease from 1999 to 2020.

Methods: We conducted a retrospective analysis using CDC WONDER (1999-2020). Adults aged ≥25 years were included if the underlying cause of death was an acute ischemic event, with both diabetes and chronic atherosclerotic heart disease listed as contributing causes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population. Joinpoint regression was used to assess trends.

Results: Among 201,980 deaths identified, AAMRs declined from 1999 to 2009 (-6.15% per year), slowed from 2009 to 2018 (-3.16%), and rose slightly from 2018 to 2020 (+4.39%; not statistically significant). Men, Black and Hispanic individuals, older adults, and residents of micropolitan counties had the highest mortality. State-level AAMRs varied nearly fourfold. Women had steeper declines than men; Black adults bore the highest burden throughout.

Conclusion: While mortality declined overall in this high-risk group, progress has slowed and significant disparities persist. Targeted, equity-focused interventions are urgently needed.

Type

Article

PubMed ID

42047215