Abstract 4367836: Trends and Disparities in Type 2 Diabetes Mellitus and Cardiac Arrest-Related Mortality Among Adults in the United States from 1999 to 2023.

Background: Type 2 Diabetes Mellitus (T2DM) is a major cardiovascular risk factor and growing contributor to sudden cardiac death. Despite growing awareness, the burden and trends of mortality attributable to concurrent T2DM and cardiac arrest at the national level remain uncharacterized. Hypothesis: We hypothesized that T2DM-related cardiac arrest mortality among U.S. adults has increased over time, with disparities by sex, age group, race/ethnicity, and geographic region. Methods: Mortality data for T2DM-related cardiac arrest among adults aged ≥25 in the US were extracted from the CDC WONDER (1999-2023), using ICD-10 codes I46 (cardiac arrest) and E11 (T2DM). Age-adjusted mortality rates (AAMRs) per 100,000 were calculated and stratified by sex, age group, race/ethnicity, geographic region and urban-rural classification. Jointpoint regression was used to estimate average annual percentage change (AAPC) and annual percentage change (APC) with 95% confidence intervals (CIs). Statistical significance was defined as p<0.05. Results: From 1999 to 2023, 339,097 T2DM-related cardiac arrest deaths occurred. AAMR increasing significantly from 3.38 in 1999 to 8.92 in 2023 (AAPC: 3.96* 95% CI: 2.72 to 5.21, p<0.01). AAMR increased from 1999 to 2021 with the most significant increase reported from 2015 to 2021 (APC: 11.14* 95% CI: 8.14 to 14.21; p<0.01). This was followed by a decline till 2023. Stratified analyses showed that AAMRs increased all age groups, with age-group (25-44) showing the largest AAPC (7.87* 95% CI: 3.46 to 12.46) and an average AAMR of (0.25). Men consistently had higher AAMRs than women (AAMR: 7.18 vs 4.65), with a notable surge in both after 2014 till 2021. By race, the average AAMRs were highest in Hispanic or Latinos (10.88), followed by non-Hispanic (NH) American Indians (8.49). Regionally, the West had the highest AAMR (11.3). Urban exhibited higher AAMR than rural areas from 1999 to 2020 (AAMR: 5.52 vs 4.84). Conclusion: Mortality related to T2DM-associated cardiac arrest has risen significantly over the past two decades, disproportionately affecting men, Hispanic or Latino individuals, and residents of Western regions. These findings highlight the need for equity-based interventions and enhanced clinical recognition of T2DM-related cardiac arrest to reduce avoidable deaths and guide future resource allocation.