Qadeer, Abdul

Abstract Disclosure: M. Kakakhel: None. F. Saleem: None. A. Ullah: None. K. Abdul Rehman: None. M.H. Alsaadi: None. H. Ahmad: None. A. Qadeer: None. R. Haider: None. M. Khawar: None. H. Jawad: None. J. Ikram: None. M. Filal: None. F. Ahmed: None. R.W. Kirchoff: None. Background: Thyroid disorders are common endocrine disorders including thyrotoxicosis, thyroiditis, hypothyroidism, and autoimmune thyroid diseases. Although it affects an estimated 200 million people globally, the epidemiology of this condition remains underexplored. Here we aimed to investigate mortality trends attributable to thyroid disorders in the US stratified by year, sex, race, and region. Methods: Using data from the CDC WONDER database, we calculated the crude and age-adjusted mortality rates (AAMRs) per 1,000,000 individuals (≥25 years) and used Joinpoint regression to determine annual and average annual percent change (AAPC) in the mortality trends. Results: Between 1999 and 2020, 561,089 deaths were recorded among patients with thyroid disorders in the United States, with an overall increasing trend in mortality (AAPC = 0.78). The age-adjusted mortality rate (AAMR) declined gradually from 1999 to 2018 (APC = -0.43, 95% CI: -0.65 to -0.22) before rising sharply from 2018 to 2020 (APC = 13.05, 95% CI: 6.39 to 20.12). Females had a higher AAMR (139.75) than males (81.99). Among racial and ethnic groups, Whites exhibited the highest AAMR (124.09), followed by American Indian or Alaskan Natives (121.36), Hispanics (89.13), Black or African Americans (88.44), and Asian or Pacific Islanders (59.36). Regional disparities showed the highest AAMR in the Midwest (130.45) and the lowest in the South (109.40). West Virginia (199.93) and North Dakota (198.82) reported the highest state-level AAMRs, while Nevada (60.18) and Florida (65.49) had the lowest. Non-metropolitan areas experienced higher mortality rates (141.04) than metropolitan areas (112.21), underscoring significant geographical and demographic variations in thyroid disorder-related mortality. Conclusion: Adults in the US have shown a rising trend in Thyroid-related deaths, with the highest mortality rates seen in females, Whites, and people living in the Midwest and Non-metropolitan areas. Our study also highlights the disparities across different demographics. Policy makers should focus on equitable access to healthcare to control this increasing mortality. Presentation: Monday, July 14, 2025

Systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) is a life-threatening vascular complication of SSc, marked by high morbidity and mortality. Early diagnosis remains a major challenge due to nonspecific symptoms and the limitations of conventional tools such as echocardiography (ECHO), pulmonary function tests (PFTs), and serum biomarkers. This review evaluates the emerging role of artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL), in improving the diagnostic landscape of SSc-PAH. A comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, Embase and Google Scholar to identify studies involving AI applications in SSc, pulmonary arterial hypertension (PAH), and their intersection. Evidence indicates that AI models can assist interpretation across modalities, including heart sounds, ECGs, chest X-rays (CXRs), ECHOs, CT pulmonary angiography (CTPA), and omics-based biomarkers. While several models show encouraging diagnostic performance, their accuracy varies by dataset and modality, and most require external validation against right heart catheterization (RHC)-confirmed cohorts. Integrating multimodal data through AI frameworks may enhance early recognition and individualized risk stratification; however, these tools remain exploratory. Future work should emphasize harmonized hemodynamic definitions, transparent validation protocols, and SSc-specific datasets to ensure clinical applicability and reproducibility.

e13154 Background: Triple-negative breast cancer (TNBC) is a less common but highly aggressive subtype of breast cancer with poor prognosis and limited therapeutic options. Despite advancements in oncology, significant survival disparities persist among racial, histologic, and socio-demographic groups. This study investigates these disparities and identifies factors contributing to unequal outcomes, providing actionable insights for improving care. Methods: Data on TNBC cases from 2000 to 2021 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database, encompassing 17 registries and 76,265 patients. Patients were categorized by stage, marital status, age, race, and histology. Kaplan-Meier survival analysis was used to estimate median survival with 95% confidence intervals (CI), and the log-rank test assessed differences across groups. Cox proportional hazards regression determined the magnitude of disparities. A p-value < 0.05 was considered statistically significant. Results: Among the 76,265 patients analyzed, those with distant-stage disease had the poorest median survival (51 months; 95% CI: 46–60), compared to localized-stage patients (128 months; 95% CI: 127–129). The youngest cohort (15–19 years) exhibited the lowest survival (43 months), while individuals aged 80–84 had a median survival of 79 months (95% CI: 76–84). South Asians, particularly Pakistani individuals, had the shortest survival among racial groups (83 months). Single patients had lower survival (116 months) compared to married or divorced individuals. Histologically, median survival was 113 months (95% CI: 103–120) for epithelial neoplasms and 78 months for mucoepidermoid neoplasms. All observed differences were statistically significant (p < 0.05). Conclusions: Localized-stage TNBC, individuals aged 40–44, and patients from White or Black racial groups exhibited better survival outcomes, as did those with cystic, mucinous, or serous histologies compared to epithelial neoplasms. Addressing these disparities through tailored treatment strategies and improved access to care is critical. Limitations of this study include the lack of treatment-level data and the potential influence of unmeasured confounders. Stage Marital Status Age Group at Diagnosis Distant Localized Single Divorced 15-19 40-44 80-84 Median Survival(LCL-UCL) 51(46-60) 128(127-129) 116(114-118) 127(124-129) 43(14-NA) 132(130-135) 79(76-84) Neoplasm Histology Race Epithelial Muco-epidermoid Cystic, Mucinous& Serous Pakistani OtherAsian Black White Median Survival(LCL-UCL) 113 (103-120) 78(63-NA) 142(123-NA) 83 (63-NA) 97(91-108) 123 (121-125) 126 (125-127) LCL= Lower Confidence Limit, UCL= Upper Confidence Limit.

e20629 Background: Lung cancer (LC) and respiratory failure (RF) are major contributors to mortality in adults globally. Understanding long-term mortality trends across demographic, racial, geographic, and socio-economic groups is crucial to addressing disparities and improving outcomes. This study examines national mortality patterns for LC and RF in the United States from 1999 to 2023, providing critical insights into changes over time and identifying key disparities in age-adjusted mortality rates (AAMRs). Methods: A descriptive analysis of mortality data from the CDC WONDER database (1999-2023) identified deaths due to LC (ICD-10 code C34) and RF (ICD-10 code J96) in adults aged 25+. AAMRs per 100,000 population were calculated and stratified by gender, race/ethnicity, region, state, and urban-rural classification. Temporal trends were analyzed with Joinpoint regression to compute APCs and 95% CIs. Statistical significance was set at p<0.05. The study followed STROBE guidelines. Results: From 1999 to 2023, a total of 456,325 adult deaths (age 25-85+) were attributed to Lung cancer and Renal failure. Age-adjusted mortality rates (AAMRs) for lung cancer (LC) and respiratory failure (RF) decreased from 1999 to 2010 (APC = -1.2, 95% CI: -1.6 to -0.9), followed by an increase from 2010 to 2023 (APC = 1.4, 95% CI: 1.1 to 1.7). Gender trends revealed a steady decline for men, while women's Age-Adjusted Mortality Rates (AAMr) initially decreased, then increased from 2011-2023 (APC: 2.0, 95% CI: 1.7 to 2.5). Non-Hispanic White populations experienced a rapid increase in age-adjusted mortality rates from 2014 to 2017 (APC: 2.7; 95% CI: 0.9 to 3.3), while other racial/ethnic groups exhibited varied trends with declines, increases, and stabilizations. Geographically, AAMRs were highest in the Northeast (8.6; 95% CI: 8.5 to 8.7) and lowest in the Midwest (7.1; 95% CI: 7.0 to 7.1). Metropolitan areas saw declining trends until 2006, stabilizing briefly, and increasing thereafter. Non-metropolitan areas experienced notable increases post-2009 (APC = 2.3, 95% CI: 1.8 to 3.1). State-level disparities revealed Mississippi with the highest AAMR (14.0; 95% CI: 13.7 to 14.4) and Wisconsin with the lowest (3.7; 95% CI: 3.5 to 3.8). These findings highlight significant demographic, racial, and geographic variations in LC and RF mortality trends. Conclusions: LC and RF-related mortality rates initially declined from 1999 to 2010 but increased significantly from 2010 onward, with notable demographic, racial, and geographic disparities. These findings highlight the urgent need for targeted interventions and resource allocation to address these rising trends and reduce inequities across vulnerable populations.

e20520 Background: Cancer and respiratory failure (RF) are amongst leading causes of mortality in adults. This study investigates national trends in age-adjusted mortality rates (AAMRs) for cancer and RF in the United States from 1999 to 2023, focusing on disparities by gender, race, region, and rural-urban residence to inform public health strategies. Methods: This descriptive study analyzed data from the CDC WONDER database, of adults aged 25 and older. Mortality data were identified using ICD-10 codes C00–C97 (cancer) and J96 (RF). AAMRs per 100,000 population were calculated and stratified by gender, race/ethnicity, census region, urban-rural classification, and state. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) with 95% confidence intervals (CIs). Statistical significance was set at p < 0.05. Results: From 1999 to 2023, total deaths of 1,263,368 attributed to cancer and RF (682,141 men, 581,227 women). AAMRs declined from 1999 to 2004 (APC = -1.5, 95% CI: -4.0 to -0.4), stabilized from 2004 to 2012 (APC = 0.8, 95% CI: 0.1 to 2.4), and increased from 2012 to 2023 (APC = 3.2, 95% CI: 2.9 to 3.8). Men experienced a greater initial decline (APC = -2.1, 1999–2004) but significant increases thereafter (APC = 3.0, 2012–2023), while women showed a slower decline followed by sharper increases (APC = 3.5, 2013–2023). Non-Hispanic Black populations initially declined (APC = -1.7, 1999–2003) but later increased significantly (APC = 3.0, 2014–2020). Hispanic/Latino populations declined (APC = -1.2, 1999–2009) before rising sharply (APC = 3.1, 2009–2020). American Indian or Alaska Native populations showed consistent increases (APC = 1.7, 1999–2020). Urban areas experienced initial declines (APC = -1.7, 1999–2004), followed by increases (APC = 2.4, 2011–2020). Non-metropolitan areas exhibited steeper increases (APC = 4.6, 2014–2020). Regionally, the West recorded the highest AAMR (24.0), followed by the Northeast (23.6), South (20.9), and Midwest (18.0). Mississippi had the highest state-level AAMR (36.3), while Wisconsin had the lowest (10.0). States in the top 90th percentile included Mississippi, Arkansas, and California, while Wisconsin, Minnesota, and Oregon were among the lowest. Conclusions: Cancer and RF mortality declined initially but have significantly increased in recent years. Disparities persist across gender, racial, and regional groups, underscoring the need for focused public health efforts and equitable resource distribution to address these trends.

e24020 Background: Transcatheter aortic valve replacement (TAVR) is a widely adopted treatment for severe aortic stenosis, but outcomes in cancer survivors with prior chest radiation therapy (C-XRT) remain uncertain. This study compares the clinical outcomes of TAVR between patients with a history of C-XRT and those without prior radiation exposure (control group). Methods: Patients with prior chest radiation therapy (C-XRT) were compared to a control group without radiation exposure to evaluate key clinical endpoints. For each endpoint, odds ratios (OR) and 95% confidence intervals (CI) were determined, and heterogeneity was analyzed using the I² statistic. A p-value of <0.05 was considered statistically significant. Results: Nine studies were included in the meta-analysis, encompassing 3083 C-XRT and 8891 control patients. Patients with prior C-XRT showed significantly higher long-term mortality (OR 1.84, 95% CI [1.08, 3.13], p=0.02) compared to controls. Other outcomes, including access-related vascular complications, Acute Kidney Injury, Congestive heart failure, major bleeding, need for pacemaker, short-term mortality, and stroke, did not demonstrate significant differences between the groups. Conclusions: Cancer survivors with prior chest radiation therapy undergoing TAVR may experience higher long-term mortality compared to patients without radiation exposure. However, no significant differences were observed in other major outcomes. These findings suggest that while TAVR is a viable treatment for C-XRT patients, long-term risks require further investigation to optimize patient selection and management strategies. Outcomes. Outcome OR 95% Confidence Interval P value Access related vascular complications 1.12 [0.85, 1.48] 0.43 Acute kidney injury 0.54 [0.20, 1.50] 0.24 Congestive heart failure 1.38 [0.88, 2.17] 0.16 Long term mortality 1.84 [1.08, 3.13] 0.02 Major bleeding 0.96 [0.78, 1.17] 0.67 Need for pacemaker 1.05 [0.88, 1.26] 0.57 Short term mortality 1.66 [0.97, 2.84] 0.06 Stroke 1.25 [0.74, 2.11] 0.39

e24024 Background: Patients with active cancer undergoing trans catheter aortic valvular replacement (TAVR) face a higher risk of adverse outcomes due to the interplay between cancer and cardiovascular disease. Although TAVR is increasingly used in high-risk populations, data on outcomes for these patients remain limited. This systematic review and meta-analysis aim to evaluate the clinical outcomes associated with TAVR in patients with active cancer compared to non-cancer controls, providing insights to inform clinical decision-making in this unique group. Methods: A systematic search of major databases (PubMed, Embase, OVID, Web of Science, Scopus) was conducted to identify studies comparing clinical outcomes of TAVR between patients with active cancer and those without cancer. Key outcomes included measures of mortality, procedural complications, and post-procedure adverse events. The Mantel-Haenszel method was used for pooled analysis, applying random-effects or fixed-effects modeling based on heterogeneity assessed by Higgins I². Statistical significance was set at a p-value < 0.05. Results: Twelve studies involving 5,73,192 patients (67,684 active cancer, 505508 control) were included. Patients with active cancer undergoing TAVR have significantly higher risks of short-term mortality (OR 1.31, 95% CI [1.15, 1.49], p < 0.0001), long-term mortality (OR 2.24, 95% CI [1.85, 2.70], p < 0.0001), and major bleeding complications (OR 1.80, 95% CI [1.68, 1.92], p < 0.0001). There were no statistically significant differences in cardiovascular mortality (OR 1.33, 95% CI [0.94, 1.89], p = 0.11), myocardial infarction (OR 1.60, 95% CI [0.82, 3.11], p = 0.17), stroke (OR 0.61, 95% CI [0.28, 1.35], p = 0.22), AKI (OR 0.92, 95% CI [0.49, 1.73], p = 0.80), or the need for permanent pacemaker implantation (OR 1.12, 95% CI [0.85, 1.48], p = 0.42). Conclusions: Patients with active cancer undergoing TAVR face significantly higher risks of mortality and major bleeding compared to non-cancer controls. However, the risks of cardiovascular mortality, MI, stroke, AKI, and the need for permanent pacemaker implantation are comparable to those of non-cancer controls. Careful risk assessment and management are crucial for optimizing outcomes in this vulnerable population, and further studies are needed to refine treatment strategies. Odds ratios of all outcomes. Outcomes OR Confidence Interval (95% CI) p-value Short term mortality 1.31 [1.15, 1.49] < 0.0001 Long term mortality 2.24 [1.85, 2.70] < 0.00001 Major bleeding 1.8 [1.68, 1.92] < 0.00001 Cardiovascular mortality 1.33 [0.94, 1.89] 0.11 Myocardial Infarction 1.6 [0.82, 3.11] 0.17 Stroke 0.61 [0.28, 1.35] 0.22 Acute Kidney Injury 0.92 [0.49, 1.73] 0.8 Need for permanent pacemaker implantation 1.12 [0.85, 1.48] 0.42

e18161 Background: Thyroid cancer remains a significant cause of mortality globally, with varying trends across demographic, geographic, and socioeconomic groups. Understanding these patterns is critical for developing effective prevention and intervention strategies. This study examines thyroid cancer-related mortality trends in the United States from 1999 to 2023, focusing on age-adjusted mortality rates (AAMRs) and disparities across demographic and geographic classifications. Methods: This descriptive study utilized the CDC WONDER database to extract data on thyroid cancer (ICD-10 code C73) deaths among adults aged 25 and older from 1999 to 2023. AAMRs per 1,000,000 individuals were calculated and stratified by gender, race/ethnicity, census region, urban-rural classification, and state. Temporal trends were analyzed using Joinpoint regression to compute annual percent changes (APCs) with 95% confidence intervals (CIs). Statistical significance was set at p<0.05. Results: Between 1999 and 2023, there were 55,971 deaths attributed to thyroid cancer (Men: 24,398; Women: 31,573). Overall, the AAMR increased modestly, with an APC of 1.0 (95% CI: 0.8 to 1.2). Men exhibited a slightly higher AAMR increase (APC: 1.2; 95% CI: 1.1 to 1.4) compared to women (APC: 0.9; 95% CI: 0.7 to 1.2). Racial disparities revealed varied trends. Non- Hispanic White individuals experienced a steady AAMR increase (APC: 1.0; 95% CI: 0.8 to 1.2), while Hispanic populations showed a smaller increase (APC: 0.4; 95% CI: -0.1 to 1.1). Non-Hispanic Asians or Pacific Islanders had a slight decline (APC: -0.4; 95% CI: -1.1 to 0.5), and Non-Hispanic Black populations showed segmented trends, with an APC of 0.3 (95% CI: - 7.8 to 16.7) from 1999 to 2018 and a subsequent increase (APC: 3.7; 95% CI: -5.5 to 10.5) from 2018 to 2020. Geographically, the West exhibited the highest overall AAMR (11.0; 95% CI: 10.8–11.2), followed by the Midwest (9.9; 95% CI: 9.7–10.0) and Northeast (9.8; 95% CI: 9.6–10.0), with the South reporting the lowest AAMR (9.0; 95% CI: 8.8–9.1). Hawaii had the highest state-level AAMR (12.3; 95% CI: 10.8–13.7), while Georgia recorded the lowest (7.6; 95% CI: 7.2–8.1). Urban-rural disparities indicated a slightly higher APC in non-metropolitan areas (1.0; 95% CI: 0.7–1.4) compared to metropolitan areas (0.8; 95% CI: 0.6–1.0). Conclusions: Thyroid cancer-related mortality has shown a gradual increase in the United States over the past two decades, with distinct gender, racial, and geographic disparities. Men, non-metropolitan residents, and individuals in the West and Hawaii faced higher mortality burdens. These findings underscore the importance of targeted public health strategies to address these disparities and reduce thyroid cancer mortality in vulnerable populations.

e16076 Background: Gastric cancer is the fourth leading cause of global cancer deaths. Despite declining incidence and mortality, it remains a significant contributor to the global disease burden. This study analyzes regional gastric cancer DALYs and mortality trends from 1990-2021 using the GBD database. Methods: The regional DALYs and mortality rates per 100,000 individuals aged 70+ from GBD 2021 were analyzed, with trends from 1990 to 2021 evaluated using AAPC, and statistical significance assessed by p-values. Results: In 2021, the greatest Age-standardized DALYs rates were recorded in Andean Latin America, with 3068.04 per 100,000; the lowest was found in High-income North America with 386.08 per 100,000. The most significant increase of DALYs rate from 1990 to 2021 was in Southern Sub-Saharan Africa, (AAPC = -0.3068%; 95% CI: -0.3852 to -0.2234; p < 0.000001), while in Western Europe, the largest decline was noted (AAPC = -2.9999%; 95% CI: -3.0164 to -2.9841; p < 0.000001). Andean Latin America was the region with the highest Age-standardized mortality rates (ASMRs) in 2021, at 207.58 per 100,000 while High-income North America had the lowest at 27.18 per 100,000. In Western Sub-Saharan Africa, the ASMRs were rising with an AAPC of -0.2601% (95% CI: -0.2872 to -0.2368; p < 0.000001), while Western Europe had the highest decline with an AAPC of -2.7658% (95% CI: -2.7895 to -2.7471; p < 0.000001). Conclusions: The global burden of diseases from 1990 to 2021 is regional in nature. In 2021, DALYs and mortality were predominantly high in Andean Latin America and East Asia and notably low in High-income North America. DALYs have risen across Southern Sub-Saharan Africa over three decades, and mortality increased over Western Sub-Saharan Africa, while both declined sharply in Western Europe. These trends underscore the importance of regionalized health solutions. DALY per 100,000. Metric Region 1990 2021 AAPC (1990-2021) HIGHEST DISABILITY-ADJUSTED LIFE YEARS (DALYS) PER 100,000 Andean Latin America 4469.23 3068.04 -1.14 East Asia 5507.72 2958.98 -1.99 High Income Asia Pacific 4849.23 2130.43 -2.71 LOWEST DISABILITY-ADJUSTED LIFE YEARS (DALYS) PER 100,000 High Income North America 758.59 386.09 -2.22 Australasia 1116.91 567.32 -2.16 South Asia 794.81 680.50 -0.46 HIGHEST MORTALITY RATE PER 100,000 Andean Latin America 293.65 207.58 -1.04 East Asia 324.60 188.92 -1.72 High Income Asia Pacific 316.44 161.94 -2.22 LOWEST MORTALITY RATE PER 100,000 High Income North America 51.24 27.19 -2.02 Australasia 74.36 41.81 -1.85 South Asia 47.50 41.95 -0.39

e16074 Background: Gastric cancer is a malignant disease characterized by the uncontrolled growth of cells in the stomach lining. It is a global health concern with regional variation in incidence and prevalence. This study examines the national mortality trends in adults aged 70 years and older from 1990 to 2021. Methods: GBD data was analysed to assess the mortality rates of Gastric cancer in individuals aged ≥ 70 years. The Estimated Annual Percentage Change (EAPC) was used to evaluate trends from 1990 to 2021, with p-values determining statistical significance. Results: From 1990 to 2021, the global prevalence of Gastric cancer increased, peaking in 2021. Japan recorded the highest prevalence (621.7379, UI: 525.93, 675.74), followed by the Republic of Korea and China.In 2021, Bolivia (Plurinational State of) had the highest mortality rate (309.7, CI: 400.9, 240.6), slightly lower than its 1990 rate (445.35, CI: 539.58, 362.14), which was the highest that year. Mongolia (303.15, CI: 378.8, 226.2) and Cabo Verde (265.1, CI: 322.6, 206.8) followed. The lowest mortality rates were observed in Morocco (20.9, CI: 25.9, 15.0), Namibia (20.93, CI: 25.93, 16.4), and Nigeria (23.27, CI: 32.3, 19.2).Countries with the largest EAPC increases included Egypt (0.98, CI: 1.84, -0.22), Honduras (0.31, CI: 0.7, -0.01), and Lesotho (0.16, CI: 0.597, -0.16). The greatest declines were seen in Austria (-0.72, CI: -0.68, -0.74), Czechia (-0.69, CI: -0.64, -0.74), and Hungary (-0.67, CI: -0.607, -0.72). Conclusions: Mortality rates associated with Gastric Cancer among individuals aged 70 and older increased globally from 1990 to 2021, notably in Egypt, Honduras and Lesotho, emphasizing the need for improved prevention, management, and research on underlying disparities. Mortality percent changes. Metric Region 1990 2021 EAPC with 95% CI (1990-2021) HIGHEST MORTALITY PERCENT CHANGE Egypt 30.43 60.44 0.98 (1.84, -0.22) Honduras 140.76 184.48 0.31 (0.7, -0.01) Lesotho 77.18 90.26 0.16 (0.59, -0.16) LOWEST MORTALITY PERCENT CHANGE Austria 177.25 49.48 -0.72 (-0.68, -0.74) Czechia 168.73 51.51 -0.69 (-0.64, -0.74) Hungary 184.88 60.55 -0.67 (0.607, -0.72)