Alcaraz, Renato

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. R. Noor: None. S. N.l: None. S.M. Irshad: None. A. Ullah: None. H. Jawad: None. A. Nawaz: None. M. Khawar: None. A. Qadeer: None. H. Ahmad: None. R. Alcaraz: None. F. Ahmed: None. Background: Bone density and structure-related disorders, such as osteoporosis and related fractures, significantly contribute to morbidity and mortality, particularly among aging populations. Monitoring temporal trends and geographic variations in mortality is essential to inform targeted public health interventions. In this study, we aimed to examine temporal and geographic variations in mortality associated with bone density and structure-related disorders in the United States from 1999 to 2022. Methods: Using ICD-10 codes M80-M85, this retrospective ecological study utilized mortality data extracted from the CDC WONDER database for the years 1999-2022. Age-adjusted mortality rates (AAMRs) were calculated and stratified by demographic variables (age, sex, and race/ethnicity) and geographic regions. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs). Geographic variations were visualized using choropleth maps, and subgroup analyses were performed to explore disparities. Statistical significance was set at p < 0.05. Results: Age-adjusted mortality rates (AAMRs) for bone density and structure-related disorders decreased overall from 1999 to 2019, with a subsequent rise observed in 2020 and 2022. Joinpoint regression revealed a significant negative trend from 2007-2016 (APC = -7.46%, p < 0.000001), followed by a positive reversal from 2019-2022 (APC = 3.78%, p = 0.013). Both males and females experienced declines in mortality, but females had a slightly higher APC of -3.10% compared to -2.82% for males. Asian/Pacific Islander groups exhibited the most pronounced decrease in mortality (APC = -11.92%, p < 0.000001) from 2009-2015, with a positive rebound in recent years. Black or African American populations had the smallest decline (APC = -1.35%). The Southern U.S. experienced the steepest decline in mortality from 2010-2016 (APC = -10.92%, p < 0.000001), followed by a strong positive trend from 2019-2022 (APC = 6.61%, p < 0.000001). Conversely, the West and Northeast regions showed milder trends with less pronounced reversals. Older age groups (65-74, 75-84) showed significant decreases in mortality, particularly the 65-74 group, which reversed to a positive trend (APC = 6.97%) from 2019-2022. The highest number of deaths occurred at the decedent’s home (3,330 in 2022). Subgroup analyses indicated significant temporal shifts in the mortality patterns across different racial/ethnic groups and geographic regions. Hispanic/Latino and Asian/Pacific Islander populations exhibited an increase in mortality rates post-2019, particularly in 2020. Conclusion: From 1999 to 2022, mortality from bone density and structure-related disorders in the U.S. exhibited significant temporal and geographic variations. These findings highlight the need for targeted public health strategies. Presentation: Monday, July 14, 2025

Abstract Disclosure: M. Kakakhel: None. R. Haider: None. S. Cheema: None. S.M. Irshad: None. M.U. Hussain: None. A. Ullah: None. A.Z. Khan: None. F. Naveed: None. H. Jawad: None. F. Naveed: None. M.F. Hemida: None. A. Qadeer: None. M. Khawar: None. H. Ahmad: None. F. Ahmed: None. R.W. Kirchoff: None. R. Alcaraz: None. Background: Hypertension has been a significant cause of morbidity and mortality for ages. Coupled with endocrine disorders, it poses a greater risk of indisposition to the U.S population. This CDC wonder analysis explores the trends and patterns of these disorders, stratified by states and rural/urban. Methods: To attain this objective, this retrospective study has utilized data from the Center for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to assess endocrine disorder-related mortality rates in the pediatric population from 1999 to 2011. Average Annual Percentage Change (AAPC) and Annual Percent Change (APC) were used to evaluate trends and produce age-adjusted mortality rates (AAMRs) per 100,000 people. Data was stratified by year, sex, race/ethnicity, state-wise and geographical regions. Statistical significance and confidence intervals were used to assess the reliability of the observed trends. Results: Between 1999 and 2020, 2383332 deaths in the United States were attributed to endocrine-related mortality with underlying hypertension. The Overall AAMR initially rose steeply from 10.7 in 1999 to 24.9 in 2001 (APC: 34.3; 95% CI: 9.5 to 56.7), followed by a period of further steady increase in AAMR till 36.5 in 2018 (APC: 1.6; 95% CI: 0.6 to 2.1). This progressive increase in AAMR then sharply spiked from 2018 onwards, reaching 51.7 in 2020 (APC: 18.1*; 95% CI: 9.3 to 23.5). Notable discrepancies were observed in urbanization. Non-metropolitan areas showed a higher AAMR (35.5) than metropolitan (31.5). State-level analysis revealed substantial heterogeneity, including Mississippi as the state of the highest AAMR (58.6). Conclusion: The concerning rise of AAMR in non-metropolitan areas and Mississippi calls for more targeted health-care policies. These findings underscore the need for geographically tailored public health interventions to address disparities in endocrine disorder-related mortality in these groups. Presentation: Monday, July 14, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. M. Filal: None. A. Ullah: None. M.U. Hussain: None. M.A. Sadiq: None. T. Asghar: None. F. Arshad: None. N.K. Binashikhbubkr: None. H. Jawad: None. A. Abdullah: None. M. Qadri: None. A. Qadeer: None. M. Khawar: None. H. Ahmad: None. F. Ahmed: None. R. Alcaraz: None. Background: Hypertension is a major global health issue, affecting nearly half of U.S. adults. It is a leading risk factor for cardiovascular diseases like stroke, heart attack, and heart failure. Additionally, it is often linked to endocrine disorders, which can result in secondary hypertension. Endocrine disorders contributed to a concerning 2,383,332 deaths in the United States between 1999 and 2020, with many of these individuals having underlying hypertension. Methods: Death certificate data for adults aged 25 and older were obtained from the CDC-WONDER database. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 individuals were computed. Temporal trends were analyzed by calculating the annual percent change (APC) and the average annual percent change (AAPC) in the rates using Joinpoint regression analysis. Results: The age-adjusted mortality rate (AAMR) rose sharply from 10.7 (95% CI:10.6-10.9) in 1999 to 24.9 (95% CI: 9.5 to 56.7) in 2001, then continued to increase steadily to 36.5 (95% CI: 0.6 to 2.1) by 2018. From 2018 onwards, the rate spiked significantly, reaching 51.7 (95% CI: 9.3 to 23.5) in 2020, which coincided with the COVID-19 pandemic. Men had higher overall AAMR i.e. 36.6 as compared to women 28.4 during the span of this study. Stratifying by race, Non-Hispanic Blacks or African Americans had the highest overall age-adjusted mortality rate at 64.4 vs non-Hispanic whites, who had the lowest rate at 27.6. Southern states exhibited the highest mortality rates among the census region followed by the Western, Midwestern, and Northeastern regions. In contrast, the Annual Mortality Rates (AAMRs) displayed similar patterns across all regions. Regarding age, people aged 85 and above had the highest mortality rate among all the age groups while ages 25-34 had the lowest. Conclusion: Endocrine disorders associated with underlying hypertension showed an increasing trend throughout the study period, peaking during the COVID-19 pandemic. These findings account for immediate targeted interventions directed at the most vulnerable demographic and geographical groups Presentation: Monday, July 14, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. F. Saleem: None. A. Ullah: None. M. Shah: None. A. Qadeer: None. M. Khawar: None. H. Jawad: None. H. Ahmad: None. F. Ahmed: None. S. N.l.: None. R. Alcaraz: None. Background: Diabetes mellitus (DM) is a global health burden, contributing significantly to mortality and comorbidities, including chronic kidney disease (CKD), which remains a leading cause of morbidity and mortality, especially in type 1 and type 2 diabetes. Methods: This retrospective cohort study examined mortality data from the United States from the CDC WONDER database, which gathers data from death certificates. Particularly, deaths from renal problems (ICD-10 codes E10.2-E14.2) linked to diabetes were the emphasis. Sex, age, race/ethnicity, and geographic location were among the important demographic factors that were used to stratify the data for the analysis. Temporal trends were examined using linear regression, while geographic disparities were assessed through chi-square tests and regression analysis. A significance level of p<0.05 was used for all tests. Results: According to the data, the death rate from diabetes increased significantly between 1999 and 2020. Between 1999 and 2020, the number of deaths from diabetes rose from 2,325 to 74,296. From 13.12 per 100,000 in 1999 to 276.92 per 100,000 in 2020, the age-adjusted death rate increased significantly, indicating a fivefold rise in mortality rates over the 21 years. After 2010, the pace of increase became especially steep, with notable yearly increases, especially in the years after 2013. In the Hispanic population alone, the number of deaths from diabetes more than quadrupled between 2013 and 2020, rising from 5,378 in 2013 to 10,395 in 2020. Male mortality rates were consistently greater than female death rates, indicating gender-based inequities as well. By 2020, there were 41,225 male deaths from diabetes (AAMR: 351.07). Notably, the death rate for men was almost 60% greater than that for women in 2020, with rates rising more sharply for men, particularly from 2010 onward. Significant differences in diabetes-related mortality were also observed by geography. Florida, Texas, and California had the largest mortality burdens; in California alone, 73,185 deaths, or 13.8% of all deaths, occurred. Lastly, more deaths were found to occur in medical facilities, especially inpatient settings, as well as at home or in hospice care, indicating a change in the place of death. Conclusions: The study shows a significant rise in diabetes-related mortality in the US over the past two decades, with males experiencing a higher mortality rate. Geographic disparities are also evident, with Southern states and large states like California, Texas, and Florida contributing disproportionately. The shift in death places suggests increased reliance on medical facilities, home care, and hospice care. The study calls for targeted public health interventions to address the growing burden of diabetes-related mortality, particularly in high-risk regions. Presentation: Sunday, July 13, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. F. Saleem: None. M.H. Alsaadi: None. H. Jawad: None. A.Z. Khan: None. A. Qadeer: None. M. Khawar: None. A. Ullah: None. M.F. Hemida: None. H. Ahmad: None. F. Ahmed: None. R. Alcaraz: None. Background: Globally, pediatric endocrine anomalies are a significant cause of early mortality. This study examines the discrepancies of paediatric endocrine abnormalities across various demographic and geographic groups in the United States, including gender, census region, race, age groups, and urbanization levels. Our objective was to identify disparities and trends to inform targeted interventions for the vulnerable demographics. Methods: Adhering to STROBES criteria, we extracted the mortality statistics due to endocrine disorders in the paediatric population from 1999-2020 from the Centre for Disease Control and Prevention-Wide Ranging Online Data for Epidemiologic research (CDC-WONDER). We calculated Age-Adjusted mortality rates (AAMRs) per 100,000 individuals. We calculated the Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) to assess trends stratified by age, gender, urbanization, race, census region, and states. Joinpoint regression model was used for analysis. Results: Between 1999 and 2020, 5161 deaths among children less than 1 year to 14 years of age in the United States were related to endocrine-related disorders. Most occurred due to thyroid disorders, diabetes mellitus, and other miscellaneous disorders related to glucose regulation and pancreatic internal secretion. The overall AAPC for endocrine-related mortality in the pediatric population increased from 1.4866 in 2008 to 2.4982 in 2020, with an AAPC of 0.1346 (95% CI: -3.1216 to -3.5003, p > 0.000001). The male population had higher AAPCs than the female population (women: -0.9938; men: 0.7223). There were notable racial differences: The Hispanic or Latino population had the highest AAPC (0.15), followed by the Black population (-0.195) and then the White population with the lowest AAPC (-0.166). According to the age group stratification, the age group with the highest AAPC was the 5-14 age group (2.03) and the lowest the less than 1 year age group, with AAPC (-2.007). There was a significant decrease in deaths in the less than 1 year age group from 1999 to 2020 (p value < 0.05) with APC (-2.0) (95% CI: -3.0191 to -0.9861) and for the 5-14 age group from 2010 to 2020 with APC (10.8861) (95% CI: 3.4843 to 18.8). Depending on the urban-rural categorization, metro areas had a higher AAPC (0.1508) compared to the non-metro areas with an AAPC (-0.4467). Conclusion: The overall decline in endocrine-related deaths in the pediatric population from 1999 to 2020 hails an improvement in efforts made to manage these disorders. However, the recent uptick in the Hispanic-Latino population emphasizes the necessity for targeted efforts to tackle these disparities and improve the health outcomes of affected communities as well as in children 1-4 years of age, depicting the increased vulnerability and need for added care in this age group. Presentation: Saturday, July 12, 2025