Citations

Background: Coronary heart disease (CHD) remains the leading cause of death in the United States, yet the benefits of modern cardiovascular care are not equitably distributed. Social determinants of health (SDoH), which includes economic stability, education, healthcare access, and neighborhood environment, may substantially shape outcomes among patients with CHD. Our study evaluates the joint association of SDoH burden and CHD with mortality outcomes. Methods: We analyzed adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2000–2018, linked with the National Death Index through 2018. Cumulative SDoH burden was derived from eight domains (employment, poverty-to-income ratio, food insecurity, education, healthcare access, insurance, housing, marital status), categorized as low (0–2), moderate (3–5), or high (6–8). Weighted Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality by SDoH burden, stratified by CHD status, with sequential adjustment for demographic and cardiometabolic factors. Results: Among 49.3 million U.S. adults (mean age 46.1 ± 15.6 years; 44.8% female), 3.7% had CHD. Those with CHD were older (64.7 vs 45.4 years, p < 0.001), more often non-Hispanic White (94.2% vs 81.5%), and had greater waist circumference (106.1 vs 87.5 cm) but lower cholesterol (176 vs 202 mg/dL, p < 0.001). Participants with high SDoH burden had lower income and education. In weighted regression, higher SDoH burden and CHD were independently associated with greater all-cause and cardiovascular mortality. Fully adjusted models showed high SDoH burden tripled all-cause mortality risk (HR 3.00, p < 0.001), while CHD further amplified risk. Compared with low SDoH/no CHD, those with CHD and high SDoH burden had nearly a 14-fold higher all-cause mortality (HR 13.6, p < 0.001) and 17-fold higher cardiovascular mortality (HR 17.7, p < 0.001). Findings were consistent across sex, race, and metabolic subgroups, with mortality hazards often exceeding tenfold among those with both CHD and high SDoH burden. Conclusions: Cumulative SDoH burden is strongly and independently associated with mortality among adults with CHD, with evidence of a synergistic effect between biological and social vulnerability. These findings underscore the need for policies and interventions addressing upstream social inequities to improve survival in cardiovascular populations.

Abstract Background Valvular heart disease (VHD) and atrial fibrillation (AF) frequently coexist, presenting complex clinical challenges despite advances in diagnostics and therapeutics. Together, they contribute substantially to cardiovascular mortality. However, epidemiological patterns vary across demographics and regions Methods Mortality data from 1999–2023 were obtained from the CDC WONDER database. Deaths attributed to VHD (ICD-10: I30-I52) with co-diagnosed AF (ICD-10: I48) among adults ≥ 45 were included. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Autoregressive integrated moving average (ARIMA) models were used to project mortality trends through 2035. Results From 1999 to 2023, there were 172,511 VHD and Afib-related deaths in adults ≥ 45. AAMRs increased until 2021, followed by a slight decline to 8.86. The overall AAPC for VHD with AF was 4.01%. AAMR increase was consistent across all age groups, highest seen in 65 + individuals. Males had consistently higher AAMRs than females. AAPC for males was 4.44% and for females 3.52%. Non- Hispanic White had the highest AAMR (10.56 in 2021), followed by Hispanics (4.19). Regionally, the West had the highest AAMR (11.27), followed by Mid-West (9.94). Non-metropolitan areas had higher AAMR 8.96 compared to metropolitan areas (AAMR: 7.59). Most VHD related deaths were reported in inpatient settings (n = 396,451) and 12% involved co-diagnosed AF. Conclusion Mortality associated with VHD and AF in the U.S population aged ≥ 45 has shown a concerning increase. Predictive models indicate this trend may persist, highlighting the need for early detection, equitable healthcare access and public health interventions tailored to high-risk populations.

Abstract Disclosure: H. Ahmad: None. M. Kakakhel: None. A. Ullah: None. M. Saeed: None. J. Ikram: None. A. Qadeer: None. M. Khawar: None. H. Jawad: None. S. Haider: None. R. Haider: None. F. Ahmed: None. R.W. Kirchoff: None. Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by the destruction of insulin-producing cells in the pancreas. It is a global health concern with regional variation in incidence and prevalence. This study aims to analyze the regional incidence and prevalence of T1DM among adolescents and young adults (15-39 years) from 1990 to 2021 in 26 regions. Methods: Global Burden of Disease (GBD) data for 2021 were analyzed to assess regional incidence and prevalence of T1DM among adolescents and young adults. The Annual Average Percentage Change (AAPC) was calculated to evaluate trends from 1990 to 2021, with statistical significance determined using p-values. Results: In 2021, middle socio-demographic index (SDI) has the highest incidence (54541) as well as prevalence (1.86 million), followed by Low-middle SDI (I: 48416, P: 1.80 million) and South Asia (I: 46310, P: 1.73 million). Oceania has the lowest incidence (356) as well as prevalence (12885), followed by Andean Latin America (I: 911, P: 31954) and Caribbean regions (I: 1214, P: 54610), respectively. The largest increase in AAPC of incidence was showed by Southern Latin America (2.23, CI: 2.11-2.30), High-income Asia Pacific (2.22, CI: 2.18-2.26), and Western Europe (1.80, CI: 1.73-1.84) regions, while Western Europe (1.72, CI: 1.66-1.75), Eastern Europe (1.64, CI: 1.63-1.66), and Australasia (1.38, CI: 1.36-1.40) showed largest increase in AAPC of prevalence. The Caribbean region had the greatest decline in AAPC of prevalence (-0.11, CI: -0.08 to -0.12) followed by Eastern Sub-Saharan Africa (-0.07, CI: -0.06 to -0.09) and Central Latin America (-0.04, CI: -0.02 to -0.07). There was no region with decline in incidence. All AAPC values were statistically significant (p &lt; 0.000001). Conclusion: Middle SDI region exhibited the highest incidence and prevalence, highlighting the vulnerability of these populations, while Oceania and Andean Latin America bore the least burden. Notably, several regions, particularly in Europe, experienced substantial increases in both incidence and prevalence, emphasizing the need for targeted interventions. Conversely, some regions, such as the Caribbean, showed encouraging declines in prevalence, suggesting that effective prevention and control strategies can be implemented. These findings underscore the importance of tailored approaches to address the evolving burden of T1DM. Presentation: Saturday, July 12, 2025

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 &lt; 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 &lt; 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 &lt; 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 &lt; 0.000001), followed by a strong positive trend from 2019-2022 (APC = 6.61%, p &lt; 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. S. Fatima: None. H. Ahmad: None. A. Ibrahim: None. W. Rahman: None. R. Haider: None. H. Jawad: None. A. Qadeer: None. M. Khawar: None. F. Ahmed: None. J. Ikram: None. R. Kirchoff: None. Background: Across the world, type 1 diabetes mellitus (T1DM) is a major health problem for teenagers and young people. This study aims to examine the incidence and prevalence of T1DM by gender in the 15-39 age range between 1990 and 2021. Methods: We analyzed data from the Global Burden of Disease (GBD) to evaluate incidence and prevalence rates of T1DM in each gender from 1990 to 2021. The Annual Percentage Change (APC) and The Annual Average Percentage Change (AAPC) was used to assess trends, with p-values determining the statistical significance. Results: From 1990 to 2021, the global prevalence of T1DM was found to be increased steadily for both genders, with the highest rates recorded in 2021: 247.32 per 100,000 for females and 246.47 per 100,000 for males. Incidence rates in 2021 showed a contrasting pattern, with males exhibiting higher rates (7.18 per 100,000) compared to females (5.98 per 100,000). AAPC analysis showed that males exhibit a faster rise in both prevalence and incidence compared to females over the study period. The difference in AAPC between males and females is more pronounced for prevalence (+0.3748%) compared to incidence (+0.1956%), with all AAPC values being statistically significant (p &lt; 0.000001). Following the APC analysis, other significant trends were revealed. Male incidence experienced the greatest increase during 2015-2021, with an APC of +1.9033% (p &lt; 0.000001), whereas female incidence increased most between 2011 and 2014 (APC = +1.3050%; p &lt; 0.000001). In contrast, the most significant decline in incidence was observed in females during 1990-1992, with an APC of +0.1665% (p = 0.006799), which was the lowest increase in the dataset. For prevalence, males exhibited the highest increase during 2015-2021, with an APC of +1.3938% (p &lt; 0.000001), whereas females had their peak increase during 2006-2009, with an APC of +0.8957% (p &lt; 0.000001). The slowest increase in prevalence for females occurred during 2014-2019, with an APC of +0.4591% (p &lt; 0.000001). Conclusion: The prevalence and incidence of T1DM among people aged 15-39 increased significantly between 1990 and 2021, with a greater increase in males. This highlights the need for gender-specific strategies in T1DM prevention and management, and research into the factors driving these disparities. Presentation: Sunday, July 13, 2025

Abstract Disclosure: M. Kakakhel: None. S. Fatima: None. H. Ahmad: None. M. Khan: None. A. Rai: None. A. Qadeer: None. R. Haider: None. M. Khawar: None. U. Habib: None. H. Jawad: None. J. Ikram: None. F. Ahmed: None. R. Kirchoff: None. Introduction: Type 1 Diabetes Mellitus (T1DM) is a disease that affects people all over the world. This condition causes significant morbidity, as measured by Disability-Adjusted Life Years (DALYs) and mortality rates, and its severity varies worldwide. The purpose of this study is to examine trends in T1DM-related death rates and DALYs across 26 geographical areas from 1990 to 2021 in order to provide a current picture of the disease's consequences and identify regional differences. Methods: This study examined DALYs and mortality rates per 100,000 people in individuals aged 15-39 years using data from the Global Burden of Disease Study from 1990 to 2021. Trends were assessed using the Average Annual Percentage Change (AAPC), with p-values used to define statistical significance. The study examined 26 regions with varied socioeconomic development indices (SDI). Using confidence intervals to account for data uncertainty, DALYs and mortality were examined to investigate the disease burden across time. Results: In 1990, the Middle SDI region had the highest DALYs at 298,352 (95% CI: 256,144 -349,670), which reached 382,857 (95% CI: 213,704-317,664) by 2021 (AAPC = 0.15, P-value &lt; 0.000001). The region with the highest DALYs in 2021 was the Low-Middle SDI, with 419,772 (95% CI: 344,307- 495,496) cases (AAPC = -2.93, P-value = &lt;0.000001). From 1990 to 2021, Oceania consistently had the lowest DALYs of 1,895 (95% CI: 1,264-2,577) and 4,210(95% CI: 3,011-5,724), respectively (AAPC= 0.15, P-value = 0.0004). Mortality rates in 1990 were highest in the Middle SDI area with 3,758 deaths (95% CI: 3,343-4,332) (AAPC= -1.23, P-value = &lt;0.000001), but by 2021, South Asia had the highest mortality rate at 5,189(95% CI: 4,272-6,087) (AAPC= -0.49). Oceania had the lowest mortality rate of 25 deaths (95% CI 145-35) (AAPC = 0.193, P-value = &lt;0.0004) in 1990, whereas Australasia had the lowest mortality rate of 28 deaths (95% CI 26-29) in 2021 (AAPC = -0.93, P-value = &lt;0.000001). Conclusion: From 1990 to 2021, the global burden of type 1 diabetes—as indicated by DALYs and death rates—underwent a substantial shift, with significant rises in several regions. DALYs were highest in the Middle SDI region in 1990 but have migrated to the Low-Middle SDI region by 2021, reflecting shifting healthcare issues and demographics. Mortality rates followed a similar pattern, with South Asia and the Low-Middle SDI regions experiencing the highest rates in 2021. Over both time periods, however, Oceania and Australasia consistently had the lowest DALYs and death rates. These findings emphasise the critical need for targeted interventions in high-burden areas. Addressing these differences is crucial for decreasing the global burden of T1DM. Presentation: Sunday, July 13, 2025

Abstract Disclosure: H. Ahmad: None. S. Fatima: None. M. Kakakhel: None. I. khan: None. A. Raza: None. Z. Khan: None. R. Haider: None. A. Qadeer: None. M. Khawar: None. F. Ullah: None. H. Jawad: None. J. Ikram: None. F. Ahmed: None. R.W. Kirchoff: None. Background: Type 1 diabetes mellitus (T1DM) is an autoimmune condition, characterized by the destruction of pancreatic beta cells, resulting in lifelong dependency on insulin. It is a significant health burden in adolescents and young adults, with long-term complications affecting quality of life and survival. We aim to explore sex-stratified trends in mortality and disability-adjusted life years (DALYs) due to T1DM from 1990 to 2021. Methods: We obtained sex-stratified data for adolescents and young adults (15-39 years) with T1DM from the Global Burden of Disease (GBD) from 1990 to 2021. The mortality rates were age-standardized and expressed per 100,000 deaths. Trends were analyzed as annual percentage change (APC) and average APC (AAPC) using Joinpoint Regression. Results: From 1990 to 2021, deaths due to T1DM in adolescent and young adult males increased globally from 7,123 to 9,244 per annum, with age-standardized mortality rates (ASMRs) decreasing from 0.64 to 0.61 and standardized DALYs rising from 49.56 to 51. In females, deaths rose from 6,160 to 6,892, with ASMRs declining from 0.57 to 0.47 and DALYs declining from 47.12 to 43.11. Despite the apparent rise in deaths, ASMRs exhibited a significant decline in both sexes, with an AAPC of -0.16% (95% CI: -0.20 to -0.12) in males and -0.62% (-0.68 to -0.55) in females, four times that of in males. The DALYs showed a significant decline in females with an AAPC of -0.31% (-0.35 to -0.26) but a significant increase in males with an AAPC of 0.09% (0.04 to 0.12). Males showed the greatest APC increase in ASMRs of 1.34% from 1990 to 1994, while females showed the greatest APC increase of 0.45% from 1990 to 2000, three times less and over twice the period seen in males. This was followed by the greatest APC decline of -1.14% in females from 2001 to 2011, and a non-significant decline of -0.14% till 2021. Males experienced the greatest decline of -1.14% from 2000 to 2013. It then increased significantly from 2013 to 2018 (APC: 0.73%), followed by a significant decline of -0.62% till 2021, almost four times that in females. DALYs showed a similar trend in females with the greatest increase of 0.45% from 1990 to 2000, followed by the greatest decrease of -1.14% till 2011, and then a non-significant decline of -0.14 till 2021. Males showed the greatest increase of 1.24% from 1990 to 1994 and the greatest decrease of 0.63% from 2000 to 2013, followed by a much smaller decline. Conclusion: Although ASMRs declined, the recent decline in ASMRs in females is becoming less pronounced highlighting the importance of ongoing monitoring and improvement strategies. The disparity in DALYs between males and females also demands the need for targeted interventions addressing male-specific challenges to reduce the burden of T1DM. Presentation: Sunday, July 13, 2025

Abstract Disclosure: M. Kakakhel: None. M. Hussein: None. S. Fatima: None. F. Arshad: None. D. Rizwan: None. A. Qadeer: None. M. Khawar: None. R. Haider: None. S. Batool: None. H. Jawad: None. N.U. saleem: None. H. Ahmad: None. F. Ahmed: None. R. Kirchoff: None. R. Kirchoff: None. Background: With a global prevalence of 586,000 cases of thyroid cancer, thyroid cancer is the 10th most common malignancy. Despite advancements in early detection and treatment, the incidence of thyroid cancer continues to increase in the United States. This study aims to assess disparities in mortality trends stratified by age, sex, race, geography, urbanization status, and location of death, to guide clinical decision making. Methodology: Mortality data on thyroid cancer were extracted from the CDC-WONDER database, from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 were stratified by age, sex, race, geography, urbanization status, and place of death. Joinpoint regression software was used to determine annual percent change (APC) and average APC. Results: From 1999 to 2020, a total of 46,777 deaths attributed to thyroid cancer occurred in the United States, among individuals aged ≥ 25 years. The overall AAMRs showed a positive trend, increasing from 0.6 per 100,000 (95% CI: 0.5-0.6) in 1999, to 0.7 (95% CI: 0.7 - 0.7) in 2020. 56.63% of those deaths, or 26,493 deaths, occurred in women. When stratified by age group, the 85+ age group had the highest CMR of 9 (95% CI: 8.3-9.7). The racial group with the highest AAMRs were Whites, with an AAMR of 0.7 per 100,000. Mortalities in the South region accounted for 33.5% of total deaths. Moreover, metro areas also had higher mortality rates than non-metro areas. Information regarding place of death was only available for 8242 deaths, with 2763 of them occurring in medical settings. Conclusion: Mortality rates in all population groups increased from 1999 to 2020, with variations in mortality rates noted among them. Risk stratification of high-risk groups, such as older people and women, and targeted interventions are key for addressing disparities in mortality rates. Presentation: Saturday, July 12, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. R. Haider: None. M.H. Alsaadi: None. M. Ikram: None. W. Ftih: None. H. Jawad: None. M.U. Rehman: None. R. Akhtar: None. A. Qadeer: None. M. Khawar: None. A. Ullah: None. H. Ahmad: None. F. Ahmed: None. R. Alcaraz: None. Introduction: Conditions that disrupt the adrenal glands' typical function are known as adrenal gland ailments or diseases. This study examines the distribution of adrenal disorders 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 and resource allocation. Methods: From 1999 to 2020, mortality statistics for adrenal diseases were extracted from the CDC-WONDER database. Age, sex, race, location, urbanization status, and place of death were used to stratify the age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000. We calculated the average annual percentage change (APC) using Joinpoint regression software. Results: A total of 31,028 fatalities were reported due to adrenal disorders from 1999-2020 (AAPC: 1.277; 95% CI, -0.032 to 2.6032, p=0.055916). An initial rising trend was observed from 1999-2003 (APC: 2.4799), followed by a declining trend from 2003-2013 (APC: -3.0094), then a modest rise from 2013-2018 (APC: -0.9188), and finally a sharp increase from 2018-2020 (APC: 2.9445). Males had a higher AAMR (6.8) than females (6.4). The West census region had the highest AAMR (7.2), followed by the Midwest (7.1), South (6.3), and Northeast (5.6). The highest crude mortality rate was observed in individuals aged 85+ years (52.2). Several disparities were noted when stratified by urbanization and race, including the highest AAMR in Non Core (Nonmetro) regions (7.9) and among American Indian or Alaska Native populations (8.2). The highest percentage of deaths occurred in medical facilities. Conclusions: The findings underscore the need for tailored public health strategies to address disparities in adrenal disorders among vulnerable populations. Specific attention should be directed towards the male gender, West census region, American Indian or Alaska Native populations, and the geriatric population. Future research should explore underlying causes and interventions to mitigate these disparities. Presentation: Monday, July 14, 2025

Abstract Disclosure: M. Kakakhel: None. S. Cheema: None. S. Fatima: None. R. Noor: None. H. Javaid: None. P.K. Singh: None. H. Jawad: None. R. Haider: None. A. Qadeer: None. M. Khawar: None. T. Ashraf: None. F. Naveed: None. H. Ahmad: None. F. Ahmed: None. R. Kirchoff: None. Introduction: The health of a nation is often a reflection of the equity within its systems. Yet, when we examine the United States, one of the most developed nations globally, a concerning picture emerges in the realm of public health significant racial and ethnic disparities in disease outcomes. Among these, endocrine- related mortality, which includes conditions like diabetes, thyroid disorders, and hormonal imbalances, stands as a silent yet significant contributor to health inequities. Using data from the CDC WONDER database, this study seeks to explore these trends in depth, not just to identify the gaps but to shed light on the lived experiences of marginalized communities who bear the brunt of these inequities to pave the way for more equitable healthcare interventions. Methods: This descriptive study analyzes Racial and Ethnic Disparities in Endocrine-Related Mortality in the United States from 1999-2022, utilizing data from CDC Wonder database. We searched the Center for Disease Control database from 1999 to 2022 for mortality statistics with an underlying cause of death. The age-adjusted mortality rate (AAMR) was calculated per 1,000,000 deaths. We evaluated the AAMR using demographic variables such as race/ethnicity, geographic density, gender, age (25 or above), place of death, and the US Census Region. Temporal trends were assessed using Joinpoint regression software. Mortality rates by age, demographics, and place of death were examined. Statistical analysis calculated endocrine-related mortality rates and trends, with findings deemed significant at P &lt; 0. 05. Results: Between the years 1999 to 2022, 837203 deaths were recorded to be caused by endocrine-related disorders. An overall rising mortality trend from 1999-2022 among all races and ethnicities is noted, except in Asian or Pacific Islander, Black or African American, and Hispanic patients, which shows a rise till 2020 followed by fall in age-adjusted mortality rates (AAMR) in 2022. A significant dip in mortality rate was seen in 2017 in all racial and ethnic groups. American Indian or Alaska Natives showed highest AAMR (181.87, 95% CI 178.06-185.69) followed by Black or African Americans (149.78, 95% CI 148.9-150.64), Hispanic or Latinos (112.33, 95% CI 111.59-113.07), Whites (94.31, 95% CI 66.6-68.25), Asian or Pacific Islanders (67.45, 95% CI 66.6-68.25). American Indians or Alaska Natives exhibit the steepest rise over time (APC -0.32 TO 8.85) from 1999-2022. Conclusions: Mortality due to endocrine-related disorders has dramatically increased over time. Significant disparities have been noted among different races and ethnic groups, with the highest rate among Americans and the lowest among Asians. This underscores the need for targeted interventions for specific racial groups to reduce the mortality burden of endocrine-related diseases. Presentation: Sunday, July 13, 2025