Analysis of Racial and Regional Disparities in Sudden Cardiac Death Related Mortality, Trends in Patients with Type 2 Diabetes Mellitus: 1999-2020.

Abstract

Subnormal glycemic control, as is seen in Type 2 Diabetes Mellitus (T2DM), has been established as a risk factor of sudden cardiac death (SCD) due to the microvascular complications of T2DM affecting the heart's conduction system, instigating arrhythmias. With increasing incidence of SCD in diabetics in the U.S., the racial and rural-urban disparities remain less well-established. This paper examines the difference in mortality trends when stratified by these two demographics.

CDC WONDER database was queried from 1999-2020 to obtain SCD related mortality trends data in diabetics. Age-adjusted mortality rates (AAMR) per 100,000 were obtained using the U.S. population in 2000 as the standard. Joinpoint regression was employed to ascertain differences in interracial trends & rural vs urban cities.

12,545 diabetics suffered from sudden cardiac death in the past 2 decades, with West Virginia (AAMR: 0.37) and Tennessee (AAMR: 0.38) recording the highest rates. Overall AAMR upturned from 1999 (AAMR: 0.14) to 2020 (AAMR: 0.22). Mortality rates were higher in the African Americans (AAMR: 0.21 [0.19,0.22]; AAPC: 2.2 [0.56,4.27]) than Whites: (AAMR: 0.17 [0.16,0.17]; AAPC: 2.3 [1.3,3.78]), AAPC declined for Hispanics (AAPC: -0.62 [-4.7,3.6]). Midwest (AAMR: 0.22 [0.21,0.23]) had the highest rates, followed by South (AAMR: 0.16 [0.16,0.17]), Northeast (AAMR: 0.14 [0.1,0.18]) and West (AAMR: 0.09 [0.09,0.1]). AAMR in rural counties (AAMR: 0.32 [0.31,0.34]; AAPC: 3.6 [2.6,5.2]) was 3.5 times higher than in large metropolitans (AAMR: 0.09 [0.09,0.1]; AAPC: 1.9 [0.8,3.5]).

Racial disparity alongside three-fold higher AAMRs in rural counties require robust mechanisms of healthcare delivery to impoverished regions and entities.