Journal of Diabetes and Metabolic Disorders · Nov 7, 2026
Trends in acute myocardial infarction mortality with diabetes mellitus as a contributing cause of death in the United States, 1999–2025, with forecasts through 2030 and exploratory projections for 2031–2040
By Ibrahim AA, Ramadan Y, Eldeeb A et al.
Background Diabetes mellitus (DM) is a major risk factor for acute myocardial infarction (AMI) and is associated with increased mortality. Despite substantial advances in the management of both conditions, the population-level mortality burden involving AMI as the underlying cause and DM as a contributing cause remains insufficiently characterized. This study aimed to evaluate national trends and disparities in mortality involving AMI as the underlying cause and DM as a contributing cause among U.S. adults aged ≥ 25 years from 1999 to 2025 using CDC WONDER data, forecasts were generated through 2030, with exploratory projections extending through 2040, stratified by DM type, age, sex, and race and ethnicity. Methods A retrospective analysis of U.S. national mortality data from 1999 to 2025 was conducted to identify deaths among adults aged ≥ 25 years in which AMI; ICD-10 code I21 was the underlying cause and DM; ICD-10 codes E10–E14 was a contributing cause. Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) were calculated. Temporal trends were assessed using joinpoint regression to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Time-series methods were used to forecast mortality through 2030, with exploratory projections through 2040 . Results Trend analyses were conducted using observed mortality data from 1999 to 2025, whereas projections extended from 2026 to 2040. A total of 762,802 deaths were attributed to AMI, with DM documented as a contributing cause, among U.S. adults aged ≥ 25 years from 1999 to 2025. Overall mortality significantly declined (AAMR: 18.9 to 9.16; AAPC: -3.05; 95% CI: -3.3 to -2.9; P < 0.001). Males showed higher AAMRs (23.32 in 1999 to 12.72 in 2025) when compared to females (15.74 to 6.2). Older adults aged ≥ 65 years carried the greatest mortality burden, with CMR decreasing from 72.9 in 1999 to 32.4 in 2025. NH Blacks had the highest AAMR (29.95 to 12.68). Forecasts projected a decline in overall AAMR from 8.17 in 2026 to 6.72 in 2030. Exploratory projections suggested a further decline to 3.08 by 2040, although substantial uncertainty surrounded these long-term estimates. The AAMR for deaths involving AMI as the underlying cause and T2DM as a contributing cause increased from 3.34 in 1999 to 4.15 in 2025, whereas the corresponding AAMR for T1DM decreased from 1.90 to 0.23. Conclusion Mortality involving AMI as the underlying cause and DM as a contributing cause has significantly declined and is projected to continue declining through 2040. Disparities among males, NH Blacks and older adults require refined strategies to improve outcomes.