AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Temporal Trends and Demographic Disparities in Mortality Associated with Rheumatic Heart Disease and Diabetes Mellitus in the United States, 1999-2024
By Zainab A, Kalsoom S, Imran Sheikh M et al.
Introduction: Rheumatic heart disease remains an important cause of cardiovascular morbidity and mortality worldwide, particularly among vulnerable populations. Diabetes mellitus is a growing public health burden that accelerates cardiovascular complications through chronic inflammation and metabolic disturbances. The coexistence of rheumatic heart disease and diabetes may further exacerbate disease burden and increase mortality risk; however, population level mortality trends remain poorly characterized. Methods: The national mortality data from CDC Wonder Multiple Cause of Death database 1999-2024 was analyzed. Deaths due to coexisting diabetes mellitus (ICD-10 codes E10-E14) and rheumatic heart disease (ICD-10 code I01, I05-I09) in adults aged 35+ years were identified. Crude and age adjusted mortality rates (AAMR) per 100,000 population were calculated. Temporal trends were assessed using joinpoint regression for average annual percent change (AAPC) and annual percent change (APC) and stratified demographic analysis was done. Results: A total of 19,210 deaths associated with coexisting rheumatic heart disease and diabetes mellitus were identified. The mortality rate increased over the study period with an overall AAPC of 0.89% (95% CI, –0.07 to 1.86; p=0.07). Mortality declined significantly from 1999 to 2017 (APC –1.40%; 95% CI –1.78 to –1.02), followed by a sharp significant increase from 2017 to 2021 (APC 12.38%; 95% CI 6.70 to 18.37) and a more gradual rise thereafter. Females accounted for 63.1% of deaths with a higher mortality burden (AAPC 0.44%). However, a steeper annual rise in mortality was seen in the male population (AAPC 2.23%). Individuals aged ≥75 years experienced the highest mortality burden and the greatest increase over time (AAPC 2.31%). Among racial and ethnic groups, Hispanic individuals had the highest mortality rate (AAPC 0.22%), while Black individuals experienced the greatest increase in mortality (AAPC 1.86%, p: 0.03). Regionally, highest mortality rates were observed in the West region (AAPC 1.46%, p: 0.006) and state of Minnesota (AAMR 1.21). Mortality was higher in rural than urban areas (AAPC rural 0.08%, urban 0.16%), and most deaths occurred in inpatient facilities (43.5%). Conclusion: Mortality associated with concomitant rheumatic heart disease and diabetes mellitus disproportionately affected females, Hispanic individuals, residents of the Western United States, and rural populations. These disparities highlight the need for earlier identification of high-risk individuals, optimized diabetes control, and comprehensive cardiovascular care to improve outcomes and reduce preventable deaths.