MON-635 - Venous Thromboembolism Mortality Trends and Sociodemographic Disparities in U.S. Adults with Diabetes - A 25 Year Population-Based Analysis (1999-2023)

Background:
Diabetes mellitus promotes a prothrombotic state through endothelial dysfunction, platelet hyperactivity, and impaired fibrinolysis.Although the casual association between diabetes and venous thromboembolism (VTE) remains uncertain, diabetes is associated with worse VTE outcomes and increased mortality. Long-term national trends and sociodemographic disparities in VTE-related mortality among U.S. adults with comorbid diabetes are poorly characterized.

Aim:
To evaluate 25-year mortality trends and demographic, geographic, and urban–rural disparities among U.S. adults with VTE and comorbid diabetes mellitus.

Methods:
We analyzed U.S. mortality data for adults aged ≥45 years from1999–2023 using CDC WONDER Multiple Cause of Death data base. VTE was identified using ICD-10 codes I26, I80, and I82, and with diabetes identified using (E10–E14). Age-adjusted mortality rates (AAMRs) per 1,000,000 population and Joinpoint regression-derived annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals were calculated and stratified by sex, race and ethnicity, geography, and urbanization. American Indian/Alaska Native individuals were excluded due to unreliable estimates. State-level and Urbanization analysis was limited to data through 2020.

Results:
From1999-2023, VTE with comorbid diabetes accounted for 128,114 deaths among U.S. adults aged ≥45 years. Overall AAMR increased from 25.50 in 1999 to 50.30 in 2023 (AAPC 2.85%, p< 0.001). Mortality followed three phases: an increase from 1999–2003 (APC 4.52%, p< 0.001), a relative stability from 2003–2018 (APC 0.57%, p=0.15), and sharp surge from 2018–2021 (APC 22.61%, p< 0.001), followed by a decline between 2021-2023 (APC-9.52%, p< 0.001). Mortality was higher in men than women (AAMR 39.04 vs 32.38), and highest among Black or African American individuals (73.92), followed by Hispanic or Latino (34.63), White (31.87), and Asian/Pacific Islanders (15.47). Mortality was greater in rural than urban areas (38.30 rural vs 31.70 urban) and highest in the Southern United States (35.30), and substantially higher among adults aged ≥65 years than those aged 45–64 years (72.10 vs 14.41).

Conclusion:
VTE-related mortality among U.S. adults with comorbid diabetes nearly doubled over the past 25 years, with a pronounced surge during COVID-19 pandemic years followed by partial decline. Persistent disparities by sex, race and ethnicity, geography, urban–rural status, and age likely reflect differences in comorbidity burden, access to care and healthcare infrastructure rather than intrinsic biological factors. These findings underscore the need for improved risk stratification, guideline-concordant thromboprophylaxis and optimized anticoagulation management in high-risk patients with diabetes.

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