ORF33-01 - National Trends, Outcomes, and Resource Utilization in Acute Myocardial Infarction-Related Hospitalizations Among Adults with Type 1 Diabetes: A National Inpatient Sample Study

Background: Type 1 diabetes mellitus (T1DM) confers high lifetime atherosclerotic cardiovascular disease (ASCVD) risk, yet contemporary national trends in acute myocardial infarction (AMI) admissions among hospitalized adults with T1DM remain incompletely characterized.

Methods: We performed a serial cross-sectional study using the National Inpatient Sample (2016–2023). Adult hospitalizations with T1DM were identified using ICD-10-CM codes; AMI-related admissions were defined by a principal AMI diagnosis. Survey weights and complex sampling methods generated national estimates. We evaluated temporal trends in AMI counts, rates per 1,000 T1DM admissions and per 100,000 adult hospitalizations, patient and hospital characteristics, in-hospital mortality, length of stay (LOS), and inflation-adjusted total charges. Multivariable regression models assessed adjusted trends and disparities.

Results: National AMI admissions among adults with T1DM increased from 11,395 (2016) to 19,070 (2023), representing a 67% increase. AMI frequency rose from 32.6 to 49.8 per 1,000 T1DM admissions (+53%) and from approximately 37.7 to 66.2 per 100,000 adult hospitalizations (+75%). Mean age remained stable at 58–59 years. Sex distribution was unchanged (~51–54% male). Admissions increasingly involved patients from the lowest ZIP-code income quartile (28.8% to 32.0%, p=0.006) and urban teaching hospitals (69% to 80%, p< 0.001). Comorbidity burden remained high with significant increase (mean Charlson index 4.8 to 5.1, p< 0.001). In-hospital mortality exhibited a U-shaped pattern: decreasing from 7.13% (2016) to a nadir of 5.73% (2019), peaking at 8.52% during the COVID-19 pandemic (2021), then returning near baseline in 2022–2023 (7.10–7.29%). After adjustment for demographics, Hispanic patients experienced 48% higher odds of in-hospital mortality compared to White patients (OR 1.48, 95% CI 1.21–1.81, p< 0.001). Mean LOS increased from 6.8 to 7.4 days (p < 0.001). Inflation-adjusted charges rose substantially (female: $115.6k to $140.4k, +21%; male: $121.4k to $159.0k, +31%).

Conclusions: AMI-related hospitalizations among adults with T1DM increased markedly from 2016–2023, with case-mix shifts toward socioeconomically vulnerable patients, concentration in urban teaching centers, rising costs, and mortality fluctuations coinciding with the COVID-19 pandemic. Significant racial disparities in outcomes persist. These findings support intensified ASCVD prevention strategies, equity-focused cardiometabolic care, and hospital-based quality improvement initiatives in this high-risk population.