MON-639 - Cardiovascular Burden of Type 2 Diabetes Mellitus in the United States: Contemporary National Trends in Acute Myocardial Infarction Outcomes and Costs

Type 2 diabetes mellitus (T2DM) is a major contributor to cardiovascular morbidity and healthcare utilization. Contemporary national patterns of cardiovascular outcomes and economic burden among adults with T2DM across the pre-pandemic, pandemic, and recovery periods have not been comprehensively examined.

Using the Nationwide Inpatient Sample (NIS, 2016–2023), we identified adult hospitalizations for acute myocardial infarction (AMI) among patients with T2DM (approximately 4.1 million weighted admissions). Survey-weighted analyses evaluated temporal trends in demographics, comorbidity burden, in-hospital mortality, length of stay (LOS), and inflation-adjusted hospital charges. Multivariable survey-weighted regression models adjusted for age category, sex, race/ethnicity, and calendar year with stratified analyses examining socioeconomic and hospital-level factors.

AMI hospitalizations among adults with T2DM increased 56% over the study period. Adjusted in-hospital mortality demonstrated a U-shaped temporal pattern, declining from 6.74% in 2016 to 6.26% in 2019, rising during the pandemic to 8.89% in 2021, and subsequently improving to 5.25% in 2023, the lowest observed rate. Mean LOS increased from approximately 6.0 days in 2016 to 6.6 days in 2023, with a pandemic-associated inflection. Inflation-adjusted hospitalization charges rose from $118,063 in 2016 to $140,732 in 2023, representing a 19.2% increase in inflation-adjusted per-hospitalization economic burden.

Comorbidity burden increased over time, with mean Charlson Comorbidity Index rising from 4.53 in 2016 to 5.07 in 2023. Older age and higher comorbidity burden were associated with increased mortality. Significant racial and socioeconomic disparities in mortality and costs persisted across analyses, with minority and lower-income populations demonstrating higher adjusted hospitalization costs (up to 18% higher mortality odds and $49,000 higher costs).

Among adults with T2DM, AMI hospitalizations are characterized by rising clinical complexity, persistent equity gaps, and escalating healthcare costs. Despite post-pandemic mortality improvement, LOS and economic burden remain elevated. These findings highlight the need for intensified cardiometabolic prevention and targeted risk-reduction strategies to mitigate the growing clinical and economic impact of diabetes-related cardiovascular disease.

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