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Objective
To describe temporal trends in the incidence and disability-adjusted life years (DALYs) of rheumatoid arthritis (RA) across sociodemographic index (SDI) quintiles and sexes from 1990 to 2019.

Methods
Data on RA incidence and DALYs with a 95% uncertainty interval from 1990 to 2019 were extracted from the Global Burden of Disease 2019. Subsequently, trends across SDI quintiles and sexes from 1990 to 2019 were determined using joinpoint regression and age–period–cohort analyses.

Results
A significant upward trend in the global age-standardised incidence rate (ASIR) of RA was observed for both sexes from 1990 to 2019 (average annual per cent change (AAPC): 0.214, 95% CI 0.179 to 0.249, p

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Circulation, Volume 150, Issue Suppl_1, Page A4139135-A4139135, November 12, 2024. Background:Stroke associated with atrial fibrillation (AF) is a significant cause of mortality. This CDC analysis delves into mortality trends due to stroke in AF patients aged ≥ 25 years, from 1999 to 2020. By analyzing extensive datasets we scrutinized how factors such as gender, race, region of residence, and level of urbanization intersect with mortality rates.Methods:Death data from 1999 to 2020 was analyzed using the Centers for Disease Control and Prevention database, employing ICD codes I48 for AF and I64 for stroke. Age-adjusted mortality rate (AAMR) per 100,000 people with 95% confidence intervals was calculated for the total population, stratified by gender, race, urban/rural status, and census region. The Joinpoint regression software was used to calculate annual percentage change (APC) trend for each stratification.Results:In the U.S. between 1999 and 2020, total of 331,106 deaths occurred among adults due to AF associated with stroke. Deaths occurred predominantly in medical facilities (43.2%). The overall AAMR for AF associated stroke decreased from 26.8 per 100,000 in 1999 to 18.4 in 2020, with an AAPC of -2.05 (p value < 0.000001). Additionally, AAMR declined significantly from 1999 to 2018 (APC: -2.65, p value = 0.012398), followed by an increase from 2018 to 2020 (APC: 3.90, p value = 0.220356). Women had slightly higher AAMRs compared to men (men: 6.6; women: 7.1). The AAMR for women reduced substantially from 1999 to 2020 than for men. AAMRs varied among racial/ethnic groups, with White patients having the highest AAMR (7.4), followed by Blacks (5.4), American Indian or Alaska Natives (4.6), Asian or Pacific Islanders (4.5), and Hispanic population (4.1). AAMRs decreased for all races except for Black population. Geographically, AAMRs ranged from 4.3 in Nevada to 11.9 in Vermont, with the Western region showing the highest mortality (AAMR: 7.9). Nonmetropolitan areas had slightly higher AAMRs than metropolitan areas, with both experiencing a decrease over the study period.Conclusion:This analysis depicts significant disparities in mortality rates attributed to stroke associated with AF and underscores the need for larger population-based studies to further understand the primary factors influencing the observed geographical, racial, and gender differences. Targeted interventions and equitable healthcare access are crucial to mitigate these disparities and improve outcomes for this population.

Circulation, Volume 150, Issue Suppl_1, Page A4147614-A4147614, November 12, 2024. Background:The risk of stroke in Adult Congenital Heart Disease (ACHD) is well established. However, the prevalence and impact of stroke in young ACHD-related admissions stratified by median household income remain underexplored.Methods:The National Inpatient Sample (2019) was utilized to identify the rate of stroke admissions among young (18-44 years) ACHD patients. We also evaluated comorbidities and outcomes (all-cause mortality [ACM], length of stay [LOS], disposition,&charges) based on the median household income quartiles and compared two cohorts of lowest (0-25th percentile) and highest (75-100thpercentile) median household income (LMHI vs HMHI).Results:Of 41950 young (18-44 years) ACHD patients, 5360 patients had stroke (12.8%). Patients in the LMHI group were relatively older (median age 36 years vs 35 years) and had a greater proportion of males (53.8% vs 46.0%) when compared to patients in the HMHI group. Patients admitted with stroke were of greater proportion in the LMHI group (13.2% vs 12.1%) compared to the HMHI group. Comorbidities like alcohol abuse (4.7% vs. 2.3%), depression (9.8% vs. 7.0%), hypertension (13.0% vs. 5.6%), obesity (21.2% vs. 18%), drug abuse (12.3% vs 4.2%), and tobacco use disorder (30.4% vs 11.2%) were higher for LMHI when compared to HMHI. Regarding in-hospital outcomes, ACM (3.7 vs. 1.9%) and discharge to home (71.6 vs. 66.5) were higher with HMHI, whereas the LMHI cohort demonstrated fewer routine discharges, higher transfers to other facilities, and prolonged LOS (5 vs. 3 days, p

Circulation, Volume 150, Issue Suppl_1, Page A4139194-A4139194, November 12, 2024. Background:In the U.S., about 8% of adults never received cholesterol screening. Although machine learning (ML) has been used to develop decision tools for Atherosclerotic Cardiovascular Disease (ASCVD) risk prediction, its application in behavioral forecasting has not yet been explored in the context of cholesterol screening behaviors. This study aimed to examine the performance and accuracy of ML algorithms in forecasting cholesterol screening behaviors in adults after age 50.Methods:This analysis used deidentified data from the Health and Retirement Study (HRS) 2004-2018. HRS is a longitudinal survey among 23,000 households in the U.S. Participants were excluded from the current analysis if they passed away by 2019, ever had ASCVD or stroke, were under age 50 at baseline, or had missing data in self-reported cholesterol screening. In total, 7176 participants (mean age [SD]=62 [8]) met the inclusion criteria; participants were randomly split into a training set (80%) and a testing set (20%). The synthetic minority oversampling technique was used to solve the imbalance distribution of the rare event. Five ML algorithms were used: random forest, gradient boosting machine (GBM), XGBoost, Support Vector Machine (SVM), and logistic regression. Accuracy, AUROC, and positive predictive value (PPV) were used to compare model performance. The average gain was evaluated for feature importance in the demographic and health domains.Results:In total, 232 (3.2%) respondents did not receive any cholesterol screening from 2008 to 2018. Experiments with five ML algorithms suggested that XGBoost with deeper trees and learning rate performed better in classifying those who did not screen for cholesterol levels over 10 years. Adding prior cholesterol screening history (2004-2006) into the model significantly improved model performance. Hypertension, self-rated health, and smoking were the major health features, while insurance, poverty, and work status were the major demographic features in the predictive model (accuracy=0.97; AUROC=0.88; PPV=0.42).Conclusion:Findings underscore the potential utility of ML models in predicting cholesterol screening behaviors after age 50. This could be the basis for developing decision tools for clinicians to identify those with a lower chance of cholesterol screening or make reminders accordingly. The low-cost predictive model might improve the uptake of preventive screening behaviors in middle-aged and older adults.

Circulation, Volume 150, Issue Suppl_1, Page A4139353-A4139353, November 12, 2024. Background:Coronary Artery Disease (CAD) in obese population is the most common cause of mortality worldwide. This study examines the variation in cardiovascular mortality rates due to CAD in obese adults aged 25 and above from 1999 to 2020.Methods:We performed a retrospective cohort study using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research (CDC WONDER) database from 1999 to 2020. We calculated age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) per 100,000 persons. The information was categorized based on year, gender, ethnicity, and geographic area.Results:Between 1999 and 2020, CAD in obesity accounted for 102,434 deaths among adults (≥25 years) in the United States. Majority of deaths occurred in medical facilities (49.0%), followed by decedents’ homes (36.8%). The overall AAMR for CAD in obesity-related deaths increased from 1.5 in 1999 to 3.3 in 2020, with an AAPC of 3.46 (95% CI: 2.83 to 3.92, p < 0.000001). Men exhibited higher AAMRs compared to women (men: 2.7; women: 1.6), with significant increases for both sex. The increase was more prominent in men (AAPC: 4.34, 95% CI: 3.73 to 4.83, p < 0.000001). Racial/ethnic disparities were evident, with American Indian or Alaska Native individuals having the highest AAMR (2.9), followed by Black or African American (2.4), White (2.3), Hispanic or Latino (1.3), and Asian or Pacific Islander (0.5). All racial groups experienced an increase in AAMR from 1999 to 2020, most pronounced in American Indian or Alaska Native individuals (AAPC: 5.06, 95% CI: 2.90 to 8.64, p < 0.000001). Geographically, AAMRs ranged from 1.0 in Alabama to 4.3 in North Dakota, with the Midwestern region having the highest mortality (AAMR: 2.6). Nonmetropolitan areas exhibited higher AAMRs than metropolitan areas (nonmetropolitan: 2.8; metropolitan: 2.0). (Figure 1)Conclusion:This study highlights significant demographic disparities in mortality rates due to CAD in obesity among adults aged 25 and older. Despite an overall increase in mortality rates, the significant rise in recent years, particularly among certain racial groups and geographical regions, emphasize the need for targeted interventions and equal healthcare access to improve outcomes for affected populations.

Circulation, Volume 150, Issue Suppl_1, Page A4140936-A4140936, November 12, 2024. Background:Atrial fibrillation/flutter (AF/AFL) significantly contributes to global cardiac morbidity and mortality. Understanding its epidemiological trends is crucial for devising effective health interventions.Objective:This study aimed to elucidate the global burden of AF/AFL among overweight and obese individuals from 1990 to 2019, exploring variations in mortality, disability-adjusted life years (DALYs), and risk factor prevalence across 204 countries, as per the Global Burden of Disease Study 2019 (GBD 2019).Methods:Utilizing GBD 2019 data, this observational study assessed age-standardized mortality and DALY rates for AF/AFL. The analysis emphasized demographic variations (age, sex), socioeconomic disparities (as indexed by the sociodemographic index, SDI), and major modifiable risk factors such as hypertension, obesity, and lifestyle choices.Results:This study revealed a significant global increase in AF/AFL-related mortality, exceeding 63,000 deaths in 2019—an increase of 2.42% since 1990. DALYs exhibited a parallel upward trajectory. Notably, the AF/AFL burden increase was more pronounced in regions with lower SDIs, indicating marked health outcome disparities. A high body mass index (BMI) was identified as a predominant modifiable risk factor, highlighting the increasing impact of lifestyle-related health challenges. Moreover, mortality rate disparities were evident across different sex and age groups, with the highest rates among women and individuals aged 85-89 years.Conclusion:The increasing global burden of AF/AFL, especially associated with higher BMI, necessitates immediate public health interventions. These findings underscore the urgency for targeted preventive strategies focusing on lifestyle modifications and enhanced healthcare access, particularly in lower-SDI regions and among vulnerable populations.

Circulation, Volume 150, Issue Suppl_1, Page A4121890-A4121890, November 12, 2024. Background:Abnormal resting heart rate (RHR) is associated with cardiovascular events and mortality. Longitudinal RHR trajectories may offer unique prognostic, but research exploring these trajectories over extended periods and their prognostic implications is limited.Methods:Using data from 5,794 participants in the Atherosclerosis Risk in Communities (ARIC) study, we first characterized RHR trajectories over 25 years (from visit 1 [1987-89] to visit 5 [2011-13]) with latent class growth mixture models. Then, we determined the predictors of those trajectories using multinomial logistic regression (n=5,432 with data on predictors of interest). We ran Cox models to quantify the associations between RHR trajectories with cardiovascular outcomes (coronary heart disease, heart failure, stroke) and all-cause mortality (n=4,329 free of cardiovascular disease at baseline).Results:We identified one typical pattern (stable/slight decline, 88.4%) and three atypical patterns (stable-slight increase, 9.2%; increase-decrease, 2.0%; stable-sharp increase, 0.4%) (Figure-Left panel). Obesity, ever smoking, a history of heart failure, and lower education levels predicted the atypical patterns. The stable-increase (combined for slight and sharp) trajectory was significantly and robustly associated with heart failure and all-cause mortality (Figure-Right panel). The increase-decrease trajectory showed a hazard ratio of ~2 for coronary heart disease, although statistical significance was restricted in the demographically adjusted model.Conclusions:We identified one typical (stable/slight decline) and three atypical (increase-decrease, stable-slight increase, and stable-sharp increase) RHR trajectories over 25 years. The atypical trajectories, particularly the stable-increase pattern, were associated with poorer prognosis. These findings highlight the value of monitoring long-term RHR trajectories for cardiovascular risk assessment.

Circulation, Volume 150, Issue Suppl_1, Page A4146291-A4146291, November 12, 2024. Background:Circulatory diseases represent the primary cause of mortality in the US. Comprehending trends and potential disparities in the prevalence of circulatory conditions, such as angina pectoris (AP), myocardial infarction (MI), hypertension (HTN), and coronary heart disease (CHD), is essential for forming public health strategies.Aim:To investigate trends in the prevalence of circulatory conditions, including AP, MI, HTN, and CHD among US adults from 2019 to 2022.Methods:Prevalence percentages for all available circulatory diseases from the Centers for Disease Control and Prevention’s National Health Interview Survey (NHIS) database were retrieved for patients aged >18 years from 2019 to 2022. Annual Percentage Changes (APCs) along with their respective 95% CIs were calculated using regression analysis with Join point. The data was stratified by year, gender, age, race, nativity, veteran status, social vulnerability, employment status, metropolitan statistical area (MSA) status and census region.Results:Between 2019 and 2022, HTN was steadily the most prevalent, staying relatively constant at 27.0% (95% CI: 26.4, 27.7) in 2019 and 27.2% (95% CI: 26.5, 27.8) in 2022. Males consistently had higher prevalence than females with significant increases noted from 2019 to 2022 (APC: 1.0234). Black or African American had the highest prevalence (34.4% in 2022). The South (30.1% in 2022) and the West (22.5% in 2022) had respectively the highest and lowest rates. The second highest prevalence was seen in CHD increasing from 4.6% (95% CI: 4.3, 4.9) in 2019 to 4.9 (95% CI: 4.7, 5.2) in 2020. Males consistently exhibited a higher prevalence than females, with both genders showing significant increases in recent years (Male APC: 3.1448) (Female APC: 2.0165). For MI, a slight decrease was noted from 3.1% (95% CI:2.9, 3.4) in 2019 to 3.0% (95% CI:2.7, 3.2) in 2022. White individuals exhibited the highest prevalence (3.3% in 2022). AP had the lowest overall prevalence staying relatively consistent (1.7% in 2019 and 1.6% in 2022) (Figure 1).Conclusion:Significant trends (Figure 2) in most common circulatory diseases have been identified. Targeted interventions are imperative, particularly for high-risk demographics such as males, older adults, veterans, and unemployed individuals.

Circulation, Volume 150, Issue Suppl_1, Page A4145979-A4145979, November 12, 2024. Introduction:Ischemic heart disease (IHD), driven predominantly by modifiable risk factors such as high fasting plasma glucose (FPG), remains a leading cause of morbidity and mortality worldwide. In the United States, understanding the state-specific burden of IHD attributable to high FPG is critical for tailoring effective public health strategies.Method:Using Global Burden of Disease tool, we estimated Deaths, DALYs (disability adjusted life years), YLDs (years lived with disability) due to IHD attributable to FPG across the US by age, sex, year and location from 1990-2019.Results:Between 2010-2019, the annual percentage change (APC) showed a significant increase in deaths rose by 17% (95% Uncertainty Interval [UI]: 10-25%), DALYs by 19% (11-26%), and YLDs by 21% (12-30%). In terms of age-standardized mortality rates (ASMR), Vermont saw the largest increase at 9%, followed by South Dakota at 8%. Conversely, New York exhibited the most substantial decrease in ASMR, declining by 11%. The YLDs rate saw its most considerable rise in the District of Columbia, up by 12%, with Wyoming following at a 7% increase. In 2019, Oklahoma recorded the highest ASMR at 43.06 (25.18-67.9) cases per 100,000, whereas Mississippi had the highest YLDs rate at 786 (495-1160). Over the last three decades, older age groups experienced a heavier burden. A gender comparison revealed an increasing trend in females compared to males, with APC in deaths for males versus females at 32% vs. 37%, DALYs at 21% vs. 25%, and YLDs at 94% vs. 116% from 1990-2019.Conclusion:IHD attributable to high FPG accounted for 34.19% of all IHD deaths in 2019, underscoring the urgent need for public health policies that promote outdoor activities and regular exercise among youth, and discourage the consumption of processed foods to foster healthier lifestyles and mitigate this significant health burden.

Circulation, Volume 150, Issue Suppl_1, Page A4139332-A4139332, November 12, 2024. Background:Strong patient-clinician communication may improve health outcomes for marginalized populations, including Hispanic/Latino individuals.Objective:We assessed the association between patient-clinician communication and cardiovascular (CV) events or death in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).Methods:HCHS/SOL is a longitudinal cohort study of individuals aged 18-74 who identified as Hispanic/Latino at 4 U.S. sites. Participants’ ratings of communication with clinicians during the year before enrollment were used to generate a communication score. The primary outcome was the composite of myocardial infarction (MI), heart failure events (HF), stroke, and all-cause mortality. The secondary outcomes included the primary outcome components. The association between the baseline communication score and outcomes of interest was assessed with Cox proportional hazards models adjusting for possible confounders. We also used multivariable linear regression to assess the cross-sectional association between communication and AHA Life’s Essential 8 (LE8), a measure of CV risk factors. All analyses accounted for the complex survey design.Results:Our sample included 10,527 individuals without prior CV events and at least one medical encounter in the year before enrollment. The median age at enrollment was 41 years (IQR 29, 53), 59% were female, and 71% perceived high-quality communication with clinicians. The mean follow-up time was 9.4 years. High-quality communication was associated with the following results in our adjusted analyses: composite outcome (aHR 0.71, 95% CI 0.49, 1.02, p = 0.066), CV events (aHR 0.79, 95% CI 0.41, 1.51, p = 0.47), all-cause mortality (aHR 0.53, 95% CI 0.35, 0.80, p < 0.01).Conclusions:High-quality patient-clinician communication was associated with a non-significant trend toward a lower rate of CV events and death, driven by a significant association with lower all-cause mortality.

Circulation, Volume 150, Issue Suppl_1, Page A4118402-A4118402, November 12, 2024. Background:Cardiovascular disease is the leading cause of death in the U.S. Mass incarceration is a national public health issue, with the US having the highest incarceration rate in the world. However, there is a paucity of data on cardiovascular mortality among incarcerated individuals, or how the racialization of mass incarceration contributes to cardiovascular health inequities. The aim of this study was to evaluate the burden of cardiovascular mortality, trends in cardiovascular deaths, as well as racial differences in cardiovascular death and receipt of care among those incarcerated in U.S. state prisons from 2001-2019.Methods:We utilized the database “Mortality in Correctional Institutions: ICD-10 Diagnosis Codes for Natural Deaths Occurring in State Prison or Local Jail Custody, 2000-2019” from the United States Bureau of Justice Statistics. This database collects inmate death records from each of the nation’s 50 state prison systems. We extracted all deaths related to cardiovascular causes to evaluate the epidemiology of individuals with cardiovascular death, trends in cardiovascular death rates, and differences between racial groups.Results:From 2000-2019, there were a total of 18227 (28.0%) deaths secondary to cardiovascular causes among those incarcerated in US state prisons. The rate of CV death increased from 71.3 per 100,000 persons in 2001 to 94 per 100,000 persons in 2019. Black individuals who died while incarcerated had higher rates of death related to a cardiovascular cause than White individuals (30.9% vs. 27.8%, p

Circulation, Volume 150, Issue Suppl_1, Page A4146355-A4146355, November 12, 2024. Background:Ischemic heart disease (IHD) is the leading cause of death in the European Union (EU). Understanding variations by sex, income, and geography can help in tailoring effective public health policies.Methods:We conducted a cross-sectional analysis of IHD using the Global Burden of Disease Study Database to examine trends in sex specific age-standardized mortality rate (ASMR)-to-age-standardized prevalence rate (ASPR) ratio (ASMR-to-ASPR index) per 100,000 inhabitants/year across the EU from 2005 to 2019.Results:Men showed higher ASMR than women. However, the ASMR-to-ASPR index was notably higher in women than in men indicating that women who develop IHD have a higher risk of dying from the disease compared with their male counterparts. Despite a significant decline in ASMR across EU from 2005 to 2019 both among women and men, sex disparities in ASMR-to-ASPR index persisted with a women-to-men ratio ranging from 1.05 to 1.36. No significant relationship was found between country-specific ASMR or country income status and ASMR-to-ASPR index. Examples include Romania which displayed higher ASMR (men: 219.87, women: 143.54) compared with Germany (men: 107.22, women: 60.76), yet with smaller differences in ASMR-to-ASPR index between women and men (Romania: 6.54% vs 5.85%; ratio: 1.12 and Germany: 4.79% vs 3.80%; ratio: 1.26).Conclusions:Mortality from IHD has decreased substantially among EU countries. However, the declines were accompanied by a persistently higher ASMR-to-ASPR index in women, indicating significant potential for further gains in closing the gender gap in IHD mortality.