P3047 - Tracking Two Decades of Disparities in Mortality From Gastrointestinal Bleeding and Acute Myocardial Infarction in the United States: A CDC WONDER Analysis (1999–2020)

Adnan Bhat, MD¹, Mariam Shahabi, MBBS², Anchit Chauhan, ³, Anish Kumar, MBBS⁴, Adil Ahmed, ⁵, Marium Zahid, ⁶, Shariq Wani, MBBS⁷, Omar Al-Radideh, MD⁸
1University of Florida, Gainesville, FL; 2Dow Medical College, Karachi, Sindh, Pakistan; 3Maulana Azad Medical College, New Delhi, Delhi, India; 4Liaquat University of Medical and Health Science, Hyderabad, Sindh, Pakistan; 5Northwest School of Medicine, Peshawar, North-West Frontier, Pakistan; 6Karachi Medical and Dental College, Karachi, Sindh, Pakistan; 7Wayne State University School of Medicine / Detroit Medical Center, Detroit, MI; 8University of Florida College of Medicine, Gainesville, FL

Introduction: Gastrointestinal bleeding (GIB) and acute myocardial infarction (MI) are distinct critical emergencies with a significant burden. However, there is increasing evidence of a bidirectional link, post-MI antithrombotic regimens increasing GIB and GIB exacerbating cardiovascular risk via reduced coronary perfusion and systemic inflammation. While short-term outcomes are recognized, population-level, long-term mortality trends from co-occurring GIB and MI remain largely unknown. This study examines these temporal and demographic patterns in the US from 1999-2020.

Methods: Death certificate data were extracted from the CDC WONDER for adults aged 25 years and older. Records listing GIB and acute MI as either contributing or underlying causes of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 were analyzed. Joinpoint regression calculated annual percent changes (APC) and average APC (AAPC), which were stratified by gender, age, race, and urban-rural classification.

Results: A total of 51,113 deaths were attributed to GIB and acute MI. The overall AAMR significantly declined from 1.72/100,000 in 1999 to 0.81 in 2020 (AAPC -3.9%), with the sharpest phase from 2002-2010 (APC -7.5%). Males consistently exhibited higher AAMRs than females (overall 1.43 vs 0.81), though both saw significant declines (AAPC -3.55% M, -3.84% F). Non-Hispanic Black individuals had the highest overall AAMR (1.26); all racial/ethnic groups showed notable mortality reductions (AAPC range -2.94% to -5.11%). AAMRs were consistently higher in non-metropolitan (1.01) versus metropolitan areas (0.94). While the 85+ age group saw large declines (AAPC -4.15%), the 55-84 group's decline (AAPC -3.99%) plateaued after 2011. The highest AAMR (1.15) was observed in the Northeast.

Discussion: Between 1999 and 2020, mortality from co-occurring GIB and acute MI declined significantly in the US, reflecting advances in antithrombotic management and supportive care. However, persistent disparities were noted, particularly among males, non-Hispanic Black individuals, older adults, and rural populations. The recent plateau and uptick in mortality may reflect an aging population, rising comorbidities, or evolving antithrombotic practices. These trends highlight the need to balance bleeding and ischemic risks more precisely and emphasize tailored strategies for vulnerable groups.


Figure: Graph depicting various trends.


Figure: Central Illustration of overall mortality trends and disparities across United States

Disclosures:
Adnan Bhat indicated no relevant financial relationships.
Mariam Shahabi indicated no relevant financial relationships.
Anchit Chauhan indicated no relevant financial relationships.
Anish Kumar indicated no relevant financial relationships.
Adil Ahmed indicated no relevant financial relationships.
Marium Zahid indicated no relevant financial relationships.
Shariq Wani indicated no relevant financial relationships.
Omar Al-Radideh indicated no relevant financial relationships.

Adnan Bhat, MD¹, Mariam Shahabi, MBBS², Anchit Chauhan, ³, Anish Kumar, MBBS⁴, Adil Ahmed, ⁵, Marium Zahid, ⁶, Shariq Wani, MBBS⁷, Omar Al-Radideh, MD⁸. P3047 - Tracking Two Decades of Disparities in Mortality From Gastrointestinal Bleeding and Acute Myocardial Infarction in the United States: A CDC WONDER Analysis (1999–2020), ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.