S1367 Tracking Two Decades of Disparities in Mortality From Gastrointestinal Bleeding and Acute Myocardial Infarction in the United States: A CDC WONDER Analysis (1999–2020)

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 women (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. Conclusion: 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 men, 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.