SUN-698 Geographic and Demographic Patterns on Mortality from Type 2 Diabetes in Patients with Obesity in the United States (1999-2020)

Abstract Disclosure: P. Ashar: None. S. Garg: None. K. Tamirisa: None. A. Chowdhury: None. Background: Type 2 diabetes (T2D) and obesity are closely linked metabolic disorders, with obesity being a major risk factor for the development and progression of T2D. While the prevalence of both conditions has risen over the past two decades, the burden of T2D mortality with comorbid obesity remains underexplored. Evaluating trends in age-adjusted mortality rates (AAMRs) and identifying disparities across demographic and geographic groups can provide critical insights for targeted public health interventions. Methods: Mortality data from the CDC WONDER database were analyzed for individuals aged >35 years between 1999 and 2020, where T2D (ICD-10 codes E11.0-E11.9) was identified as the underlying cause of death and obesity (ICD-10 codes E66.0-E66.9) as a contributing cause. AAMRs per 1,000,000 individuals were computed, and temporal trends were assessed using Joinpoint regression. Subgroup analyses examined differences by sex, race, urban-rural classification, and geographic region. Results: Between 1999 and 2020, the AAMR for T2D mortality with comorbid obesity increased markedly from 1.4 (95% CI, 1.2-1.6) to 11.9 (95% CI, 11.5-12.4), reflecting an annual percent change of 8.81% (p<0.001). Males exhibited a higher cumulative AAMR (5.6 [95% CI, 5.5-5.7]) compared to females (4.4 [95% CI, 4.3-4.5]). Racial disparities were evident, with American Indians experiencing the highest AAMR (8.5 [95% CI, 7.5-9.6]), followed by African Americans (6.7 [95% CI, 6.4-6.9]), White individuals (4.9 [95% CI, 4.8-5.0]), and Asians (1.6 [95% CI, 1.4-1.7]). Mortality rates also varied by urbanization, with noncore rural areas reporting a higher AAMR (6.1 [95% CI, 5.8-6.4]) compared to large central metropolitan regions (4.5 [95% CI, 4.4-4.6]). Regionally, the West exhibited the highest AAMR (7.0 [95% CI, 6.8-7.2]), followed by the Midwest (5.9 [95% CI, 5.7-6.1]), South (4.3 [95% CI, 4.2-4.4]), and Northeast (2.9 [95% CI, 2.8-3.0]). Conclusion: Mortality associated with T2D and comorbid obesity has increased significantly over the past two decades, with substantial disparities by sex, race, and geography. The findings underscore the heightened burden among American Indian and African American populations, rural communities, and individuals in the Western and Midwestern regions of the United States. These disparities highlight the need for tailored public health initiatives aimed at early detection, obesity management, and diabetes care in the most affected populations. Presentation: Sunday, July 13, 2025