SAT-650 Trends and Disparities in DKA-Related Mortality in the United States (1999-2022): Insights from the CDC WONDER Database

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Abstract Disclosure: V. Gill: None. S. Govekar: None. S. Soni: None. A. Grover: None. S. Shekhar: None. Background: Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes characterized by hyperglycemia, ketonemia, and acidosis, primarily affecting individuals with type 1 diabetes. DKA continues to be a major cause of diabetes-related mortality in the United States. We analyzed morbidity and mortality trends in relation to DKA in a large US database. Methods: We queried the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database, which is a publicly accessible online platform designed to facilitate epidemiologic research and public health surveillance. We investigated the underlying cause of death, for DKA-related mortality in the U.S. from 1999 to 2022. Mortality rates were stratified by age, sex, urbanization, and year. Average age-adjusted mortality rates (AAMR) were computed across and between two distinct periods (2003-2012 and 2013-2022) to analyze temporal trends. Linear regression analysis was done to analyze mortality trends across all years. Statistical analyses were conducted in R software, adjusting for confounders (age, sex, and urbanization). A p-value < 0.05 was considered significant. Results: Between 1999 and 2022, there were 40,770 DKA-related deaths in the U.S., with 55.6% among males and 73.4% among white individuals. Mortality rates began increasing in 2015, with a sharp rise during the COVID-19 pandemic from 2020-2022. DKA-related mortality rates were 1.67%, 1.81%, and 1.73% in 2020, 2021, and 2022, respectively, compared to 1.23% in 2019 (p-value < 0.05). A 37.2% increase in DKA-related mortality was observed in 2013-2022 compared to 2003-2012. The age-adjusted mortality rate (AAMR) increased by 32.6%, from 1.29 per 100,000 in 2003-2012 to 1.71 per 100,000 in 2013-2022. Furthermore, in relation to 2013, higher DKA-associated mortality rates were noted in non-metro regions (compared to metro regions (2.1% vs 1.1%, p<0.05). Conclusion: Mortality in relation to DKA in the U.S. has significantly risen since 2012, with a major spike during the COVID-19 pandemic years. These trends suggest potential gaps in diabetes management and timely access to medical care exacerbated by healthcare disruptions such as a pandemic. To our knowledge, this is the first study to comprehensively examine age, sex, and urbanization disparities in DKA mortality using the CDC WONDER database. Presentation: Saturday, July 12, 2025