Prevalence and Hospitalization Trends of Cardiovascular Disease in Diabetic Populations: An Analysis of the United States Diabetes Surveillance System (USDSS) Data From 2000 to 2022.

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among individuals with diabetes. Understanding national time trends in both CVD prevalence and related hospitalizations is essential for informing clinical and public health strategies. This study aims to examine long‑term trends in CVD prevalence and hospitalization rates among US adults with diagnosed diabetes using the United States Diabetes Surveillance System (USDSS), which combines self‑reported survey data and administrative claims.

METHODS

We conducted a retrospective observational analysis of USDSS data from 2000 to 2022. Adults aged ≥18 years with diagnosed diabetes were included. CVD prevalence was ascertained via self‑report or claims of coronary heart disease, myocardial infarction, or stroke. Annual crude hospitalization rates (per 1,000 diabetic individuals) were calculated using the total number of adults with diagnosed diabetes each year as the denominator; hospitalization data were available through 2020. Temporal trends were evaluated using linear trend analysis in addition to independent t‑tests (sex differences) and one‑way analysis of variance (ANOVA) (age and race/ethnicity disparities), with p < 0.05 denoting significance.

RESULTS

From 2000 to 2022, major heart disease prevalence rose from 21.1% to 23.7% and then declined to 17.4%; however, absolute cases increased from 2.7 million to 4.9 million, a reflection of a growing diabetic population rather than a static denominator. Stroke prevalence peaked at 10.5% in 2008 before falling to 7.4% in 2022, while case counts doubled from 1.1 million to 2.1 million. Between 2000 and 2020, crude CVD hospitalization rates fell from 78.6 to 46.0 per 1,000 (data truncated at 2020 due to USDSS availability). Males consistently had higher rates than females (p < 0.05). Older adults (≥65 years) demonstrated the highest rates, with the ≥75 subgroup exhibiting the greatest absolute decline. Non‑Hispanic Black individuals experienced significantly higher hospitalization rates than other racial/ethnic groups (p < 0.05).

CONCLUSIONS

Although crude hospitalization rates for CVD among adults with diabetes declined over two decades, the absolute burden of disease rose in step with the expanding diabetic population. Significant disparities by age, sex, and race persist. Targeted interventions addressing both clinical care and population‑level drivers are needed for high‑risk diabetic subgroups.