B58-12 Chronic Insomnia as an Emerging Determinant of Cardiovascular Disease in the United States: Population Projections Through 2050

Abstract Rationale Chronic insomnia is highly prevalent and a risk factor for cardiometabolic morbidity and mortality. However, the long-term population burden of insomnia and its potential contribution to cardiovascular disease (CVD) outcomes remain poorly quantified. Methods We projected U.S. trends in insomnia and CVD (according to Global Burden of Disease classification) from 2020 to 2050 using an empirically calibrated population simulation in five-year cycles that incorporated demographic aging, disease incidence, remission, comorbidity, and mortality, and estimated changes in the prevalence of insomnia and CVD and the incremental CVD burden associated with insomnia. Baseline prevalences of insomnia (16.2%) and severe insomnia (7.9%) were based on a recently published synthesis of global prevalence studies. Incidence probabilities were derived from longitudinal studies and adjusted using global scaling and caps to maintain epidemiologic plausibility. Remission rates (0.45 per five years for insomnia; 0.02 for severe insomnia) were based on previously published data. Non-chronic cases that remained symptomatic could progress to chronic insomnia with a probability of 0.08 per five-year step. Associations between insomnia, severe insomnia, and CVD were parameterized based on risk ratios from a recent meta-analysis ((RR) ∼1.15-1.30 for CVD incidence, RR ∼1.14 for all-cause mortality), applying an odds-to-risk correction to avoid overestimation under non-rare baseline risks. Comorbidity and mortality risks were drawn from previously published data. Results In 2020, modeled U.S. prevalence of insomnia was 16.3% (female 18.7%, male 14.0%) and the modeled U.S. prevalence of severe insomnia was 8.0% (female 9.1%, male 6.9%), consistent with prior literature. By 2050, the prevalence of insomnia increased 33.9% and the prevalence of severe insomnia increased 65.1% (i.e., to 21.9% female 23.2%, male 20.6% and to 13.2% female 14.1%, male 12.3%, respectively). The proportion of people with insomnia that was severe increased from 49% to 61%, reflecting aging, moderate incidence, and limited remission. CVD prevalence doubled from 8.8% to 17.8% (female 17.4%, male 18.3%), consistent with aging and comorbidity effects. Insomnia was associated with a modest elevation in CVD risk (RR ∼1.15), translating to approximately a 6-8% higher CVD prevalence in 2050 relative to counterfactual scenarios without insomnia. This abstract is funded by: Resmed