1420-P: Temporal Trends and Sociodemographic Disparities in Acute Myocardial Infarction Outcomes among Hospitalized Patients with Diabetes Mellitus: Impact of the COVID-19 Pandemic in California, 2016–2022

Introduction and Objective: Diabetes mellitus increases the risk of acute myocardial infarction (AMI) and associated mortality. The COVID-19 pandemic disrupted cardiovascular care delivery; however, comprehensive evaluations of diabetes-AMI outcomes across diverse sociodemographics remain limited. To (i) examine temporal trends in AMI discharges and in-hospital mortality among adults with diabetes in California from 2016-2022; (ii) assess sociodemographic disparities; and (iii) quantify relative inequalities across age, race/ethnicity, insurance, and geography. Methods: Population-based retrospective cohort analysis using California hospital discharge data (2016-2022) for all adults (≥18 years) hospitalized with concurrent diabetes mellitus and AMI. Multivariable logistic regression estimated adjusted odds ratios (aOR) with 95% confidence intervals. Results: Discharges increased 34.8-46.5% during COVID-19 era versus 7.1-20.0% pre-pandemic. In-hospital mortality peaked with a 24.4% increase in 2022. Age showed the largest disparities (8.27-fold discharges increase in very old adults) with 80.7% attenuation to mortality. Asian populations demonstrated consistent dual elevation: discharges (+29.7%) and mortality (+21.1%) vs White populations. Geographic clustering identified Sacramento (+48.6% discharges), and Los Angeles and Inland Empire (+49.5% and +46.9% mortality) as highest affected regions when compared with Central and Coast regions. Private insurance showed paradoxical effects: +19.0% admissions but -7.8% mortality versus Medi-Cal. Conclusion: The COVID-19 pandemic substantially increased diabetes-AMI burden across multiple domains. Increased age represents the dominant non-modifiable disparity and insurance status represents the most-modifiable factor with disparities. Race and geographic location are likely surrogates for complex socioeconomic disparities that will need additional studies.