Diabetes-associated cardiovascular mortality among Hispanic males in the United States, 1999–2024: trend analysis and projections to 2040

Background CVD is the primary driver of mortality in diabetes mellitus (DM), and the eroding “Hispanic Paradox” is not uniform across causes of death. We analyzed DM associated CVD mortality trends among Hispanic males, 1999–2024, projecting trajectories to 2040. Methods We conducted a retrospective, population-based mortality trend analysis of Hispanic male decedents aged ≥ 25 years using multiple-cause-of-death data from the CDC WONDER database (1999–2024). CVD (ICD-10 I00-I99) was the underlying cause of death and DM (E10-E14) was a contributing cause. Age-adjusted mortality rates (AAMR), annual percent change (APC), average annual percent change (AAPC), and forecasted AAMR through 2040 were evaluated using Joinpoint regression and ARIMA forecasting. Results Among 106,769 deaths, AAMR for Hispanic males declined from 66.57 (1999) to 47.55 (2024); AAPC: −1.29% (95% CI: −1.61 to − 0.98; p < 0.001), with decline through 2016 (APC: −2.40%; 95% CI: −2.95 to − 1.88), a rise from 2016 to 2021 (APC: +3.88%; 95% CI: +1.56 to + 8.18), then non-significant decline (APC: −3.34%; 95% CI: −8.19 to + 0.14). The 25–44 age group showed a sustained increase (AAPC: 2.16%); the South showed the least regional improvement (AAPC: -0.69%). Hypertensive heart disease (AAPC: 3.25%) and heart failure (AAPC: 0.78%) also rose significantly. Decline was less pronounced among males than females (-1.29% vs. -2.45%), and non-Hispanic males surpassed Hispanic males in AAMR by 2021. ARIMA model forecasted AAMR to remain stable at approximately 47.55 through 2040 (95% CI: 28.30–66.80). An exploratory drift scenario projects a gradual decline to 35.38 (95% CI: 14.20–56.56) by 2040. Conclusions Over 26 years, DM-associated cardiovascular mortality among Hispanic males declined, reflecting advances in care and prevention. However, persistent and emerging disparities (southern burden, younger individuals) highlight the need for sustained, equity-focused interventions. Trial registration Not applicable. This is a retrospective, population-based observational study using publicly available, de-identified aggregate mortality data; no healthcare intervention on human participants was performed.