1260-P: Forecasting Health Disparity Burden of Cardiometabolic Diseases among U.S. Middle-Aged Adults—A Microsimulation Study

Background: Understanding the future health disparity burden of cardiometabolic diseases across racial-ethnic and socioeconomic (SES) groups is essential for policy and priority setting.

Methods: Using a validated US Diabetes, Obesity, Cardiovascular Disease microsimulation (DOC-M) model, we predicted absolute and relative changes (Δ) in the prevalence of diabetes, obesity, cardiovascular diseases (CVD), and all-cause mortality over the next 20 years, overall and by racial-ethnic and SES groups (education and income) among the US population aged 40-79 using the NHANES 2017-2020 data (n=5,745, representing 142.5 million).

Results: As the population aged over the next 20 years, our model predicted that all-cause mortality reached 40.9% overall, with the largest increase in non-Hispanic Black adults (46.7%), followed by adults with less than high school education (44.3%). CVD was projected to increase most in Hispanic adults (11.0% to 23.4%, Δ=↑113.5%), adults with high school equivalent education (18.4% to 33.4%, Δ=↑81.7%), and middle-income adults (16.1% to 29.2%, Δ=↑80.9%). Diabetes prevalence would grow the fastest among Hispanic adults (24.3% in 2020 to 52.9% in 2040, Δ=↑118.3%), versus Non-Hispanic Black adults (23.7% to 45.0%, Δ=↑90.2%) and Non-Hispanic White adults (17.1% to 30.0%, Δ=↑75.5%). Although diabetes prevalence would grow fastest among college-educated adults (16.5% to 31.2%, Δ=↑89.3%) and high-income adults (16.1% to 30.3%, Δ=↑88.0%), the greatest burden of diabetes remains among adults with less than high school education (27.0% to 47.0%, Δ=↑74.4%) and low-income adults (25.9% to 44.2%, Δ=↑74.4%).

Conclusion: Our population health model predicts worsening obesity, diabetes, and CVD that will exacerbate health disparities without targeted health interventions and policies.