Background: Lung cancer (LC) and pneumonia remain leading causes of mortality in the United States, with particularly severe impacts on vulnerable populations. While LC continues to be the deadliest cancer, pneumonia poses a critical threat to immunocompromised individuals, especially those with LC. This study examines 24-year trends in LC and pneumonia-related deaths, analyzing disparities across demographic groups and geographic regions to inform targeted public health strategies. Methods: We analyzed mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database (1999-2023), calculating age-adjusted mortality rates (AAMRs) per 100 000 population. The study population included adults aged 25 + with LC and pneumonia listed as underlying or contributing causes of death. Joinpoint regression identified significant trends in mortality rates, stratified by sex, race/ethnicity, urbanization level, and US census region. Results: The analysis revealed a 51% decline in LC and pneumonia-related mortality over 24 years, with AAMRs dropping from 53.1 to 25.9 deaths per 100 000. The most dramatic improvement occurred between 2006 and 2009, when mortality rates fell by nearly 10% annually – likely reflecting advances in targeted cancer therapies, expanded screening programs, and stronger vaccination efforts. Despite overall progress, significant disparities persisted. Men died at twice the rate of women throughout the study period, with 2023 AAMRs of 32.6 for males versus 20.1 for females. Racial gaps remained troubling, as Black Americans consistently faced the highest mortality rates (65.7 in 1999 vs 30.7 in 2023), while Asian/Pacific Islanders saw an unexpected 10% mortality increase post-2021. Geographically, rural areas had 31% higher death rates than urban centers, and Southern states carried the heaviest burden across all regions. Conclusions: While national mortality trends show encouraging declines – particularly after 2006 – persistent disparities by sex, race, and geography highlight unmet public health needs. The findings call for tailored interventions addressing higher-risk groups, including enhanced screening in rural areas, culturally competent care for racial/ethnic minorities, and continued smoking cessation support. Sustained progress will require equitable access to emerging treatments and preventive services across all communities.

Background: Pneumonia is the most common respiratory tract infection among patients with diabetes, affecting individuals across all age groups and sexes. Objective: This study aims to examine demographic trends in mortality among patients diagnosed with both diabetes mellitus (DM) and pneumonia. Methods: Deidentified death certificate data for DM- and pneumonia-related deaths in adults aged 25 years and older from 1999 to 2022 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. The Joinpoint Regression Program was used to evaluate annual percentage changes (APCs) in mortality trends, with statistical significance set at P<.05. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting. Results: Between 1999 and 2022, a total of 425,777 deaths were recorded from DM and pneumonia. The overall AAMR declined significantly (P=.001) from 98.73 in 1999 to 49.17 in 2016 (APC –4.68), and then surged to 97.66 by 2022 (APC 23.55). Men consistently experienced higher mortality than women throughout the study period. Male AAMR rose from 62.61 in 2016 to 127.05 in 2022 (APC 24.88), while female AAMR increased from 41.05 in 2017 to 75.25 in 2022 (APC 27.60). Race-based analysis demonstrated that American Indian or Alaska Native populations had the highest mortality rates among racial groups. Non-Hispanic White individuals exhibited a significant decline in AAMR (P=.002) from 89.76 in 1999 to 44.19 in 2017 (APC −4.58), followed by an increase to 83.11 by 2022 (APC 25.25). Adults aged 65 years or older bore the highest mortality burden, with rates declining steadily to 206.9 in 2017 (APC –5.15) before rising sharply to 371.3 in 2022 (APC 20.01). Nonmetropolitan areas consistently exhibited higher mortality than metropolitan areas, with particularly steep increases after 2018 (APC 64.42). Type-specific mortality revealed that type 1 DM AAMRs declined from 9.2 in 1999 to 1.4 in 2015 (APC –11.94) before rising again. By contrast, type 2 DM AAMRs surged drastically after 2017, peaking at 62.2 in 2020 (APC 58.74) before partially declining to 41.6 by 2022. Conclusions: DM is associated with an increased risk of mortality following pneumonia, particularly among men, older adults, and American Indian populations. Strengthening health care interventions and policies is essential to curb the rising mortality trend in these at-risk groups.

Background and Objectives: Electronic glycemic management systems (eGMSs) are increasingly used to guide intravenous insulin infusion for hospitalized patients with diabetic ketoacidosis (DKA), but available comparative evidence remains non-randomized and clinically heterogeneous and includes multiple algorithmically distinct platforms. Methods and Materials: We conducted a systematic review and meta-analysis in accordance with PRISMA guidance and a prospectively registered protocol (PROSPERO: 2025 CRD420251019614). Seven non-randomized studies comprising 3874 hospitalized patients were included; six studies contributed data to the primary meta-analysis of time to DKA resolution. The primary outcome was time to DKA resolution. Secondary outcomes included ICU length of stay (LOS), hospital LOS, duration of insulin infusion, and hypoglycemia (mild and severe). Random-effects models were applied. Results: Six studies contributed to the primary meta-analysis of time to DKA resolution; across the review, seven studies included 3874 patients. The pooled analysis showed no statistically significant difference between groups (SMD −0.04, 95% CI −0.22 to 0.14; I² = 74.8%). Recorded hypoglycemia was lower among patients managed with eGMS; however, these estimates should be interpreted cautiously because of heterogeneity, serious-to-critical risk of bias, and potential differences in glucose-monitoring and documentation practices. ICU and hospital LOSs and duration of insulin infusion showed no statistically significant differences overall, with heterogeneity across studies. Conclusions: In available non-randomized evidence, eGMS-guided insulin infusion was not associated with a clear difference in time to DKA resolution, ICU length of stay, hospital length of stay, or insulin infusion duration compared with conventional protocols. Lower recorded hypoglycemia was observed with eGMSs, but this finding should be considered hypothesis-generating because of serious-to-critical risk of bias, residual confounding, substantial heterogeneity, and possible detection bias. High-quality randomized trials or target trial emulation studies are needed before recommending widespread adoption, as certainty of evidence was very low across all outcomes.

Background: Gamma-glutamyl transferase (GGT) has been associated with increased risks of multiple cancers and mortality. Because GGT is also a marker of hepatobiliary injury, metabolic dysfunction, and alcohol exposure, this study evaluated associations between persistently elevated GGT and hepatobiliary and pancreatic outcomes. Materials and Methods: This retrospective cohort study used TriNetX data from the US Collaborative Network to compare adults aged 40 years or older with persistently elevated GGT against those with normal GGT using a 65 U/L threshold on two occasions 6–12 months apart. Outcomes were assessed from 180 to 1095 days after the index event. Following 1:1 propensity score matching, 14,590 patients per cohort were analyzed. Cox proportional hazards analysis estimated hazard ratios (HRs) with 95% confidence intervals (CIs). Results: Elevated GGT was associated with increased hazards of cholangiocarcinoma (HR 3.715, 95% CI 1.899–7.268), hepatocellular carcinoma (HR 2.260, 95% CI 1.677–3.045), acute pancreatitis (HR 3.359, 95% CI 2.284–4.941), chronic pancreatitis (HR 3.086, 95% CI 1.975–4.821), pancreatic cysts (HR 2.160, 95% CI 1.493–3.127), hospitalization (HR 1.363, 95% CI 1.236–1.503), and all-cause mortality (HR 2.250, 95% CI 2.051–2.467). No statistically significant association was observed with pancreatic cancer (HR 1.591, 95% CI 0.766–3.303; log-rank p = 0.209). Mean follow-up after matching was 799.722 ± 391.071 days in the elevated GGT cohort and 844.685 ± 374.676 days in controls. Conclusions: Persistent GGT elevation was associated with hepatobiliary malignancies, pancreatic inflammatory diseases, pancreatic cysts, hospitalization, and all-cause mortality, but not pancreatic cancer. These results suggest that persistent GGT elevation may be a non-specific clinical marker of underlying hepatobiliary and metabolic risk.

Objective: To describe nationwide mortality patterns related to Alzheimer's disease and cerebrovascular disease in United States adults aged ≥65 years and explore future trend projections. Methods: In this retrospective study, we utilized the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database (ICD-10 G30, I60–I69) to calculate crude and age-adjusted mortality rates per 100,000 population. Temporal trends were modeled using Joinpoint regression, and 10-year forecasts were obtained using autoregressive integrated moving average models. Subgroup analyses were performed by sex, race/ethnicity, census region, urbanization, and place of death. Results: We identified 199,606 Alzheimer's disease–cardiovascular disease-related deaths. Overall, age-adjusted mortality rates peaked at 24.8 in 2002, reduced to 14.2 in 2013, and then rose to 18.7 in 2020 before dropping to 16.6 in 2023. Women exhibited higher age-adjusted mortality rates than men (20.1 vs. 16.0). Individuals of White and Black ethnicity bore the greatest burden, and the South and West recorded the highest regional age-adjusted mortality rates. These rates were consistently higher in non-metropolitan areas than in metropolitan areas. Exploratory projections estimate an overall age-adjusted mortality rate of 16.6 by 2033, with persistently higher rates in women, non-Hispanic Black populations, and among those residing in the West and non-metropolitan areas. Conclusions: Despite substantial decline since the early 2000s, Alzheimer's disease–cardiovascular disease mortality remains high and unevenly distributed. Exploratory projections suggest that the burden will remain substantial, underscoring the need for targeted prevention, vascular risk reduction, and equity-focused dementia care.

Background and aims: Pneumonia is a leading cause of death among Alzheimer’s disease (AD) patients, often due to complications like sepsis or respiratory failure. This study aims to analyze the joint mortality patterns of AD and pneumonia to provide an accurate update on the public health impact and help uncover modifiable factors that could mitigate the disease burden. Methods: In this retrospective observational study, deidentified CDC WONDER death certificate data (1999–2022) were analyzed for individuals aged 65+ with ICD-10 codes for AD (G30) and pneumonia (J09-J18). To identify cases of AD and pneumonia, death records from the Multiple Causes of Death Public Use registry were reviewed, with these conditions listed as either a contributing or underlying cause of death. Mortality rates were calculated, and trends were evaluated using the Joinpoint Regression Program (National Cancer Institute). Results: From 1999 to 2022, the overall mean age-adjusted mortality rate (AAMR) for AD- and pneumonia-related deaths was 21.33 (95% CI: 17.91–24.75). The AAMR declined significantly from 37 in 1999 to 11.32 in 2016 (APC: −7.20, 95% CI: −12.97 to −5.47; P = 0.03) and then remained stable until 2022 (APC: −0.79, P = 0.88). Males consistently had higher mortality (mean AAMR: 22.57) than females (20.39), with a notable decline in male AAMR from 42.36 in 1999 to 10.43 in 2022, and female AAMR from 33.81 to 8.58. Racial disparities were evident: NH Whites had the highest mean AAMR (22.21), followed by Hispanics (17.51), NH Blacks (14.81), and NH Asians (13.62). Regionally, the West had the highest AAMR (26.32), while the Northeast had the lowest (16.39). Metropolitan AAMR decreased significantly from 2004 to 2018 (APC: −8.41), while non-metropolitan areas showed a slower decline with a slight rise post-2018. Conclusion: Significant disparities in AD and pneumonia mortality highlight the need for targeted, community-focused interventions.