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: Whether the fatal and non-fatal composition of aggregate pancreatitis burden has changed over time remains unclear. We assessed long-term changes in the fatal-to-non-fatal composition of aggregate pancreatitis burden using Global Burden of Disease (GBD) 2023 estimates. Methods: We conducted a systematic descriptive and trend analysis using publicly available estimates from the GBD 2023 Results Tool for incidence, prevalence, deaths, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) across 204 countries and territories from 1990 to 2023. Because GBD reports pancreatitis as an aggregate cause category, the analysis could not distinguish acute pancreatitis, recurrent acute pancreatitis, chronic pancreatitis, or acute exacerbations of chronic pancreatitis. Primary analyses used age-standardised rates per 100,000 population. Four burden–composition metrics were derived within each location–year stratum: the YLL:YLD ratio, YLD:DALY proportion, deaths-to-incidence ratio, and prevalence-to-incidence ratio. Temporal trends were modelled in R version 4.5, using segmented regression, with up to three joinpoints selected by a Bayesian information criterion. Results: Globally, all six age-standardised native GBD measures declined between 1990 and 2023. The age-standardised incidence rate decreased from 37.62 (95% UI 32.20–43.11) to 32.91 (28.84–37.17) per 100,000, prevalence from 93.78 (69.26–126.25) to 68.92 (52.53–90.32), deaths from 1.76 (1.49–2.16) to 1.40 (1.21–1.66), YLDs from 5.70 (2.75–9.45) to 4.34 (2.18–7.04), YLLs from 55.96 (46.50–69.72) to 43.60 (36.89–53.53), and DALYs from 61.66 (50.62–75.61) to 47.94 (40.57–58.16). However, the fatal-to-non-fatal composition changed little: the global YLL:YLD ratio was 9.82 in 1990 and 10.04 in 2023, while the YLD share of DALYs was 0.092 and 0.091, respectively. Joinpoint modelling showed fluctuation rather than a sustained shift toward disability-dominant burden: the global YLL:YLD ratio was stable until 1998, increased from 1998 to 2002 (annual percent change [APC] 1.38%, 95% CI 0.42 to 2.36), and then declined modestly thereafter (APC −0.13%, −0.20 to −0.06). Burden remained higher in males, whereas females had a greater non-fatal share of total burden (YLD:DALY in 2023: 0.134 vs. 0.073). All sociodemographic index strata remained mortality-dominant in both 1990 and 2023; low-SDI settings had the greatest fatal dominance (YLL:YLD 34.94 in 1990; 24.72 in 2023). Using a descriptive YLD:DALY ≥ 0.50 benchmark, 203 of 204 countries and territories remained below the disability-dominant threshold in both years, no country crossed from below to above this benchmark, and only Georgia moved from above to below the benchmark. Conclusions: Despite declines in global incidence, mortality, and DALY rates, the aggregate GBD pancreatitis burden remained overwhelmingly mortality-dominant from 1990 to 2023. Because GBD pancreatitis combines acute and chronic pancreatitis, this finding should be interpreted as describing the modelled aggregate pancreatitis cause category rather than proving subtype-specific mortality dominance. The intensity of fatal dominance varied by sex, SDI, region, age, and country, but a structural shift toward disability-dominant aggregate burden was not observed.

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: Gastric cancer remains one of the leading causes of death globally and a major health concern. This study aims to analyze gastric cancer-related mortality trends over 2 decades. Methods: The CDC WONDER database was used to analyze and stratify de-identified death certificates from 1999 to 2022 across the United States. Trends in age-adjusted mortality rates (AAMR) were assessed using the Joinpoint Regression Program to determine annual percentage changes. Results: Overall, AAMR decreased from 79.26 in 1999 to 44.81 in 2022. Men and older adults had the highest AAMRs. Non-Hispanic (NH) Black or African Americans had the highest AAMR, while NH Whites had the lowest. Geographically, the Northeast had the highest AAMR, and metropolitan areas had higher AAMRs than nonmetropolitan areas. Conclusion: Gastric carcinoma has a poor prognosis, and although the general trend is decreasing across all sociodemographic areas, further research is required for targeted interventions and health policies for high-risk populations.

Background: Stroke, a major cause of death and disability, is closely linked to hypertension. This study analyzes trends in mortality from stroke with hypertension as a contributing factor in adults aged 65+ in the U.S. over the past two decades. Methods: Data were extracted from the CDC WONDER database for 2000-2023, focusing on deaths from hypertension-related stroke. Mortality rates were calculated using both crude and age-adjusted mortality rates (AAMRs). Joinpoint regression was used to calculate annual percent changes (APC). Results: From 2000 to 2023, 356,432 deaths were recorded due to hypertension-related stroke. The age-adjusted mortality rate (AAMR) decreased from 48.7 in 2000 to 19.4 in 2023. Mortality rates declined steadily, with a slight increase from 2018 to 2021 (APC: 0.53), followed by a sharp decline from 2021 to 2023 (APC: -11.09). In females, the AAMR decreased from 51.9 in 2000 to 19.8 in 2023, with the largest decline from 2012 to 2018 (APC: -7.12). In males, the AAMR dropped from 41.1 in 2000 to 18.3 in 2023, with a notable decrease from 2012 to 2018 (APC: -6.39). For racial groups, the AAMR for Black or African American individuals decreased from 85.7 in 2000 to 29.2 in 2023, for White individuals from 45.4 to 18.8, and for Hispanic individuals from 42.9 to 16.6. Regional trends showed significant declines in the Midwest (APC: -6.64), Northeast (APC: -5.15), and West (APC: -11.51). Conclusion: Hypertension-related stroke mortality has significantly declined, though disparities persist, especially among racial minorities and non-metropolitan areas. Continued targeted public health efforts are necessary to address these disparities and further reduce mortality.