Sahil Jairamani

Cardiovascular disease remains the leading cause of death in the United States, with heart failure (HF) and hyperlipidemia substantially contributing to mortality. This study aimed to examine national trends in HF-related mortality with coexisting hyperlipidemia from 1999 to 2024 and project future mortality patterns through 2035. Mortality data were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Deaths were identified when heart failure and hyperlipidemia were listed on death certificates using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. standard population and were stratified by sex, race/ethnicity, census region, and urbanization level. Temporal trends were evaluated using joinpoint regression analysis. Forecasts for 2025–2035 were generated using machine learning-based Seasonal Autoregressive Integrated Moving Average (SARIMA) time-series models. From 1999 to 2024, 283,161 deaths involving HF with hyperlipidemia were recorded on death certificates. The AAMR increased from 0.7 to 6.8 per 100,000 population, with a notable increase after 2018. Mortality rates were higher among men than women and were elevated in the non-Hispanic Black and American Indian/Alaska Native populations. Higher rates were also observed in nonmetropolitan counties and in the Midwest and West regions of the United States. Mortality involving HF with hyperlipidemia has increased over the past two decades, with persistent demographic and geographic differences. These findings highlight the importance of continued surveillance and targeted prevention strategies to address the cardiovascular health disparities in the United States.

Background Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality in the United States. It can coexist with diabetes mellitus (DM) as they share metabolic, inflammatory, and lifestyle risk factors. Despite the clinical significance, national trends in CRC-related mortality among adults with DM remain unexplored. Methods We performed a retrospective analysis using U.S. national mortality data (1999–2025) to identify deaths with CRC (ICD-10: C18-C20) among diabetics (E10-E14) aged ≥ 45 years. Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) were calculated per 1,000,000. Trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), with 95% confidence intervals (CIs). Forecasting analyses estimated future mortality trends through 2040 using time-series projection methods. Results A total of 103,289 deaths were attributed to CRC and DM among adults aged ≥ 45 years (1999–2025). Overall mortality showed a non-significant decline (AAMR: 18.95 to 16.77; AAPC: -0.6; 95% CI: -1.3 to 0.09; P = 0.09). Men showed higher AAMRs (24.4 in 1999 to 22.1 in 2025) when compared to women (15.27 to 12.47). Older adults aged ≥ 65 years carried the greatest mortality burden, with CMR decreasing from 83.08 in 1999 to 63.96 in 2025 (AAPC: -1.2; 95% CI: -1.9 to -0.4; P = 0.002). Racially, NH Blacks had the highest AAMR (31.66 to 24.08). Regionally, the greatest mortality was observed in the South with AAMRs (16.11 to 20.12). The decedent’s home carried the most common place of death (37.5%). Forecasts project overall AAMR to reach 11.98 by 2040. Conclusion CRC and DM-related mortality demonstrated an overall declining trend and is projected to continue declining through 2040. Disparities among men, NH Blacks and older adults require refined strategies to improve outcomes.

Gastric cancer (GC) remains a major cause of cancer-related mortality worldwide, driven by multiple risk factors including infection, diet, genetics, and lifestyle behaviors. Tobacco use is a well-established modifiable risk factor that contributes to gastric carcinogenesis through chronic mucosal injury. This study aimed to evaluate long-term mortality trends of tobacco-associated GC among United States adults aged ≥ 25 years. We conducted a retrospective cross-sectional analysis using the CDC WONDER Multiple Cause of Death database from 2003 to 2023. Adults aged ≥ 25 years with GC (International Classification of Diseases, Tenth Revision: C16) and tobacco use disorder (International Classification of Diseases, Tenth Revision: F17) listed as underlying or contributing causes of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Temporal trends were assessed using Joinpoint regression, reporting annual percent change and average annual percent change (AAPC). A total of 17,357 deaths were attributed to tobacco-associated GC (overall AAMR: 0.34). Mortality was higher among males (AAMR: 0.58) compared with females (AAMR: 0.15), with comparable temporal trends (AAPC: 4.59% vs 4.58%, respectively). Overall AAMR increased significantly from 0.15 in 2003 to 0.40 in 2023 (AAPC: 4.60%; 95% confidence interval: 3.11–6.18). Across racial groups, non-Hispanic (NH) Black individuals exhibited the highest mortality burden (AAMR: 0.56). However, NH White individuals demonstrated the steepest relative increase over time (AAPC: 3.89%). Regionally, the Midwest had the highest mortality burden (AAMR: 0.45) and the fastest growth (AAPC: 7.33%). Nonmetropolitan areas showed higher mortality (AAMR: 0.45) and a greater increase (AAPC: 4.73%) than metropolitan areas (AAMR: 0.33; AAPC: 4.14%). Tobacco-associated GC mortality has increased significantly in the United States from 2003 to 2023. While NH Black individuals bear the greatest overall mortality burden, NH White individuals exhibit the steepest rise in mortality rates. Higher burden and growth in the Midwest and rural areas highlight persistent geographic disparities.

Background: Sepsis is a life-threatening condition that complicates major diseases like myeloid leukemia. Both conditions can lead to morbidity and mortality. Despite its clinical significance, trends in sepsis among myeloid leukemia patients remain understudied. Methods: Nationwide mortality records were obtained from the CDC-WONDER database for U.S. adults aged ≥25 with myeloid leukemia (ICD-10 code C92) and sepsis (ICD-10 codes A40, A41) from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated for variables. Joinpoint analysis was utilized to evaluate annual percent changes (APCs). Results: From 1999 to 2023, a total of 35,075 deaths were recorded. The overall AAMR showed a modest but statistically significant increase (0.62) per 100,000 (AAPC 0.31; 95% CI 0.09 to 0.53; p = 0.007). Males experienced higher AAMRs (AAPC: 0.17, 95% CI: -0.05 to 0.40; p = 0.113) than females (0.82 vs.0.48) (AAPC: 0.33, 95% CI: -0.01 to 0.67; p = 0.056). Time trends within each sex were not statistically significant. The highest overall AAMR was recorded among NH Blacks (0.68), followed by NH Whites (0.64). Regional AAMRs were similar; the Northeast showed the largest decline, while the West increased modestly. The overall AAMR was slightly higher in metropolitan areas (0.64) compared to non-metropolitan areas (0.60). Older adults aged ≥ 65 years consistently exhibited the highest CMRs (1.86). Most deaths occurred in inpatient medical facilities (88.80%). Conclusion: Trends in sepsis mortality among myeloid leukemia patients increased modestly. Higher trends observed in urban areas and NH Blacks. Declines were observed in the Northeast region.

Stroke and malnutrition remain significant contributors to preventable mortality in the United States. Stroke is a leading cause of death and disability, while malnutrition, often underrecognized, exacerbates neurological and systemic vulnerability. Characterizing long-term national and subgroup-specific mortality patterns is critical for guiding public health interventions. Mortality data for stroke and malnutrition were analyzed from 1999 to 2023 using the Centers for Disease Control and Prevention's Wide Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMR) per 1,000,000 population were calculated and stratified by sex, race/ethnicity, census region, state and urbanization status. Joinpoint regression estimated average annual percent change (AAPC) with 95% confidence intervals (CIs). From 1999 to 2023, 44,368 deaths were attributed to malnutrition and stroke. The overall AAMR rose from 12.11 in 1999 to 14.75 in 2023, with an overall AAPC of 0.88% (95% CI: -0.14 to 1.91). Males had higher AAMRs than females. By race, Non Hispanic (NH) Black experienced the greatest AAMRs, whereas NH Asian had the lowest rates. Regionally, the South showed the highest rate, whereas Northeast had the lowest. Nonmetropolitan areas exceeded metropolitan areas. At the state level, the highest rates were observed in South Dakota and Arkansas, while Massachusetts recorded the lowest rates. From 1999 to 2023, combined mortality from stroke and malnutrition increased modestly nationwide, with enduring disparities across demographics and geography. The highest burdens fell on NH Black individuals, people living in the South and nonmetropolitan areas, and certain central states. These findings highlight the need for region-specific prevention and better access to nutritional and neurological care.

Background: Ischemic heart disease (IHD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in IHD-related mortality among adults (> 25 years) from 1968 to 2023 using the CDC WONDER database. Methods: We analyzed death certificates of adults aged >25 years from the CDC-WONDER database with IHD (ICD-8 codes: 410-413, ICD-9 codes: 410-414 and ICD-10 codes: I20-I25) from 1968-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, and year. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC), complemented by spatiotemporal modeling to capture the geographic variations and evolving patterns of IHD mortality over time. Results: Between 1968 and 2023, IHD caused 27,685,173 deaths in adults aged >25 years. Throughout the study period, the overall AAMR demonstrated a sustained and significant decline, falling from 746.29 in 1968 to 127.07 in 2023 with an AAPC (−3.12; 95% CI: −3.51 to −2.73; p<0.001). Additionally, the overall AAMR for males (452.99) was higher than that of females (260.08). Non-Hispanic (NH) Black or African American displayed slightly higher AAMR (346.75) as compared to NH white (345.38). The Northeast had the highest overall AAMR (379.61), followed by the Midwest (351.31), the South (329.15), and the West (303.15). Older adults (≥65 years) had the highest overall crude mortality rate (CMR) (1312.66), followed by middle-aged adults (45–64 years) (171.67). Younger adults (25–44 years) had the lowest rate (12.18). Conclusion: Mortality rates due to IHD have decreased in the United States over the last few decades. However, the rate of decline has decreased in the past decade. In addition, significant disparities still exist across different sexes, age, race/ethnicity, and geographic regions. These disparities highlight the need for targeted interventions and improvement of clinical care facilities in high-risk populations.

Background: Ischemic heart disease (IHD) is a leading cause of mortality in the United States, with significant variations across demographic and geographic factors. This study analyzes trends in IHD-related mortality among adults (> 25 years) from 1968 to 2023 using the CDC WONDER database. Methods: We analyzed death certificates of adults aged >25 years from the CDC-WONDER database with IHD (ICD-8 codes: 410-413, ICD-9 codes: 410-414 and ICD-10 codes: I20-I25) from 1968-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, and year. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC), complemented by spatiotemporal modeling to capture the geographic variations and evolving patterns of IHD mortality over time. Results: Between 1968 and 2023, IHD caused 27,685,173 deaths in adults aged >25 years. Throughout the study period, the overall AAMR demonstrated a sustained and significant decline, falling from 746.29 in 1968 to 127.07 in 2023 with an AAPC (-3.12; 95% CI: -3.51 to -2.73; p<0.001). Additionally, the overall AAMR for males (452.99) was higher than that of females (260.08). Non-Hispanic (NH) Black or African American displayed slightly higher AAMR (346.75) as compared to NH white (345.38). The Northeast had the highest overall AAMR (379.61), followed by the Midwest (351.31), the South (329.15), and the West (303.15). Older adults (≥65 years) had the highest overall crude mortality rate (CMR) (1312.66), followed by middle-aged adults (45–64 years) (171.67). Younger adults (25–44 years) had the lowest rate (12.18). Conclusion: Mortality rates due to IHD have decreased in the United States over the last few decades. However, the rate of decline has decreased in the past decade. In addition, significant disparities still exist across different sexes, age, race/ethnicity, and geographic regions. These disparities highlight the need for targeted interventions and improvement of clinical care facilities in high-risk populations.

Introduction: Cutaneous toxicities are common and distressing complications of cancer therapy, impairing quality of life (QoL), treatment adherence, and psychological well-being. Despite their high prevalence, management has historically relied on supportive measures with limited efficacy. Recognizing skin health as integral to supportive oncology, this review highlights novel pharmacological strategies that may improve outcomes and reduce treatment interruptions. Areas covered: We conducted a literature search (PubMed, Embase, Cochrane; 2015–2025) to synthesize evidence on skin toxicities across chemotherapy, targeted therapies, immunotherapy, and radiotherapy. We discuss pathophysiological mechanisms underlying these toxicities and emerging pharmacological interventions, including biologics (dupilumab, JAK inhibitors), barrier-repair agents, antioxidants, advanced topical and systemic formulations, and repurposed drugs. Special attention is given to vulnerable populations—patients with darker skin phototypes, those in low- and middle-income countries (LMICs), and pediatric/geriatric oncology patients—where equity gaps in evidence and access are most pressing. Expert opinion: Dermatologic adverse events are no longer secondary concerns; they represent a central component of supportive oncology. Innovative, mechanism-based pharmacological approaches hold promise to transform management, but robust randomized controlled trials remain limited. Future directions include biomarker-driven prevention, integration of digital toxicity monitoring, and global equity–focused guidelines. Prioritizing dermatologic health alongside oncologic efficacy can help preserve treatment intensity, minimize hospitalizations, and enhance patient quality of life worldwide