Diabetes- and CVD-Related Mortality Rise after Steady 10-Year Decline

While the overall age-adjusted mortality rate for diabetes and cardiovascular disease (CVD) declined between 1999 and 2019, researchers found an average annual 1% increase since 2014.

Following a decade-long decrease in diabetes- and CVD–related mortality, new research published in The American Journal of Medicine shows this trend has reversed.

According to the study, the overall age-adjusted mortality rate for diabetes and CVD was 99.18 in 1999 and 91.43 in 2019. While this still shows an overall decrease in mortality, researchers found an average annual percent change (AAPC) of 1.0% between 2014 and 2019 (95% CI, 0.3-1.6).

“Most notably, we found that while the cardiovascular disease (alone)-related mortality rates have relatively plateaued after years of decline, the diabetes mellitus-related mortality trends have reversed in the last decade,” the researchers wrote. “This is important from a public health point of view, as diabetes mellitus increases the risk of other noncardiovascular complications as well, and better population-level control of diabetes may have far-reaching positive effects on life expectancy.”

To come to these findings, the researchers used data from the CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER) database, which has been previously used to determine CVD mortality trends. The WONDER database helped them identify adults aged 25 years and older who had both diabetes and CVD recorded as an underlying or contributing cause of death between 1999 and 2019. The researchers then determined crude and age-adjusted mortality rates per 100 000 population.

FINDINGS

They found that the age-adjusted mortality rate for both conditions was higher among men compared with women, with an AAPC of 1.5% for men between 2014 and 2019 (95% CI, 0.9-2.0). Based on race and ethnicity, age-adjusted mortality was highest for non-Hispanic Black adults and was about 2 times higher compared with non-Hispanic White adults.

When stratified by age groups, the age-adjusted mortality rates increased for young and middle-aged adults in recent years. Among individuals aged 25-39 years, the mortality rate for diabetes and CVD combined increased annually by 4.4% between 1999 and 2003 and continued to increase by 1.6% annually between 2010 and 2019 (95% CI, 0.9-2.2).

Similarly, individuals aged 40-54 saw an AAPC of 2.0% (95% CI, 1.6-2.4) between 2012 and 2019, and individuals aged 55-69 had an AAPC of 1.5% (95% CI, 0.9-2.1) between 2014 and 2019.

“These findings may be secondary to the rising rates of obesity, smoking, substance use, and other cardiovascular comorbidities among young adults,” the researchers said. “Further, despite high levels of cardiometabolic risk factors among younger adults, they may be less knowledgeable about their comorbidities and may be less likely to seek primary preventative care, which leads to excess premature mortality.”

These findings may be secondary to the rising rates of obesity, smoking, substance use, and other cardiovascular comorbidities among young adults. Further, despite high levels of cardiometabolic risk factors among younger adults, they may be less knowledgeable about their comorbidities and may be less likely to seek primary preventative care, which leads to excess premature mortality.

Demographics

The study also revealed significant disparities in age-adjusted mortality rates between individuals living in urban vs rural areas. Mortality rates in rural US counties increased 2.2% annually from 2014 to 2019 (95% CI, 1.5-2.9).

Across states, age-adjusted mortality rates varied widely, ranging from 62.98 to 141.8. States in the 90th percentile of mortality—Ohio, West Virginia, Mississippi, and Oklahoma—had age-adjusted mortality rates approximately 2 times higher than states in the bottom 10th percentile—Nevada, Massachusetts, Arizona, and Connecticut.

“The demographic and regional variations might have emerged from different clinical and social determinants of health among patients,” the researchers said. “Targeted health policy interventions are needed to prevent the loss of years of progress, with a focus on prevention, early diagnosis, and reduction in disparities.”

When looking at age-adjusted mortality rates for diabetes alone, these rates initially decreased between 2003 and 2013 with an AAPC of 1.4% (95% CI, 1.6-1.2). However, this was followed by a 0.7% annual increase between 2014 and 2019 (95% CI, 0.1-1.3).

The study also briefly covered age-adjusted mortality rates for 2020. For diabetes-related mortality alone, rates increased from 107 in 2019, to 144.5 in 2020. For CVD-related mortality, these rates increased from 595.6 in 2019, to 691.0 in 2020. Meanwhile, mortality rates for both conditions combined increased from 91.4 in 2019, to 121.3 in 2020.

Source: Jain V, Minhas AMK, Ariss RW, et al. Demographic and regional trends of cardiovascular diseases and diabetes mellitus-related mortality in the United States from 1999 to 2019. Am J Med. 2023;136(7):659-668.e7. doi:10.1016/j.amjmed.2023.03.002