Trends and Disparities in Mortality Due to Coexisting Diabetes Mellitus and Chronic Obstructive Pulmonary Disease Among Adults in the United States (1999 to 2023): Insights From the CDC WONDER Database.

Abstract

Objective: Diabetes mellitus (DM) and chronic obstructive pulmonary disease (COPD) are major health concerns in the United States, and both contribute significantly to mortality. However, trends in mortality due to their co-occurrence from 1999 to 2023 remain underexplored. We therefore examined these trends and associated demographic and geographic disparities.

Methods: This study used data from the CDC WONDER database, focusing on death certificates with both DM and COPD listed as causes. We analyzed deaths among individuals aged 35 years and older, categorized by demographic (age, sex, race/ethnicity) and geographic factors. Crude mortality rates and age-adjusted mortality rates (AAMRs) were calculated. Joinpoint regression analysis was used to assess mortality trends, with the annual percent change and average annual percent change determining rate shifts across time periods.

Results: From 1999 to 2023, the AAMR for DM and COPD increased 1.5 times, peaking in 2021 before declining by 2023. Significant increases in mortality were observed across sexes, with males consistently having higher rates. Racial disparities were evident, with non-Hispanic Black and American Indian populations experiencing higher AAMRs. Age group analysis revealed a sharp rise in mortality among older adults, particularly those aged 65 years and older. Geographically, rural areas exhibited higher AAMRs than metropolitan regions, with the South having the highest mortality rates.

Conclusions: The mortality burden from coexisting DM and COPD has significantly increased in the past 2 decades, particularly among older adults and certain racial/ethnic groups. These findings highlight the need for targeted public health interventions and health-care strategies to address these disparities.