Malnutrition Mortality Among Older Adults by County and Race and/or Ethnicity in the United States, 2000–2019

Background

Older adults are at an increased risk of malnutrition due to chronic diseases and social vulnerabilities. This study estimates protein-energy malnutrition mortality rates among adults aged 65–74 and ≥ 75 by race and ethnic population group and county.

Methods

We analyzed death data from the National Vital Statistics System and population data from the National Center for Health Statistics from 2000 to 2019. We calculated county-level mortality rates using small-area estimation methods, adjusting for misclassifications in death certificates. The primary outcome was deaths attributed to malnutrition. The exposures were to populations (American Indian/Alaskan Native [AIAN], Asian, Black, Hispanic/Latino, and White) and the county.

Results

From 2000 to 2019, malnutrition mortality rates increased in individuals aged ≥ 75 from 19.5 (95% uncertainty interval [UI]: 18.8–20.1) to 49.2 (48.4–50.0) deaths per 100,000, and in those aged 65–74 from 2.2 (2.0–2.3) to 4.6 (4.4–4.7). In 2019, Black individuals had the highest national mortality rates: 60.8 (58.2–63.3) for ≥ 75 years and 7.7 (7.3–8.2) for 65–74 years. In 2019, a county in Georgia had the highest rate for White individuals aged ≥ 75 at 334.9 (236.6–464.8), and a county in Montana had the highest for AIAN individuals aged 65–74 at 34.9 (13.1–72.0). Counties in the New York metro had the lowest mortality rates across all population groups and ages.

Conclusion

Malnutrition mortality rates have increased among older adults, varying by geography and population group, underscoring the need for targeted nutritional interventions.