Epidemiological Trends and Demographic Disparities in Type 1 Diabetes-related Mortality in the United States (1999-2020): A CDC WONDER Analysis - 09/01/26

Doi : 10.1016/j.deman.2026.100300

Shahzaib Khan ¹, Fatima Najam ¹, Rawdah Shakil ², Momina Javed ³, Talha Anwar ⁴, Sabin Zafar ⁵, Amna Rizwan ⁶, Hajrah Munir ⁷, Maryam Butt ¹, Muhammad Wahaj Pirzada ⁸, Ishaque Hameed ⁹, Rida Shakeel ⁹, Dr Asraf Hussain ^10,^⁎
¹ Department of Medicine, King Edward Medical University, Lahore, Pakistan
² Department of Medicine, Dow International Medical College, Karachi, Pakistan
³ Department of Medicine, Abbottabad International Medical & Dental College, Abbottabad, Pakistan
⁴ Department of Medicine, Khyber Medical College, Peshawar, Pakistan
⁵ Department of Family Medicine, University of Manitoba, Canada
⁶ Department of Medicine, Federal Medical and Dental College, Islamabad, Pakistan
⁷ Department of Medicine, Ziauddin Medical College, Karachi, Pakistan
⁸ Department of Medicine, Jinnah Medical and Dental College, Karachi, Pakistan
⁹ Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
¹⁰ Department of Cardiology, Chitwan Medical College, Bharatpur, Nepal

^⁎Corresponding Author: Dr Asraf Hussain, Department of Cardiology, Chitwan Medical College, NepalDepartment of CardiologyChitwan Medical CollegeNepal

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Highlights

•	AAMRs declined from 117.9 to 35.1 with an average APC of -5.7 (95% CI: -6.4 to -5.4).
•	Males consistently had higher mortality rates than females (58.7 vs. 46.9).
•	NH Blacks had the highest AAMR (77.0), 1.5 times greater than NH Whites (52.4).
•	AAMR declined across all age groups, but mortality increased in younger adults from 2014 onward.
•	Geographically, rural areas and the Midwest region had the highest AAMRs, 72.4 and 64, respectively. States in the 90th percentile were West Virginia, Rhode Island, Kansas, Ohio, and Tennessee
•	Although overall mortality declined, disparities persist, urging the need for targeted research and interventions.

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Abstract

Context

Type 1 Diabetes (T1D) accounts for 5-10 of diabetes cases. Previous studies have shown declining T1D mortality, but comprehensive US data on demographic and geographic disparities are lacking.

Objective

To assess demographic and regional trends in T1D-related mortality among adults in the U.S

Methods

Death certificates (1999–2020) from the CDC WONDER database were analyzed for T1D-related mortality in adults aged ≥25 years. Age-adjusted mortality rates (AAMR) per million persons (95% CIs) and annual percentage change (APC) were calculated.

Results

From 1999 to 2020, 247,303 T1D-related deaths occurred in the US, with most deaths occurring in medical facilities (43.9%). AAMRs declined from 117.9 in 1999 to 35.1 in 2020, reflecting an overall 70.2% decrease. Males consistently had higher mortality rates than females (58.7 vs. 46.9). NH Blacks had the highest AAMR (77.0), 1.5 times greater than NH Whites (52.4), while NH Asian or Pacific Islanders had the lowest (18.4). AAMR declined across all age groups, but mortality increased in younger adults from 2014 onward. Rural areas had the highest AAMRs (72.4) compared to medium-small (55.7) and large metropolitan areas (43.9). The Midwest had the highest AAMR (64), while the West had the lowest (42.6). States in the 90th percentile were West Virginia, Rhode Island, Kansas, Ohio, and Tennessee which had rates four times higher than the 10th percentile states.

Conclusion

Overall mortality has declined, but disparities remain, with higher AAMRs in males, NH Blacks, younger adults, and rural areas. These findings underscore the need for targeted research and interventions.

Le texte complet de cet article est disponible en PDF.