Demographic trends and disparities in mortality related to coexisting heart failure and diabetes mellitus among older adults in the United States between 1999 and 2020: A retrospective population-based cohort study from the CDC WONDER database

Abstract

Background: Heart Failure (HF) and Diabetes Mellitus (DM) often coexist, and each condition independently increases the likelihood of developing the other. While there has been concern regarding the increasing burden of disease for both conditions individually over the last decade, a comprehensive examination of mortality trends and demographic and regional disparities needs to be thoroughly explored in the United States (US).

Methods: This study analyzed death certificates from the CDC WONDER database, focusing on mortality caused by the co-occurrence of HF and DM in adults aged 75 and older from 1999 to 2020. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were computed and categorized by year, gender, race, census region, state, and metropolitan status.

Results: A total of 663,016 deaths were reported in patients with coexisting HF and DM. Overall, AAMR increased from 154.1 to 186.1 per 100,000 population between 1999 and 2020, with a notable significant increase from 2018 to 2020 (APC: 11.30). Older men had consistently higher AAMRs than older women (185 vs. 135.4). Furthermore, we found that AAMRs were highest among non-Hispanic (NH) American Indian or Alaskan natives and lowest in NH Asian or Pacific Islanders (214.4 vs. 104.1). Similarly, AAMRs were highest in the Midwestern region and among those dwelling in non-metropolitan areas.

Conclusions: Mortality from HF and DM has risen significantly in recent years, especially among older men, NH American Indian or Alaska Natives, and those in non-metropolitan areas. Urgent policies need to be developed to address these disparities and promote equitable healthcare access.

Keywords: COVID-19; Coexistence; Diabetes; Heart failure; Mortality; Older adults.

Graphical abstract

Fig. 1

Overall and Sex-Stratified Heart Failure and Diabetes Mellitus-related Age-Adjusted Mortality Rates per 100,000 in Older Adults in the United States, 1999 to 2020. * Indicates that the annual percentage change (APC) is significantly different from zero at α = 0.05. AAMR = age-adjusted mortality rate; APC = annual percent change; CI = confidence interval.

Fig. 2

Heart Failure and Diabetes Mellitus-related Age-Adjusted Mortality Rates per 100,000, Stratified by Race in Older Adults in the United States, 1999 to 2020 * Indicates that the APC is significantly different from zero at α = 0.05. Abbreviations as in Fig. 1.

Fig. 3

Heart failure and diabetes mellitus-related age-adjusted mortality rates per 100,000, stratified by State in older adults in the United States, 1999 to 2020.

Fig. 4

Heart Failure and Diabetes Mellitus-related Age-Adjusted Mortality Rates per 100,000, Stratified by Census Regions in Older Adults in the United States, 1999 to 2020 * Indicates that the APC is significantly different from zero at α = 0.05. Abbreviations as in Fig. 1.

Fig. 5

Heart Failure and Diabetes Mellitus-related Age-Adjusted Mortality Rates per 100,000 in Older Adults in the Metropolitan and Non-metropolitan areas in the United States, 1999 to 2020 * Indicates that the APC is significantly different from zero at α = 0.05. Abbreviations as in Fig. 1.

Fig. 6

(A) Heart Failure and (B) Diabetes Mellitus-related Age-Adjusted Mortality Rates per 100,000 in the United States among older adults, 1999–2020 * Indicates that the APC is significantly different from zero at α = 0.05. Abbreviations as in Fig. 1.