The Burden of Diabetes Mortality by County, Race, and Ethnicity in the U.S., 2000-2019

Abstract

Objective: Diabetes is a leading cause of death in the U.S. Previous studies have found substantial racial, ethnic, and geographical disparities in diabetes mortality; however, research considering racial, ethnic, and geographical disparities simultaneously has been limited. To fill this gap, we estimated trends in diabetes mortality rates from 2000 to 2019 at the county level for five racial and ethnic populations.

Research design and methods: We applied small-area estimation methods to death registration data from the U.S. National Vital Statistics System and population data from the U.S. National Center for Health Statistics and corrected for misclassification of race and ethnicity on death certificates.

Results: Age-standardized diabetes mortality rates decreased in the U.S. from 28.1 deaths per 100,000 (95% uncertainty interval 27.9-28.2) in 2000 to 19.1 deaths per 100,000 (19.0-19.2) in 2019. In 2019, national-level rates were highest for the American Indian or Alaska Native (AIAN) population (35.6 [32.1-39.4]), followed by the Black (31.9 [31.5-32.3]), Latino (19.7 [19.3-20.2]), White (17.6 [17.5-17.8]), and Asian (12.6 [12.1-13.1]) populations. There was substantial heterogeneity in diabetes mortality rates across counties within each racial and ethnic population, with the AIAN population experiencing the greatest heterogeneity in 2019 (interquartile range 18.7-50.3 [median 31.9]). For each racial and ethnic population, mortality rates declined in most counties from 2000 to 2019.

Conclusions: Since 2000, progress has been made in reducing diabetes mortality rates. Nonetheless, diabetes mortality remains too high for many Americans. Interventions focusing on communities at highest risk are vital to resolving persistent health inequities.

Graphical abstract

Figure 1

National estimated age-standardized diabetes mortality rates from 2000 to 2019, by racial and ethnic population. Shaded areas indicate 95% UIs.

Figure 2

Estimated age-standardized diabetes mortality rates in 2019, by county and racial and ethnic population. Estimates have been masked (shown in white) for counties and racial and ethnic populations with a mean annual population fewer than 1,000 people, because model performance declined notably below this threshold.

Figure 3

Percent change in estimated age-standardized diabetes mortality rates from 2000 to 2019, by county and racial and ethnic population. Estimates have been masked (shown in white) for counties and racial and ethnic populations with a mean annual population fewer than 1,000 people, because model performance declined notably below this threshold. Inset maps show where the change in mortality rates was statistically significant.

Figure 4

Percent change in estimated age-standardized diabetes mortality rates from 2000 to 2005, 2005 to 2013, and 2013 to 2019, by county and racial and ethnic population. Estimates have been masked (shown in white) for counties and racial and ethnic populations with a mean annual population fewer than 1,000 people, because model performance declined notably below this threshold. Inset maps show where the change in mortality rates was statistically significant.