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. 2025 Jul;4(7):101882.
doi: 10.1016/j.jacadv.2025.101882. Epub 2025 Jun 18.

Type 2 Diabetes Mellitus-Related Mortality in the United States, 1999 to 2023

Mushood Ahmed  1 , Eeshal Zulfiqar  2 , Aimen Shafiq  2 , Maryam Shahzad  2 , Tallal Mushtaq Hashmi  1 , Raheel Ahmed  3 , Jamal S Rana  4 , Stephen Sidney  5 , Stephen J Greene  6 , Robert J Mentz  6 , Marat Fudim  6 , Gregg C Fonarow  7
Affiliations

Type 2 Diabetes Mellitus-Related Mortality in the United States, 1999 to 2023

Mushood Ahmed et al. JACC Adv. 2025 Jul.

Abstract

Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased in the United States, contributing significantly to morbidity and mortality.

Objectives: This study analyzes trends in T2DM-related mortality focusing on demographic and regional disparities.

Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized to extract death certificate data for adults aged 25 and older from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Temporal trends were assessed by calculating the annual percent change using Joinpoint regression analysis.

Results: From 1999 to 2023, a total of 2,031,626 deaths were attributed to T2DM in the United States. The AAMR more than doubled from 21.54 per 100,000 in 1999 to 53.95 per 100,000 in 2023 with a pronounced increase between 2018 and 2021 (AAMR: 62.7 in 2021, annual percent change: 16.06%; 95% CI: 11.84-19.66). Males had considerably higher AAMR than females (68.82 vs 42.48 in 2023). Among racial and ethnic groups, Hispanic or Latino populations had the highest AAMR in 2023 (69.69), followed by non-Hispanic Black or African American (65.45), non-Hispanic other populations (53.7), and non-Hispanic White group (49.98). The Western region of the United States showed the highest AAMR (78.29), and rural areas consistently had higher mortality rates compared to urban areas (69.88 vs 55.32 in 2020). From 1999 to 2023, cardiovascular disease accounted for 626,706 deaths among adults with T2DM.

Conclusions: T2DM-related mortality has increased substantially over the time in the United States, with a peak observed between 2018 and 2021, emphasizing the need for targeted interventions.

Keywords: CDC WONDER; cardiovascular; mortality; type 2 diabetes mellitus.

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Conflict of interest statement

Funding support and author disclosures Dr Fonarow has received personal fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer outside the submitted work. Dr Fudim has received personal fees from Alleviant, Ajax, Alio Health, Alleviant, Artha, Audicor, Axon Therapies, Bayer, Bodyguide, Bodyport, Boston Scientific, Broadview, Cadence, Cardioflow, Cardionomics, Coridea, CVRx, Daxor, Deerfield Catalyst, Edwards Lifesciences, Echosens, EKO, Feldschuh Foundation, Fire1, FutureCardia, Galvani, Gradient, Hatteras, HemodynamiQ, Impulse Dynamics, Intershunt, Medtronic, Merck, NIMedical, NovoNordisk, NucleusRx, NXT Biomedical, Orchestra, Pharmacosmos, PreHealth, Presidio, Procyreon, ReCor, Rockley, SCPharma, Shifamed, Splendo, Summacor, SyMap, Verily, Vironix, Viscardia, and Zoll; and has received grants from the National Institutes of Health, Doris Duke, outside the submitted work. Dr Mentz has received research support and honoraria from Abbott, American Regent, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Fast BioMedical, Gilead, Innolife, Eli Lilly, Medtronic, Medable, Merck, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Relypsa, Respicardia, Roche, Rocket Pharmaceuticals, Sanofi, Verily, Vifor, Windtree Therapeutics, and Zoll. Dr Greene has received research support from the Duke University Department of Medicine Chair's Research Award, American Heart Association, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Otsuka, Pfizer, and Sanofi; has served on advisory boards or as consultant for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corcept, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Eli Lilly, Lexicon, Merck, Novo Nordisk, Otsuka, Roche Diagnostics, Sanofi, scPharmaceuticals, Tricog Health, and Urovant Pharmaceuticals; and has received speaker fees from AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Lexicon, and Roche Diagnostics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Type 2 Diabetes Mortality by Sex in the United States, 1999 to 2023 Age-adjusted mortality rates (AAMRs) per 100,000 individuals are shown for overall and sex-stratified populations in the United States from 1999 to 2023. APC = annual percent change.
Central Illustration
Central Illustration
Trends in Type 2 Diabetes Mortality in the United States, 1999 to 2023 This central illustration summarizes the trends in age-adjusted mortality rates (AAMRs) related to type 2 diabetes mellitus in the United States from 1999 through 2023. The data highlight persistent disparities based on sex, race/ethnicity, and urbanization status. Despite advancements in diabetes care, mortality remains high, particularly among certain vulnerable populations. NH = non-Hispanic; T2DM = type 2 diabetes mellitus.
Figure 2
Figure 2
Type 2 Diabetes Mortality by Race/Ethnicity in the United States, 1999 to 2023 This figure presents age-adjusted mortality rates (AAMRs) per 100,000 individuals stratified by race/ethnicity, including non-Hispanic (NH) White, NH Black, Hispanic, and NH others, from 1999 to 2023. Abbreviation as in Figure 1.
Figure 3
Figure 3
Type 2 Diabetes Mortality by Urbanization Level, 1999 to 2020 This figure presents age-adjusted mortality rates (AAMRs) per 100,000 individuals across different levels of urbanization (urban vs rural) in the United States from 1999 to 2020.∗Data for urbanization AAMRs were unavailable for 2021 to 2023. Abbreviation as in Figure 1.
Figure 4
Figure 4
Cardiovascular Mortality Among Adults With Type 2 Diabetes, 1999 to 2023 This figure shows age-adjusted mortality rates (AAMRs) per 100,000 individuals for cardiovascular disease mortality among adults diagnosed with type 2 diabetes in the United States from 1999 to 2023. Abbreviation as in Figure 1.
See this image and copyright information in PMC

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