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. 2025 May 25;15(6):852.
doi: 10.3390/life15060852.

Trends in Liver Cirrhosis and Diabetes-Related Mortality Among Adults in the United States: A CDC WONDER Database Analysis (1999-2020)

Manahil Irfan  1 , Rameesha Ahmad  1 , Mariam Arshad Ahmed  1 , Ayan Mohammed Khan  1 , Zoya Aamir  2 , Rayaan Imran  2 , Raheel Ahmed  3
Affiliations

Trends in Liver Cirrhosis and Diabetes-Related Mortality Among Adults in the United States: A CDC WONDER Database Analysis (1999-2020)

Manahil Irfan et al. Life (Basel). .

Abstract

Background: The burden of liver cirrhosis correlated with diabetes mellitus (DM) poses a significant public health challenge in the United States. Both conditions independently contribute to high morbidity and mortality rates. While extensive individual analyses have been conducted, US trends in comorbid liver cirrhosis-DM-related mortality remain unexplored. This study seeks to investigate mortality trends associated with the simultaneous occurrence of liver cirrhosis and DM among U.S. adults over the period from 1999 to 2020. Methods: We conducted a descriptive analysis using publicly available mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using the 2000 U.S. standard population. Trends were stratified by year, age, sex, race/ethnicity, urbanization, region, and state. Joinpoint regression analysis was employed to determine annual percentage changes (APCs) and assess statistical significance (p < 0.05). Results: A total of 90,418 deaths were recorded among adults with both cirrhosis and DM between 1999 and 2020. The overall AAMR increased from 1.02/100,000 in 1999 to 1.78/100,000 in 2020, reflecting a significant upward trend in mortality. The highest mortality rates were observed in non-metropolitan regions, in the South, and among males, older adults (65+), and NH American Indian or Alaska Native and Hispanic populations. All demographic groups exhibited a pronounced mortality surge between 2018 and 2020. A state-level analysis revealed notable disparities, with Oklahoma and Texas presenting the highest AAMRs. Conclusions: Liver cirrhosis and diabetes-related mortality have been steadily increasing over the past two decades, with notable disparities in demographics and regions. These findings underscore the urgent necessity for targeted prevention, early intervention, and policy-level strategies specifically designed for high-risk populations to reduce future mortality rates in the US and ultimately, globally.

Keywords: United States CDC WONDER; chronic liver disease; diabetes mellitus; liver cirrhosis; mortality trends.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Yearly Age-Adjusted Mortality Rate.
Figure 2
Figure 2
Age-Adjusted Mortality Rate Stratified by Gender.
Figure 3
Figure 3
Age-Adjusted Mortality Rate Stratified by Race.
Figure 4
Figure 4
Age-Adjusted Mortality Rate Stratified by Age Groups.
Figure 5
Figure 5
Age-Adjusted Mortality Rate Stratified by Urbanization.
Figure 6
Figure 6
Age-Adjusted Mortality Rate Stratified by Census Region.
Figure 7
Figure 7
Age-Adjusted Mortality Rate Stratified by State.
Figure 8
Figure 8
Trends in Liver Cirrhosis and Diabetes-Related Mortality Among Adults in the U.S.
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