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Review
. 2025 Sep;8(5):e70083.
doi: 10.1002/edm2.70083.

Disparities in Peripheral Circulatory Complication-Related Mortality in Type 2 Diabetes Mellitus Patients: A CDC Analysis (1999-2020)

Iqra Shahid  1 , Hadia Ahmad  1 , Saad Ashraf  2 , Qasim Mehmood  1   3   4 , Azka Ijaz  1 , Suraksha Rani  5 , Sara Sohail  1 , Shameer Iqbal Ghuman  1 , Mahnoor Fatima  1 , Minaam Farooq  1 , Hafsa Shahid  6 , Minhal Chaudhry  1 , Aayush Chaulagain  7
Affiliations
Review

Disparities in Peripheral Circulatory Complication-Related Mortality in Type 2 Diabetes Mellitus Patients: A CDC Analysis (1999-2020)

Iqra Shahid et al. Endocrinol Diabetes Metab. 2025 Sep.

Abstract

Introduction: Peripheral circulatory complication (PCC), a significant complication of type 2 diabetes mellitus (T2DM), poses a considerable mortality burden in the United States. This study aimed to analyse demographic and geographic disparities in PCC-related mortality in T2DM patients from 1999 to 2020.

Methods: Utilising the CDC WONDER database, we utilised death certificates to identify PCC-related deaths using ICD-10 Code E11.5 and calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals. Joinpoint regression analysis was used to assess annual percent changes (APCs) in mortality rates.

Results: PCC caused 81,793 deaths. The AAMR increased from 1999 to 2004 (APC: 5.88, 95% CI: 2.44 to 12.70), followed by a decrease from 2004 to 2014 (APC: -3.70, 95% CI: -5.83 to -2.45), and an increase again until 2020 (APC: 8.34, 95% CI: 6.05 to 11.50). Males consistently exhibited higher mortality rates (AAMR: 11.08, 95% CI: 11.00 to 11.6) than females (AAMR: 8.34, 95% CI: 8.26 to 8.43). Racial/ethnic disparities were evident, with American Indian or Alaskan natives showing the highest AAMR (19.76) compared to Asian or Pacific Islanders (6.11). Geographic disparities were observed, with the Midwest region (AAMR: 12.86) and West Virginia (AAMR: 18.52) exhibiting significantly higher mortality rates.

Conclusion: Mortality trends associated with PCC in T2DM patients have shown complex trajectories, with notable disparities across demographic and geographic lines. Further research is needed to comprehensively understand the dynamics of PCC and its implications for public health.

Keywords: CDC WONDER; disparities; mortality; peripheral circulatory complications; type 2 diabetes mellitus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Overall and sex‐stratified PCC related AAMRs per 100,000 in type 2 diabetes mellitus patients in the United States, 1999 to 2020.
FIGURE 2
FIGURE 2
PCC‐related AAMRs in T2DM patients per 1,000,000 stratified by urbanisation per 1,000,000 in the US, 1999 to 2020.
FIGURE 3
FIGURE 3
PCC‐related AAMRs in T2DM patients per 1,000,000 stratified by census region in the US, 1999 to 2020.
FIGURE 4
FIGURE 4
PCC‐related AAMRs in T2DM patients per 1,000,000 stratified by state in the US, 1999 to 2020.
FIGURE 5
FIGURE 5
PCC‐related death in T2DM patients per 1,000,000 stratified by race in the US, 1999 to 2020.
See this image and copyright information in PMC

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