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. 2025 Aug;15(8):e70723.
doi: 10.1002/brb3.70723.

Trends in Diabetes Mellitus and Associated Mental Disorders-Related Mortality (1999-2023): A CDC WONDER Database Analysis

Syed Tawassul Hassan  1 , Muhammad Shaheer Bin Faheem  2 , Yasmeen Sufi  1 , Anushah Nadeem  3 , Wajeeha Siddiqui  1 , Dur E Sameen  3 , Amna Kaleem Ahmed  3 , Faiza Nasir  3 , Sumaya Samadi  4
Affiliations

Trends in Diabetes Mellitus and Associated Mental Disorders-Related Mortality (1999-2023): A CDC WONDER Database Analysis

Syed Tawassul Hassan et al. Brain Behav. 2025 Aug.

Abstract

Objectives: Diabetes mellitus (DM) has a strong bidirectional relationship with mental disorders, collectively increasing the risk of mortality. We aim to analyze the mortality trends related to DM and associated mental disorders while exploring demographic and regional disparities in the United States from 1999 to 2023.

Methods: Death records were obtained from the Centers for Disease Control and Prevention-Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2023. Crude and age-adjusted mortality rates (AAMRs), measured per 100,000 people, were calculated and standardized to the 2000 US standard population. Annual percent changes (APCs) in AAMRs and crude mortality rates (CMRs) were computed through the Joinpoint regression program and data stratification was done based on sex, race, age, and geographical regions.

Results: A total of 1,332,198 death records indicated the presence of both DM and mental disorders. AAMR increased fourfold from 1999 (9.5) to 2023 (40.4) per 100,000 population. Notable increase shifts were noted in AAMR across different periods between 1999 and 2021 (APC: 1999-2005: 14.98; 2005-2018: 2.92; 2018-2021: 8.98), after which it declined sharply until 2023 (APC: -6.42). Males (36.8) had elevated AAMRs in comparison to females (22.4). Non-Hispanic (NH) American Indians contributed to most of the AAMR (39.8). CMR was 11-fold higher in older adults as compared to those aged between 35 and 64 years. Regionally, AAMRs in nonmetropolitan areas (35.9) and Midwest regions (34.7) were the highest.

Conclusions: Further research and targeted interventions are needed for in-depth evaluation of these rising mortality trends to find the root cause and lower the burden of DM and associated mental disorders.

Keywords: CDC WONDER; age‐adjusted mortality rates; associated mental and behavioral disorders; diabetes mellitus.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Overall trends in DM and mental disorders‐related age‐adjusted mortality rates per 100,000 among adults aged 35 and above in the United States, 1999–2023. APC = annual percentage change, CI = confidence interval. * The annual percentage change (APC) is significantly different from zero at α = 0.05.
FIGURE 2
FIGURE 2
Trends in DM and mental disorders‐related age‐adjusted mortality rates per 100,000, stratified by sex among adults aged 35 and above in the United States, 1999–2023. APC = annual percentage change, CI = confidence interval. * The annual percentage change (APC) is significantly different from zero at α = 0.05.
FIGURE 3
FIGURE 3
Trends in DM and mental disorders‐related age‐adjusted mortality rates per 100,000, stratified by race and ethnicity among adults aged 35 and above in the United States, 1999–2023. APC = annual percentage change, CI = confidence interval. * The annual percentage change (APC) is significantly different from zero at α = 0.05.
FIGURE 4
FIGURE 4
Trends in DM and mental disorders‐related age‐adjusted mortality rates per 100,000, stratified by urbanization among adults aged 35 and above in the United States, 1999–2020. APC = annual percentage change, CI = confidence interval. * The annual percentage change (APC) is significantly different from zero at α = 0.05.
FIGURE 5
FIGURE 5
DM and mental disorders‐related age‐adjusted mortality rates per 100,000, stratified by states among adults aged 35 and above in the United States, 1999–2020.
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