Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep;73(9):2868-2877.
doi: 10.1111/jgs.70042. Epub 2025 Sep 12.

Malnutrition Mortality Among Older Adults by County and Race and/or Ethnicity in the United States, 2000-2019

Juliana Teruel Camargo  1 , Jessica Otero Machuca  1 , Amanda S Hinerman  1 , Erik J Rodriquez  1 , Christian S Alvarez  2 , George A Mensah  3 , Stephanie M George  4 , Frank Bandiera  5 , Zhuochen Li  6 , Dillon O Sylte  6 , Yekaterina O Kelly  6 , Theresa A McHugh  6 , Mathew M Baumann  6 , Michael Celone  6 , Demewoz Haile  6 , Wichada La Motte-Kerr  6 , Christopher J L Murray  6   7 , Laura Dwyer-Lindgren  6   7 , Ali H Mokdad  6   7 , Eliseo J Pérez-Stable  1
Affiliations

Malnutrition Mortality Among Older Adults by County and Race and/or Ethnicity in the United States, 2000-2019

Juliana Teruel Camargo et al. J Am Geriatr Soc. 2025 Sep.

Abstract

Background: Older adults are at an increased risk of malnutrition due to chronic diseases and social vulnerabilities. This study estimates protein-energy malnutrition mortality rates among adults aged 65-74 and ≥ 75 by race and ethnic population group and county.

Methods: We analyzed death data from the National Vital Statistics System and population data from the National Center for Health Statistics from 2000 to 2019. We calculated county-level mortality rates using small-area estimation methods, adjusting for misclassifications in death certificates. The primary outcome was deaths attributed to malnutrition. The exposures were to populations (American Indian/Alaskan Native [AIAN], Asian, Black, Hispanic/Latino, and White) and the county.

Results: From 2000 to 2019, malnutrition mortality rates increased in individuals aged ≥ 75 from 19.5 (95% uncertainty interval [UI]: 18.8-20.1) to 49.2 (48.4-50.0) deaths per 100,000, and in those aged 65-74 from 2.2 (2.0-2.3) to 4.6 (4.4-4.7). In 2019, Black individuals had the highest national mortality rates: 60.8 (58.2-63.3) for ≥ 75 years and 7.7 (7.3-8.2) for 65-74 years. In 2019, a county in Georgia had the highest rate for White individuals aged ≥ 75 at 334.9 (236.6-464.8), and a county in Montana had the highest for AIAN individuals aged 65-74 at 34.9 (13.1-72.0). Counties in the New York metro had the lowest mortality rates across all population groups and ages.

Conclusion: Malnutrition mortality rates have increased among older adults, varying by geography and population group, underscoring the need for targeted nutritional interventions.

Keywords: malnutrition; medical geography; mortality; older adults; population groups.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

This research was supported [in part] by the Intramural Research Program of the National Institutes of Health (NIH). The contributions of the NIH author(s) are considered Works of the United States Government. The findings and conclusions presented in this paper are those of the author(s) and do not necessarily reflect the views of the NIH or the U.S. Department of Health and Human Services.

Figures

FIGURE 1
FIGURE 1
National estimated age‐standardized protein‐energy malnutrition mortality rates for individuals aged ≥ 75, by year and race and/or ethnic population groups, 2000–2019, U.S. Shaded areas are 95% uncertainty intervals.
FIGURE 2
FIGURE 2
National estimated age‐standardized protein‐energy malnutrition mortality rates for individuals aged 65 to 74, by year and race and/or ethnic population groups, 2000–2019, U.S. Shaded areas are 95% uncertainty intervals.
FIGURE 3
FIGURE 3
County‐level estimated age‐standardized protein‐energy malnutrition mortality rates for individuals aged ≥ 75 by race and/or ethnic population groups, 2019, U.S. Estimates are masked (shown in white) for county and race and/or ethnicity combinations with a mean annual population < 1000.
FIGURE 4
FIGURE 4
County‐level estimated age‐standardized protein‐energy malnutrition mortality rates for individuals aged 65 to 74 by race and/or ethnic population groups, 2019, U.S. Estimates are masked (shown in white) for county and race and/or ethnicity combinations with a mean annual population < 1000.
See this image and copyright information in PMC

References

    1. Rudnicka E., Napieraťa P., Podfigurna A., Męczwkalski B., Smolarczyk R., and Grymowicz M., “The World Health Organization (WHO) Approach to Healthy Aging,” Maturitas 139 (2020): 6–11, 10.1016/j.maturitas.2020.05.018. - DOI - PMC - PubMed
    1. Dwyer J. T., Gahche J. J., Weiler M., and Arensberg M. B., “Screening Community‐Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps,” Journal of Community Health 45, no. 3 (2020): 640–660, 10.1007/s10900-019-00739-1. - DOI - PMC - PubMed
    1. Guenter P., Abdelhadi R., Anthony P., et al., “Malnutrition Diagnoses and Associated Outcomes in Hospitalized Patients: United States, 2018,” Nutrition in Clinical Practice 36, no. 5 (2021): 957–969, 10.1002/ncp.10771. - DOI - PubMed
    1. Corish C. A. and Bardon L. A., “Malnutrition in Older Adults: Screening and Determinants,” Proceedings of the Nutrition Society 78, no. 3 (2019): 372–379, 10.1017/S0029665118002628. - DOI - PubMed
    1. Niccoli T. and Partridge L., “Ageing as a Risk Factor for Disease,” Current Biology 22, no. 17 (2012): R741–R752, 10.1016/j.cub.2012.07.024. - DOI - PubMed

LinkOut - more resources