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Purpose <p>To analyze long-term mortality trends among U.S. adults aged ≥ 25 years with death certificates listing both diabetes mellitus and tobacco use disorder from 1999 to 2024, and to evaluate persistent disparities by sex, age, race and ethnicity, urbanization level, and geographic region.</p> Methods <p>A retrospective analysis was conducted using CDC WONDER Multiple Cause of Death data for 1999–2024, identifying U.S. decedents aged ≥ 25 years with death certificates listing both diabetes mellitus (ICD-10 codes E10–E14) and tobacco use disorder (ICD-10 code F17) as multiple causes of death. Mortality was expressed per 100,000 population. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percent change (AAPC) were estimated using Joinpoint regression (<i>p</i> ≤ 0.05).</p> Results <p>From 1999 to 2024, a total of 734,333 deaths involved co-occurring diabetes mellitus and tobacco use disorder among U.S. adults. The overall AAMR increased substantially from 1999, peaked in 2021, and then demonstrated a statistically significant decline through 2024, which may represent an emerging change in mortality trends for this comorbidity; to our knowledge, this is the first national study to document such a pattern. Mortality remained consistently higher among males than females throughout the study period, with a modest widening of the sex gap over time. The highest mortality burden was observed among adults aged ≥ 85 years. American Indian and Alaska Native adults experienced the highest AAMR and the steepest increases among all racial and ethnic groups. Nonmetropolitan counties exhibited persistently higher AAMRs than metropolitan counties. Regionally, the Midwest demonstrated the highest AAPC, with substantial state-level heterogeneity observed across the United States.</p> Conclusion <p>Although the post-2021 decline represents the most notable finding of this study, substantial disparities persist among men, older adults, American Indian and Alaska Native populations, rural residents, and Midwestern communities. Strengthened, equity-oriented integration of tobacco cessation interventions within diabetes care is required to consolidate and extend these gains across all high-risk populations.</p>

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“Trends in diabetes mellitus and tobacco use disorder related mortality in the United States, 1999–2024: a CDC WONDER analysis”

  • 期刊论文

  • 发表日期：

    2026年7月30日

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  • Taha Yahya,
  • Syed Ali Raza Zaidi,
  • Suleman Arshad,
  • Muhammad Hammad Farooq,
  • Mehmood Hassan,
  • Ali Ashraf

摘要

Purpose

To analyze long-term mortality trends among U.S. adults aged ≥ 25 years with death certificates listing both diabetes mellitus and tobacco use disorder from 1999 to 2024, and to evaluate persistent disparities by sex, age, race and ethnicity, urbanization level, and geographic region.

Methods

A retrospective analysis was conducted using CDC WONDER Multiple Cause of Death data for 1999–2024, identifying U.S. decedents aged ≥ 25 years with death certificates listing both diabetes mellitus (ICD-10 codes E10–E14) and tobacco use disorder (ICD-10 code F17) as multiple causes of death. Mortality was expressed per 100,000 population. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percent change (AAPC) were estimated using Joinpoint regression (p ≤ 0.05).

Results

From 1999 to 2024, a total of 734,333 deaths involved co-occurring diabetes mellitus and tobacco use disorder among U.S. adults. The overall AAMR increased substantially from 1999, peaked in 2021, and then demonstrated a statistically significant decline through 2024, which may represent an emerging change in mortality trends for this comorbidity; to our knowledge, this is the first national study to document such a pattern. Mortality remained consistently higher among males than females throughout the study period, with a modest widening of the sex gap over time. The highest mortality burden was observed among adults aged ≥ 85 years. American Indian and Alaska Native adults experienced the highest AAMR and the steepest increases among all racial and ethnic groups. Nonmetropolitan counties exhibited persistently higher AAMRs than metropolitan counties. Regionally, the Midwest demonstrated the highest AAPC, with substantial state-level heterogeneity observed across the United States.

Conclusion

Although the post-2021 decline represents the most notable finding of this study, substantial disparities persist among men, older adults, American Indian and Alaska Native populations, rural residents, and Midwestern communities. Strengthened, equity-oriented integration of tobacco cessation interventions within diabetes care is required to consolidate and extend these gains across all high-risk populations.