Anemia and diabetes related mortality in older adults: Geographic and temporal trends in the US, 1999-2023

Abstract Background: Diabetes is an insidiously prevailing condition across the U.S, with millions affected nationwide. It is uncontrolled and often undiagnosed, leading to adverse health outcomes and serious threats. Additionally, Anemia also compromises the public wellbeing, affecting more than 3 million annually, and when coexisting with Diabetes can lead to decreased survival outcomes and widespread mortality. Methods: Mortality data were extracted from the CDC WONDER database using Multiple Cause of Death files. Deaths among individuals aged ≥45 years with both anemia (ICD-10 codes: D50–D64) and Diabetes (E10-E14) were included. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population, standardized to the 2000 U.S. Census population. Joinpoint regression was used to estimate annual percent changes (APC) and average annual percent changes (AAPC), stratified by age groups, sex, and race/ethnicity. Statistical significance was set at p < 0.05. Results: Between 1999 and 2023, 214,549 deaths were recorded. The overall age-adjusted mortality rate (AAMR) increased from 5.44 per 100,000 in 1999 to 8.86 in 2023. The average annual percent change (AAPC) was 1.85* (95% CI: 1.55-2.19, p<0.000001). The most significant increase occurred between 2018-2021 (APC: 15.47*, 95% CI: 12.50-17.65, p= 0.001691). Both females (AAMR: 6.41) and males (AAMR: 7.90), exhibited fluctuating trends, with males showing a more significant change (AAPC: 2.32*, p value < 0.000001). Racial disparities were observed: African Americans had the highest AAMR (12.67), followed by American Indians (9.84), Hispanics (9.58), Whites (6.40), and Asians or Pacific Islanders (5.95). Significant overall change was observed among Asians (AAPC: 5.23*, 95% CI: -82.33-6.84, p value= 0.062787). Geographical disparities were prominent with South exhibiting highest AAMRs (7.40), followed by Midwest (7.17), West (7.08), and Northeast (5.94). Most significant overall change was noted for South (AAPC: 2.31* 95% CI: 1.98-2.67, p value<0.000001). By urbanization status, Nonmetropolitan areas showed highest AAMR (8.08), followed by Metropolitan (6.41). Among age groups, older adults had significantly greater mortality rates (16.61) than Middle aged adults (1.55). Conclusion: Mortality from Anemia and Diabetes in U.S. adults aged ≥45 years showed fluctuating trends between 1999 and 2023, with an overall increase in mortality rates. The disparities noticed across different demographic segments, such as African American men, non-metropolitan areas and the Southern region highlight the need for further investigations into the factors driving these trends and disparities. It is important to carry out targeted interventions, raise public health campaigns, and address the socioeconomic inequities to mitigate these discrepancies.