Trends and disparities in gastrointestinal hemorrhage-related mortality in individuals with diabetes in the United States from 1999 to 2023: A cross-sectional study

Gastrointestinal hemorrhage in patients with diabetes is associated with a higher risk of death. This study examined the trends and disparities in U.S. adult mortality due to coexisting diabetes and gastrointestinal hemorrhage. We analyzed CDC WONDER data (1999-2023) for adults (≥25 years), where gastrointestinal hemorrhage and diabetes were listed together as underlying or contributory causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 U.S. population were calculated, and trends in AAMRs were analyzed using Joinpoint regression software. Relevant sensitivity analyses were conducted to verify the direction of the overall trend. Sociodemographic and geographical disparities in relevant trends were also explored. From 1999 to 2023, gastrointestinal hemorrhage and diabetes mellitus concurrently led to 80,833 deaths among U.S. adults, at an AAMR of 1.45/100,000. There was no net change in mortality rates over this period (AAPC -0.16; 95% CI: -0.58-0.15). In contrast, the AAMRs from gastrointestinal hemorrhage without fatal diabetes decreased (AAPC -1.03; 95% CI: -1.56 to -0.52). Males exhibited higher mortality rates from coexisting gastrointestinal hemorrhage and diabetes (Males 1.84 vs Females 1.15). Non-Hispanic American Indian/Alaska Native (2.97) and NH Black/African American (2.32) populations had the highest AAMRs. Disproportionately high overall rates were observed in the West (1.53) and South (1.48) regions. Moreover, AAMRs were notably higher in rural areas (rural: 1.72 vs urban: 1.31). Further evidence is required to establish the bidirectional mortality risks associated with gastrointestinal hemorrhage in patients with diabetes. Nonetheless, the disproportionate and persistent mortality burden in the U.S. demands attention.