Trends in both Alzheimer’s disease and Diabetes mellitus related mortality among middle-aged and older adults in the United States, 1999 to 2023: a CDC WONDER database analysis

OBJECTIVE: To analyze the temporal trends of both Alzheimer's disease and Diabetes mellitus-related mortality in adults aged > 45years in the United States between 1999 and 2023, and to evaluate the changes in mortality patterns over time. BACKGROUND: Alzheimer's Disease and Diabetes Mellitus are two different diseases that have diverse underlying pathophysiology, but they often coexist, having common pathways. There is a high prevalence of concurrence between these two conditions, yet their combined mortality trend is underexplored. METHODS: We utilize mortality data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER). Individuals aged > 45 were included who had both Alzheimer's disease (G30) and Diabetes mellitus(E10-14). Age-adjusted mortality rates (AAMRs) and crude mortality rates (CMRs) per 100,000 were calculated and were standardized to the 2000 U.S population. Joint point regression models were used to identify the temporal variations and to calculate Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) with 95% confidence intervals. RESULTS: Overall, a total of 224,082 deaths occurred in patients of both Alzheimer's disease and Diabetes mellitus, in the age group ≥ 45 years, from 1999 to 2023. There is an upward trajectory noted from 2.82 in 1999 to 4.42 in 2023, with the highest incidence between 2017 and 2020, followed by a decline. Mortality rose in both sexes, with a persistently higher rate in females. The mortality rise from 1999 to 2023 in middle-aged people (45-64 years), and there was a rise in the trend of around 41% among adults ≥ 65 years. White individuals show higher deaths (78.9%), yet higher AAMR is observed in Black and Hispanic populations, showing racial disparities. Regionally, the West shows the highest AAMR, while non-metropolitan areas show higher mortality than metropolitan areas. CONCLUSION: The trend of mortality in individuals with both Alzheimer's disease and Diabetes Mellitus has increased in the past two decades, but there is a sharp rise observed after 2020 that may show the impact of the COVID-19 pandemic. These findings emphasized public health strategies.