Trends in ARDS-related mortality among US adult patients with diabetes, 1999–2023

Acute respiratory distress syndrome (ARDS) and diabetes mellitus (DM) constitute a high-risk comorbidity, with diabetes-related immune dysfunction and metabolic dysregulation exacerbating ARDS severity and worsening outcomes. However, long-term national mortality trends and subgroup disparities for this comorbidity remain inadequately characterized. Using US national mortality data from the CDC WONDER database (1999-2023), we analyzed death records listing both ARDS (ICD-10 J80) and all types of DM (ICD-10 E10-E14) as underlying or contributing causes of death. Age-adjusted mortality rates (AAMR) per 1,00,000 population were standardized to the 2000 US census. Temporal trends were evaluated using Joinpoint regression to compute average annual percent change (AAPC) and identify inflection points, with stratification by sex, race/ethnicity, census region, urbanization level, and age group. From 1999 to 2023, overall AAMR for ARDS-DM comorbidity declined from 0.66 to 0.40 per 1,00,000 (AAPC: -0.12%, 95% CI: -2.75 to 2.58). A triphasic pattern emerged: pre-pandemic relative stability or gradual decline, a sharp mortality surge during the COVID-19 pandemic (2017-2020/21), followed by steep post-pandemic decline (2020/21-2023). Persistent disparities were evident, with higher 2023 mortality among males, non-Hispanic Black and Hispanic populations, and residents of the South and West census regions. While long-term AAMR for ARDS-DM comorbidity showed an overall declining trend, the COVID-19 pandemic induced significant transient disruption. Preexisting socioeconomic and demographic disparities in mortality persisted throughout the 25-year period, most evident in rural areas, the South, and the Midwest, highlighting the continued need for targeted public health strategies to reduce severe respiratory complications in high-risk diabetic populations.