Temporal and Regional Trends in Cardiovascular Mortality Associated With Diabetes Mellitus: A Nationwide Analysis From 1999 to 2020 in the United States

ABSTRACT Background Diabetes mellitus (DM) is a major global health concern and a significant risk factor for cardiovascular disease (CVD), a leading cause of mortality worldwide. Individuals with diabetes face a two‐to‐four‐fold higher risk of CVD‐related death compared to the general population. This study aims to evaluate national trends in CVD mortality among diabetic patients in the United States from 1999 to 2020. Methods We conducted a retrospective analysis using CDC WONDER death certificate data. Deaths were identified using ICD‐10 codes I00–I99 (CVD) as the underlying cause and E10–E14 (DM) as multiple causes of death. Age‐adjusted mortality rates (AAMRs) were calculated per 100,000 population using the 2000 US standard population. Trends were analyzed using Joinpoint regression, with annual percentage changes (APCs) and average annual percentage changes reported across demographic subgroups. Results From 1999 to 2020, 1,854,384 CVD deaths occurred among individuals with DM (AAMR: 25.06). Mortality rates declined significantly from 1999 to 2012 (APC: –2.64*) and stabilized until 2018, followed by a sharp increase from 2018 to 2020 (APC: 6.94*). Males, NH Black or African Americans, and residents in rural and Southern states exhibited higher AAMRs. Regional and racial disparities were evident, with Oklahoma and Mississippi showing the highest state‐level mortality rates. Mortality trends for CVD with DM differed significantly from those for CVD alone across all demographic strata ( p < 0.05). Conclusion While CVD mortality among diabetic patients initially declined, recent increases signal a concerning reversal. These findings highlight the urgent need for targeted public health interventions and equitable care strategies to address persistent disparities.