Age-adjusted mortality rates involving both chronic lower respiratory disease and type 2 diabetes mellitus in the United States increased substantially from 1999 to 2024, rising from 2.65 per 100,000 persons to 7.92 per 100,000 persons. Across the 25-year study interval, researchers identified 326,655 deaths meeting the dual-diagnosis criteria, reflecting an overall average annual percentage change of 4.14 percent with a 95 percent confidence interval ranging from 2.88 to 5.42 percent.
Chronic lower respiratory disease and type 2 diabetes mellitus represent leading causes of mortality in the United States that frequently co-occur. According to the study, both conditions share overlapping clinical and social risk factors, including obesity, sedentary lifestyle, systemic inflammation, and socioeconomic disadvantage, which can interact to worsen patient outcomes.
To evaluate these long-term trends, investigators conducted a serial cross-sectional analysis using death certificates sourced from the Centers for Disease Control and Prevention WONDER database for the years 1999 through 2024. The study sample encompassed decedents aged 25 years and older with chronic lower respiratory disease, defined by ICD-10 codes J40 through J47, and type 2 diabetes mellitus, captured by ICD-10 codes E11.0 through E11.9, recorded anywhere on the death certificate. Mortality rates were standardized to the 2000 United States standard population, and Joinpoint regression was utilized to estimate annual percentage changes and average annual percentage changes across demographic, temporal, and geographic strata.
Analysis by demographic subgroups showed that mortality rates climbed across both sexes. Among women, the age-adjusted mortality rate increased from 2.09 to 6.54 per 100,000 persons, corresponding to an average annual percentage change of 4.32 percent. Among men, the rate rose from 3.60 to 9.75 per 100,000 persons, representing an average annual percentage change of 3.79 percent, with both sex-specific trends achieving statistical significance at the P < 0.001 level.
Age-stratified trends revealed distinct variations across adulthood. The steepest upward trajectory occurred among adults aged 45 to 64 years, whose mortality rate rose from 1.03 to 3.49 per 100,000 persons with an average annual percentage change of 4.85 percent (95% CI 3.21–6.50; P < 0.001). Decedents aged 65 years and older demonstrated the highest absolute mortality burden, rising from 11.71 to 34.13 per 100,000 persons with an average annual percentage change of 4.04 percent (P < 0.001). Conversely, the rate increase observed among younger adults aged 25 to 44 years between 2000 and 2024 did not reach statistical significance, registering an average annual percentage change of 3.47 percent (P = 0.141).
Disparities were also pronounced across racial, ethnic, and geographic groups. Rates rose across all examined racial and ethnic populations, with the steepest relative increase occurring among non-Hispanic Black adults, where rates increased from 2.19 to 8.00 per 100,000 persons (AAPC 4.56%; 95% CI 2.21–6.98; P < 0.001). Across census regions, the West exhibited the sharpest rise, moving from 2.31 to 9.55 per 100,000 persons (AAPC 5.84%; 95% CI 4.45–7.25; P < 0.001). In addition, non-metropolitan areas sustained higher age-adjusted mortality rates than metropolitan areas between 1999 and 2020, with average annual percentage changes of 5.72 percent and 5.23 percent, respectively.
At the state level, California accounted for the highest total number of deaths over the study period. West Virginia documented the highest age-adjusted mortality rate between 1999 and 2020 at 11.46 per 100,000 persons, while Wyoming recorded the highest rate between 2021 and 2024 at 19.16 per 100,000 persons. The decedent’s home became an increasingly common place of death over time, accounting for 33.2 percent of deaths in 1999–2020 and increasing to 42.4 percent in 2021–2024. The authors noted that while these observational findings support evaluating coordinated pulmonary and metabolic care models for high-risk populations, the design of the study limits causal inference.
When tracking deaths where both chronic lower respiratory disease and type 2 diabetes were recorded, the baseline age-adjusted rate of 2.65 per 100,000 persons in 1999 was bounded by a 95 percent confidence interval of 2.57 to 2.73, while the final rate of 7.92 per 100,000 persons in 2024 fell within an interval of 7.82 to 8.02 (P < 0.001). Additionally, the annual percentage growth documented across both metropolitan and non-metropolitan classifications achieved statistical significance (both P < 0.001) during the 1999–2020 interval.
Beyond regional and demographic shifts, the records identified the decedent’s home as the single most common place of death across both evaluated intervals. Summarizing the population-level impact, the investigators concluded that while dual-diagnosis mortality expanded substantially overall, age-adjusted rates reached their highest absolute levels among older adults, men, and non-metropolitan residents. These pronounced concentrations led the authors to recommend evaluating targeted, coordinated pulmonary and metabolic care strategies tailored specifically to these disproportionately affected groups.
Subject of Research: Mortality trends involving co-occurring chronic lower respiratory disease and type 2 diabetes mellitus in the United States
Article Title: Trends in mortality involving both chronic lower respiratory disease and type 2 diabetes mellitus in the United States, 1999–2024: a CDC WONDER analysis
Article References: Kumari, L., Al-Akash, H. Y., Shaikh, M. M., Mazhar, M. A., Kumar, D., Kumar, A., Das, V., Hanif, Z., Khan, M. U., & Elsiddig Mohammed, F. E. (2026). Trends in mortality involving both chronic lower respiratory disease and type 2 diabetes mellitus in the United States, 1999–2024: a CDC WONDER analysis. Diabetology & Metabolic Syndrome. https://doi.org/10.1186/s13098-026-02347-1
Image Credits: AI Generated
DOI: 10.1186/s13098-026-02347-1
Keywords: chronic lower respiratory disease, type 2 diabetes mellitus, mortality trends, CDC WONDER database, death certificates, age-adjusted mortality rates, Joinpoint regression, annual percentage change, average annual percentage change, non-metropolitan mortality, non-Hispanic Black adults, respiratory disease mortality, metabolic disease mortality, West Virginia mortality rates, Wyoming mortality rates, place of death trends, pulmonary and metabolic care
