Epidemiological Trends and Disparities in Renal Complications Among Adults with Diabetes Mellitus in the United States: A CDC WONDER Database Analysis (1999-2020)

Backgrounds: Renal complications of diabetes mellitus pose a significant public health challenge, contributing to substantial morbidity and mortality globally. Understanding temporal trends and regional disparities in mortality related to diabetic nephropathy is crucial for guiding targeted interventions and policy decisions. Our study aimed to analyze the trends and regional differences in mortality related to renal complications of diabetes among adults in the United States from 1999 to 2020.Methods: A retrospective analysis has been conducted using death certificate data from the CDC WONDER database, spanning from 1999 to 2020, to investigate mortality related to renal complications of diabetes in adults aged 35 or above. Age-adjusted mortality rate (AAMR) per 100,000 persons and annual percent change (APC) were computed, with stratification by year, sex, race/ethnicity, and geographic regionResults: Between 1999 and 2020, a total of 525,804 deaths occurred among adults aged 35 to 85+ years due to renal-related issues associated with diabetes. The age-adjusted mortality rate (AAMR) for renal-related deaths in adult diabetic patients showed a consistent increase from 1.6 in 1999 to 34.9 in 2020 (AAPC: 17.23; 95% CI: 13.35-28.79). Throughout the study period, men consistently had higher AAMR than women (overall AAMR for men: 17.8, 95% CI: 17.7-17.9; for women: 11.2, 95% CI: 11.1-11.2). In 1999, the AAMR for men was 1.6, increasing to 27.6 by 2020, while for women, it was 1.8 in 1999 and rose to 44.2 by 2020 (Men: AAPC: 17.54, 95% CI: 13.09-29.53; Women: AAPC: 15.55, 95% CI: 13.35-21.10). American Indian/Alaska Native adults exhibited the highest overall AAMR (36.1), followed by Black/African American (25.5), Hispanic (22.5), Asian/Pacific Islander adults (15.4), and White Population (11.4). Significant variations in AAMR were observed among different states, with Oklahoma recording the highest (21.2) and Connecticut the lowest (7). Furthermore, AAMR varied by region (overall AAMR: Western 16.6; Midwestern: 14.4; Southern: 14.1; Northeastern: 9.9), and nonmetropolitan areas had a higher AAMR for renal complications of diabetes (16) compared to metropolitan areas (13.5).Conclusion: Our findings highlight a concerning rise in mortality related to renal complications of diabetes among U.S. adults over the past two decades, with notable disparities across demographic and geographic factors. These results underscore the urgent need for targeted interventions to mitigate the burden of diabetic nephropathy and reduce mortality rates in the United States.