Trends in Mortality Related to Sepsis and Diabetes Mellitus in the United States: A 1999–2020 analysis

Background Sepsis and diabetes mellitus (DM) are major public health challenges in the United States, contributing significantly to morbidity, mortality, and healthcare costs. The co-occurrence of these conditions has prompted concerns about outcomes, yet national mortality trends remain underexplored. This study aimed to analyze long-term trends in age-adjusted mortality rates (AAMRs) associated with sepsis and DM in the U.S. from 1999 to 2020. Methods Using the CDC WONDER database, we conducted a retrospective analysis of deaths where both sepsis and DM were listed. Joinpoint regression was employed to examine changes in AAMRs over time, stratified by sex, race/ethnicity, and region. Results From 1999 to 2018, AAMRs declined modestly (APC: −1.22%, p  < 0.05), reflecting possible improvements in care. However, post-2018 marked a sharp reversal with a significant rise (APC: +18.32%, p  < 0.05). Males, racial minorities, and residents of the South and West showed disproportionately higher mortality increases. Conclusion After years of improvement, sepsis-DM mortality rose sharply after 2018, likely influenced by healthcare disruptions during the COVID-19 pandemic. Marked disparities by sex, race, and geography highlight the need for equity-driven interventions and regionally tailored health policies to mitigate excess mortality in high-risk populations.