Trends and disparities in diabetes mortality among adults in China, 2013-2021

Background Diabetes is a major contributor to premature mortality, yet updated national evidence on diabetes mortality trends and inequalities in China is scarce. We assessed trends in diabetes mortality among adults in China from 2013 to 2021 and quantified disparities by sex, region, and urban–rural residence. Methods We conducted a population-based analysis using national mortality surveillance data for adults aged ≥ 20 years, 2013–2021. We calculated annual CMR and ASMR per 100,000 using direct age standardization. Temporal trends were evaluated using age-adjusted Poisson regression models with calendar year as a continuous variable, reporting APCs with 95% CIs. We tested heterogeneity in trends using interaction terms. Results Diabetes deaths nearly doubled from 26,842 in 2013 to 50,548 in 2021. National ASMR increased from 13.67 (95% CI 13.51–13.84) to 16.27 (16.12–16.41) per 100,000; the overall APC was 1.89% per year (95% CI 1.76–2.03). Mortality rose more rapidly among males than females (APC 3.01% vs 0.90%), producing a widening sex gap. Regional disparities were pronounced: the West showed the steepest increase (APC 3.85%), followed by the Central region (2.44%), while the East increased minimally (0.36%). Urban areas consistently exhibited higher ASMR levels, but rural areas experienced faster increases (APC 2.68% vs 0.37%), narrowing the urban–rural differential over time. Age-specific mortality rose sharply with advancing age, and intersectional analyses highlighted particularly high mortality among males residing in Central and Western China. Conclusions Diabetes mortality among adults in China increased substantially between 2013 and 2021, accompanied by widening disparities by sex and geography and accelerating increases in rural areas. Strengthening equitable chronic disease prevention and management—especially for high-burden, rapidly worsening subpopulations—is essential to curb rising diabetes mortality and reduce inequalities.