The burden of diabetes mortality by county, race, and ethnicity in the USA, 2000–2019

Objective

Diabetes is a leading cause of death in the USA. Previous studies have found substantial racial and ethnic and geographical disparities in diabetes mortality, however research considering racial and ethnic and geographical disparities simultaneously has been limited. To fill this gap, we estimated trends in diabetes mortality rates from 2000 to 2019 at the county level for five racial and ethnic populations.

Research Design and Methods

We applied small-area estimation methods to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics and corrected for misclassification of race and ethnicity on death certificates.

Results

Age-standardized diabetes mortality rates decreased in the USA from 28.1 (95% uncertainty interval 27.9–28.2) in 2000 to 19.1 (19.0–19.2) deaths per 100,000 population in 2019. In 2019, national-level rates were highest for the AIAN population (35.6 [32.1–39.4]), followed by the Black (31.9 [31.5–32.3]), Latino (19.7 [19.3–20.2]), White (17.6 [17.5–17.8]), and Asian (12.6 [12.1–13.1]) populations. There was substantial heterogeneity in diabetes mortality rates across counties within each racial and ethnic population, with the AIAN population experiencing the greatest heterogeneity in 2019 (IQR 18.7–50.3 [median 31.9]). For each racial and ethnic population, mortality rates declined in most counties from 2000–2019.

Conclusions

Since 2000, progress has been made in reducing diabetes mortality rates. Nonetheless, diabetes mortality remains too high for many Americans. Interventions focusing on communities at highest risk are vital to resolving persistent health inequities.