A Nationwide Study of Mortality Trends in Chronic Lower Respiratory Diseases Patients With Underlying Diabetes Mellitus

Document Type

Conference Proceeding

Publication Date

10-2025

Publication Title

Chest

Abstract

PURPOSE: Diabetes mellitus (DM), a highly prevalent comorbidity, is associated with an increased risk of developing chronic lower respiratory diseases (CLRD) and poor clinical outcomes in CLRD patients, such as a high number of hospitalizations and odds of respiratory failure. We planned this study to assess the nationwide mortality trends over the last two decades in CLRD patients with underlying DM to highlight the combined detrimental effect of these common long-term comorbidities METHODS: We conducted a retrospective study using the CDC-WONDER database (1999–2020) to analyze mortalities resulting from CLRD (ICD-10 codes: J40-J47) with DM (ICD-10 codes: E10-E14) as an underlying cause of death. Adults aged $55 were abstracted by gender, race, Hispanic origin, census region, and 2013 urbanization. The variation in trends was analyzed using the Weighted Bayesian approach in joinpoint regression. Age-adjusted mortality rates (AAMR) and annual person changes (APC) with 95% confidence intervals were calculated, and a P value < 0.05 was considered statistically significant. RESULTS: Chronic Lower Respiratory Diseases (CLRD) with underlying DM in adults aged $55 years resulted in 219,853 deaths, yielding an AAMR of 13.9 (95% CI: 13.8-13.9). The initial significant increase in mortality rate from 1999 to 2008 in both males and females (APC 3.47, 95% CI: 2.25 to 5.39) and (APC 4.24, 95% CI: 3.24 to 5.84) was followed by a decline in 2008 to 2020 (APC -0.42, 95% CI: -1.28 to 0.25) and (APC -0.66, 95% CI: -1.37 to -0.09) respectively. Mortality among non-Hispanic males and females significantly increased from 1999 to 2008, with APC of 3.63 and 4.42, respectively. Black or African Americans exhibited significant upward inflections from 1999 to 2009 (APC 3.63, 95% CI: 2.31 to 6.97) and 2014 to 2020 (APC 3.52, 95% CI: 1.35 to 10.09). Nonmetro regions, as classified under the 2013 U.S. urbanization framework, experienced an increase in mortality rates with a recent notable upward shift from 2018 to 2020 in the noncore areas (APC 8.46, 95% CI: 1.48 to 12.80, P=0.0008). All census regions showed a downward deflection from 2008 to 2020 except CENS-R3 (South), which showed an upward shift with an APC of 0.65 (95% CI: -0.21 to 1.36) CONCLUSIONS: Our study revealed an initial increase in mortality rates in CLRD with co-existing DM from 1999 to 2008, followed by a decline from 2008 to 2020 highlights the dire need to develop multidisciplinary care teams to ensure integrated management of these two common long-term comorbidities leading to poor outcomes. Significant disparities across Hispanic origin, race, census region, and urbanization were observed. Noncore areas, the CENS-R3 South region, and Black or African Americans displayed unusually steep upward trends compared to other groups within their respective categories. CLINICAL IMPLICATIONS: There is a critical need for multidisciplinary collaboration to develop comprehensive, integrated management plans for patients with both CLRD and DM, enhance early identification of these conditions, and improve healthcare access to high-risk populations.

Volume

168

Issue

4S

First Page

1244A

Comments

American College of Chest Physicians CHEST Annual Meeting, October 19-22, 2025, Chicago, IL

Last Page

1245A

DOI

10.1016/j.chest.2025.07.724

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