ORIGINAL RESEARCH article
Front. Med.
Sec. Family Medicine and Primary Care
Temporal and geographic trends in mortality involving co-occurring Depression and Diabetes mellitus in U.S., 1999–2023
1. Department of Cardiovascular Medicine, Baotou Central Hospital, Baotou, China
2. Inner Mongolia Medical University, Hohhot, China
3. Taizhou Municipal Hospital, Taizhou, China
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Abstract
Background: Diabetes mellitus (DM) and depression commonly co-occur, worsening self-management, complications, and survival. Yet long-term, population-based surveillance of mortality that involves both conditions remains limited. Objective: To characterise national trends in mortality co-listing diabetes and depression and to examine disparities by demographics and geography. Methods: We analysed U.S. Multiple Cause-of-Death records from CDC WONDER for 1999–2023. Deaths that listed diabetes (ICD-10 E10–E14) and depressive disorders (ICD-10 F32–F33, F41.2) as underlying or contributing causes were included. We calculated crude and age-adjusted mortality rates (AAMRs) per 100,000, directly standardised to the 2000 U.S. population, and fitted segmented Joinpoint regression to estimate annual percent change (APC) and average APC. Stratifications included sex, age group, race/ethnicity, Census region, state, urban–rural category (2020 NCHS scheme applied uniformly across years), and place of death, with adherence to CDC WONDER suppression rules. Results: National AAMRs were low and broadly stable through the mid-to-late 2000s, rose in the late 2010s, and plateaued in the early 2020s. Rates were consistently higher in men than women and increased with age, peaking in adults aged 85 years or older. By race/ethnicity, non-Hispanic American Indian/Alaska Native populations had the highest AAMRs, followed by non-Hispanic Black and Hispanic groups, with non-Hispanic White and non-Hispanic Asian/Pacific Islander populations lower. Regionally, the West had the highest rates and the Northeast the lowest; nonmetropolitan counties exceeded metropolitan counties. States showed wide heterogeneity, with roughly threefold differences between the top and bottom deciles. Conclusions: Mortality involving co-occurring depression and diabetes shows an upswing in the late 2010s and substantial demographic and geographic inequalities. These findings support targeted, place-based strategies and integrated diabetes–mental health care to reduce preventable deaths.
Summary
Keywords
Age-adjusted mortality, CDC WONDER, Depression, Diabetes Mellitus, Geographic trends
Received
28 October 2025
Accepted
13 February 2026
Copyright
© 2026 Wang, Xu and Ye. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wenbin Xu; Zhinan Ye
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