Long-term mortality trends in patients with concurrent hernia and diabetes in the United States

The coexistence of hernia and diabetes mellitus presents substantial clinical challenges due to diabetes-related impairment of wound healing, immune response, and vascular function. Despite this established pathophysiological relationship, national mortality trends for patients with both conditions remain inadequately characterized.

This population-based study analyzed U.S. mortality data from 1999-2023. We included decedents aged ≥25 years with both hernia (ICD-10 K40-K46) and diabetes mellitus (E10-E14) listed as contributing causes of death. Age-adjusted mortality rates were calculated using the 2000 U.S. standard population. Joinpoint regression analyzed temporal trends stratified by demographic and geographic factors.

From 1999 to 2023, 7,128 U.S. deaths involved both hernia and diabetes. Overall age-adjusted mortality rates showed no significant long-term change, with a modest decline before 2019 followed by a sharp increase thereafter. Mortality rose more prominently among males, older adults, and individuals aged 65 years and above. Females and younger age groups experienced earlier declines but demonstrated clear reversals in recent years. Regional analyses revealed sustained declines in the Midwest, relative stability in the Northeast, and increasing mortality in the South and West. Racial and ethnic disparities persisted, with recent upward trends observed among Non-Hispanic White, Hispanic, and Non-Hispanic Black populations. Metropolitan areas showed greater mortality reductions than nonmetropolitan areas.

Mortality involving both hernia and diabetes in the United States has remained largely stable over the past two decades but has increased markedly in recent years. Substantial disparities by sex, age, race, region, and urbanization persist. These findings highlight the need for improved perioperative risk management, equitable access to timely hernia repair, and integrated diabetes care, particularly for older adults and underserved populations.