Trends in respiratory mortality among older U.S. adults with diabetes, 1999-2023

To evaluate trends in respiratory-related deaths among U.S. adults aged ≥ 65 years with diabetes mellitus listed as a contributing cause of death.

Using nationally representative mortality data from 1999 to 2023, we evaluated trends in respiratory-related deaths among U.S. adults aged ≥ 65 years with diabetes mellitus listed as a contributing cause of death. Age-adjusted mortality rates (AAMRs) were calculated, and temporal trends were assessed using Joinpoint regression.

Over this 25-year period, the age-adjusted mortality rate (AAMR) for respiratory diseases remained relatively stable (from 29.24 to 31.21 per 100,000; average annual percent change [AAPC]: 0.19%), though their relative contribution to overall mortality increased, with respiratory diseases rising from the 9th to the 6th leading cause of death. Joinpoint regression identified two statistically significant temporal segments: an initial rise from 1999 to 2005 (APC: +2.60%, 95% CI: 0.60 to 4.63; P < 0.05), followed by a sustained decline from 2005 to 2023 (APC: -0.60%, 95% CI: -0.92 to - 0.28; P < 0.001). Chronic lower respiratory diseases were the leading cause, followed by pneumonia and interstitial lung diseases. Mortality was consistently higher among men, with substantial geographic variation.

These findings highlight evolving respiratory mortality patterns and underscore the importance of continued surveillance and targeted prevention strategies for older adults with diabetes.