Temporal patterns in mortality from type 2 diabetes and digestive system cancers-an epidemiological analysis of the US population from 1999 to 2023.

OBJECTIVE

Type 2 Diabetes Mellitus (T2DM) is closely associated with digestive organ malignancies; however, population-level data remains scarce regarding mortality trends where both conditions coexist. This study aims to assess the national trends and disparities in mortality rates for deaths in which both T2DM and digestive organ malignancies were listed on the death certificate among middle-aged and elderly individuals in the United States from 1999 to 2023. MATERIALS AND

METHODS

Using the CDC WONDER database, this study analyzed deaths among U.S. individuals aged ≥ 45 years from 1999 to 2023. Deaths were included if both T2DM (ICD-10: E11) and digestive organ malignancies (ICD-10: C15-C26) were listed on the death certificate as either underlying or contributing causes. The crude mortality rate (CDR) and age-adjusted mortality rate (AAMR) per 100,000 people were calculated. Joinpoint regression analysis was used to estimate the average annual percent change (AAPC) and identify significant trend shifts.

RESULTS

A total of 94,676 deaths involving both T2DM and digestive organ malignancies were identified. The overall AAMR increased significantly from 1.82 (95%CI 1.74–1.91) to 4.93 (95%CI 4.82–5.04) per 100,000, with an AAPC of + 4.13% (95%CI 3.83–4.56, P < 0.05). Sensitivity analysis confirmed the robustness of this upward trend, with a significant acceleration after 2013 (APC + 7.07%, 95%CI 5.91–8.60, P < 0.05). Significant disparities were observed across all subgroups: males had consistently higher AAMR than females (AAMR 6.80 vs 3.47; AAPC + 4.39% vs + 3.91%, all P < 0.05); the Hispanic/Latino population had the fastest growth (AAPC + 5.56%, P < 0.05); the West region showed the most pronounced increase (AAPC + 6.58%, P < 0.05); and rural areas had persistently higher AAMR than urban metropolitan areas (AAMR 5.79 vs 3.90, P < 0.05). While crude mortality was highest in adults aged ≥ 85 years, the 45–54 age group exhibited the steepest annual increase (AAPC + 7.4%, P < 0.05).

CONCLUSIONS

Between 1999 and 2023, mortality involving both T2DM and digestive malignancies in the U.S. rose sharply, with significant acceleration in the last decade. The pronounced disparities across gender, race, and geography—particularly the heavy burden in rural and Hispanic populations—necessitate targeted public health interventions and integrated metabolic-oncological screening protocols to mitigate these increasing burdens.