Abstract
IntroductionDiabetes and chronic kidney diseases are associated with a large health burden in the USA and globally.ObjectiveTo estimate age-standardized mortality rates by county from diabetes mellitus and chronic kidney disease.Design and settingValidated small area estimation models were applied to de-identified death records from the National Center for Health Statistics (NCHS) and population counts from the census bureau, NCHS, and the Human Mortality Database to estimate county-level mortality rates from 1980 to 2014 from diabetes mellitus and chronic kidney disease (CKD).ExposuresCounty of residence.Main outcomes and measuresAge-standardized mortality rates by county, year, sex, and cause.ResultsBetween 1980 and 2014, 2,067,805 deaths due to diabetes were recorded in the USA. The mortality rate due to diabetes increased by 33.6% (95% UI: 26.5%–41.3%) between 1980 and 2000 and then declined by 26.4% (95% UI: 22.8%–30.0%) between 2000 and 2014. Counties with very high mortality rates were found along the southern half of the Mississippi river and in parts of South and North Dakota, while very low rates were observed in central Colorado, and select counties in the Midwest, California, and southern Florida. A total of 1,659,045 deaths due to CKD were recorded between 1980 and 2014 (477,332 due to diabetes mellitus, 1,056,150 due to hypertension, 122,795 due to glomerulonephritis, and 2,768 due to other causes). CKD mortality varied among counties with very low mortality rates observed in central Colorado as well as some counties in southern Florida, California, and Great Plains states. High mortality rates from CKD were observed in counties throughout much of the Deep South, and a cluster of counties with particularly high rates was observed around the Mississippi river.Conclusions and relevanceThis study found large inequalities in diabetes and CKD mortality among US counties. The findings provide insights into the root causes of this variation and call for improvements in risk factors, access to medical care, and quality of medical care.
Highlights
Diabetes and chronic kidney diseases are associated with a large health burden in the USA and globally
The mortality rate due to diabetes increased by 33.6% (95% UI: 26.5%–41.3%) between 1980 and 2000 and declined by 26.4% (95% UI: 22.8%–30.0%) between 2000 and 2014
chronic kidney disease (CKD) mortality varied among counties with very low mortality rates observed in central Colorado as well as some counties in southern Florida, California, and Great Plains states
Summary
Diabetes and chronic kidney diseases are associated with a large health burden in the USA and globally. Mokdad et al Population Health Metrics (2022) 20:9 prevalence has increased rapidly in the USA in recent decades, reaching 11.8% in 2019 [2, 3]. Diabetes is associated with several diseases including chronic kidney disease (CKD). CKD was the 6th leading cause of death in 2019, accounting for 3.6% of all deaths [2]. In 1990, CKD, which is preventable by adequate medical care, was the 14th leading cause of death, accounting for 1.5% of all deaths [2]. Recent data from the Behavioral Risk Factor Surveillance System (BRFSS), a large state-based surveillance system, show that the self-reported prevalence of diagnosed diabetes in 2020 was 10.6% among adults aged 18 or older. West Virginia had the highest prevalence (15.7%) and Alabama 14.8%, while District of Columbia (7.5%) and Colorado (7.6%) had the lowest rates [4]
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