©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Temporal trends and disparities in substance use and diabetes mellitus-related mortality in the United States (1999-2022)
Sardar Muhammad Imran Khan, Muhammad Waqas, Muneeb Khawar, Arshia Batool, Aqsa Komel, Muhammad Aizaz Ashraf, Muneeb Saifullah, Ikra Rana
Sardar Muhammad Imran Khan, Department of Cardiology, National University of Medical Sciences, Rawalpindi 04616, Punjab, Pakistan
Muhammad Waqas, Department of Cardiology, Wah Medical College, Islamabad 04433, Pakistan
Muneeb Khawar, Muneeb Saifullah, Department of Medicine, King Edward Medical University, Lahore 05450, Punjab, Pakistan
Arshia Batool, Aqsa Komel, Muhammad Aizaz Ashraf, Department of Medicine, Nishtar Medical University, Multan, Multan 66000, Punjab, Pakistan
Ikra Rana, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, Bishkek 720074, Kyrgyzstan
Author contributions: Khan SMA, Waqas M, and Khawar M led the conceptualization, methodology, and formal analysis and contributed to writing and reviewing the manuscript; Batool A, Komel A, Ashraf MA, and Saifullah M led the formal analysis and contributed to writing and reviewing the manuscript; Rana I contributed to writing, critical review, and final editing of the manuscript; All authors thoroughly reviewed and approved the final version of the manuscript.
Institutional review board statement: An Institutional Review Board approval was not required for this study as it involved secondary analysis of publicly available, de-identified data from national surveillance sources (e.g., CDC WONDER). The study did not involve human subjects research as defined by federal regulations.
Informed consent statement: This study did not involve the recruitment or enrollment of human subjects. It was based entirely on secondary analysis of publicly available, de-identified mortality data. Therefore, the requirement to upload an Informed Consent Form is not applicable.
Conflict-of-interest statement: All authors declare no conflicts of interest relevant to this study.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: Not applicable.
Corresponding author: Ikra Rana, MD, Department of Medicine, International School of Medicine, International University of Kyrgyzstan, 6, St. April 7, Bishkek 720074, Kyrgyzstan.
ikrarana100@gmail.com
Received: June 3, 2025
Revised: June 21, 2025
Accepted: July 16, 2025
Published online: March 20, 2026
Processing time: 255 Days and 19.1 Hours
BACKGROUND
Substance use (SU) and diabetes mellitus (DM) are major public health concerns and leading causes of mortality in the United States. However, trends examining their combined impact remain limited. This study analyzed mortality trends related to SU and DM from 1999-2022, focusing on demographic disparities, geographic patterns, and substance-specific contributions using Centers for Disease Control and Prevention data.
AIM
To examine trends in DM-related mortality involving SU in the United States from 1999-2022, focusing on demographic and geographic disparities and to identify high-risk groups to guide equitable public health interventions.
METHODS
Mortality data were obtained from death certificate records. Age-adjusted mortality rates (AAMRs) per 1000000 and annual percentage changes (APCs) with 95% confidence intervals (CIs) were calculated. Temporal trends were assessed using the Joinpoint Regression Program.
RESULTS
From the years 1999-2022 127659 adult deaths were disclosed with SU and DM as the primary cause. The overall AAMR rose with an APC of 4.4% (95%CI: 3.6-5.0) from 1999-2016, accelerating to 11.8 (95%CI: 10.2-14.5) from 2016-2022. Gender disparities showed males having higher AAMRs throughout the study period as compared with females. Among racial groups there was a significantly higher AAMR consistently for American Indian/Alaska Natives compared with other races. Geographic analysis showed the highest AAMR in the western states (32/1000000) and pronounced rural increases (APC: 17.6%, 95%CI: 13.2–20.5) after 2018. Alcohol use was the leading contributor (71861 deaths), followed by cocaine and stimulant use.
CONCLUSION
This study revealed alarming increases in mortality linked to SU and DM, with widening demographic and geographic disparities. Targeted strategies addressing SU and DM within vulnerable populations are urgently needed to reduce preventable deaths and health inequities.
Core Tip: Substance use-related diabetes mortality rose sharply from 1999-2022, disproportionately affecting males, American Indian/Alaska Native populations, and western states. A pronounced surge during 2018-2020, especially among Hispanic/Latino and rural populations, underscores the need for equity-focused healthcare policies and culturally informed interventions.
