Diabetes Research and Clinical Practice · Jan 14, 2026

Cardiovascular mortality trends and disparities among older adults (≥65 years) with type 2 diabetes in the United States: a CDC WONDER database analysis, 1999-2023

By Zhou X, Ruan W, Pu J et al.

AIMS: To analyze 25-year trends (1999-2023) in cardiovascular mortality among U.S. adults ≥ 65 years with type 2 diabetes. METHODS: Using CDC WONDER data, we assessed age-adjusted mortality rates (AAMR) for cardiovascular deaths with type 2 diabetes as a contributing cause, stratified by sex, age group, race/ethnicity, and geographic region. RESULTS: Between 1999-2023, 529,472 cardiovascular deaths occurred among older adults with type 2 diabetes. AAMR increased significantly from 40.58 to 66.93 per 100,000 population. A dramatic acceleration occurred during 2019-2021 with a 26.2% mortality increase, coinciding with the COVID-19 pandemic. Men consistently demonstrated higher AAMR and steeper increases. Hispanic older adults shifted from third-highest to the highest AAMR by 2023. States with elevated mortality concentrated in the West and Midwest regions. Atherosclerotic heart disease remained the leading cause, while atrial fibrillation emerged as the 5th leading cause with a 624.7% increase in AAMR. CONCLUSIONS: Cardiovascular mortality among older adults with type 2 diabetes increased over 25 years, with a devastating acceleration during 2019-2021 that temporally coincided with the COVID-19 pandemic. Persistent sex-, racial-, and geographic-based disparities, combined with evolving cardiovascular mortality patterns, underscore the imperative for targeted interventions addressing the fundamental social determinants of health underlying these inequities.

doi.org/10.1016/j.diabres.2026.113107PubMed 41544900Populations