- NAFLD and diabetes mellitus mortality rose markedly from 1999 to 2022, accelerating after 2016 and nearly doubling during the COVID-19 period.
- Mortality burden was higher in males, American Indians, Hispanics, and rural residents, indicating pronounced demographic disparities.
- Geographic variation evident: highest age-adjusted mortality rates in Oklahoma and Texas; lowest in Connecticut and New York; most deaths in medical facilities.
J Diabetes Metab Disord. 2026 Aug 17;25(2):237. doi: 10.1007/s40200-026-02044-w. eCollection 2026 Dec.
ABSTRACT
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) and diabetes mellitus (DM) are increasingly prevalent, interrelated conditions contributing significantly to morbidity and mortality. Understanding long-term mortality trends is essential to guide public health strategies. This study aimed to evaluate nationwide mortality trends involving NAFLD and DM in the United States from 1999 to 2022 and to assess demographic and geographic disparities.
METHODS: CDC WONDER was used to extract data for adults aged ≥ 25 years. 10th Revision (ICD-10), using the explicit codes with K74.0, K74.6, K75.8, K76.0 and K76.9 for NAFLD and E10-E14 for DM. Age- Adjusted Mortality Rates (AAMRs) per million population were calculated and trends were analyzed by calculating annual percent change (APC) and the average annual percent change (AAPC) using Joinpoint Regression Program (version 5.2.0.0; National Cancer Institute), with statistical significance set at p < 0.05.
RESULTS: From 1999 to 2022, a total of 126,431 NAFLD and DM related deaths were recorded with most of the deaths occurring in Medical Facilities (43.52%) followed by Decedent’s homes (32.89%). The AAMR increased consistently from 1999 to 2016 (APC: 1.2, 95% CI: 0.3-1.9) and surged thereafter till 2022 (APC: 9.6; 95% CI: 7.2-14.6). During the COVID-19 pandemic, AAMR almost doubled. AAMR for males was greater than the females. American Indians and Hispanics displayed the highest AAMR, followed by NH Whites and other NH populations. AAMRs showed an increase over the years by census regions. Rural areas exhibited a higher AAMR (AAMR: 25.0, 95% CI: 24.6-25.3) than urban areas (AAMR: 21.2, 95% CI: 21.1-21.4). States with highest AAMR include Oklahoma and Texas while those with the lowest include Connecticut and New York.
CONCLUSION: NAFLD and DM-related mortality in the U.S. rose sharply from 1999 to 2022, especially during the COVID-19 era. Males, American Indians, Hispanics, rural residents, and states like Oklahoma and Texas faced the highest burden, highlighting urgent disparities in disease outcomes.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-02044-w.
PMID:42614368 | PMC:PMC13481608 | DOI:10.1007/s40200-026-02044-w
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