Rao Asad Gul, Shahid Sufyan, Pervez Neha, Pervez Ramsha, Ahmed Raheel
Dow University of Health Sciences, Karachi, Pakistan.
Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan.
Endocrinol Diabetes Metab. 2025 Sep;8(5):e70082. doi: 10.1002/edm2.70082.
BACKGROUND: Diabetes mellitus (DM) increases susceptibility to infection and worsens outcomes in sepsis, a leading cause of preventable death. However, population-level trends in sepsis-related mortality among diabetic individuals in the United States (US) remain poorly characterised, especially in the context of the COVID-19 pandemic. This study evaluates national patterns, temporal shifts, and demographic disparities in sepsis-related mortality in diabetic patients from 1999 to 2023. METHODS: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database. Sepsis-related deaths with co-listed DM were extracted for US adults between 1999 and 2023. Age-adjusted mortality rates (AAMRs) were calculated and Joinpoint regression was used to estimate annual percentage changes (APCs) and identify significant trends. RESULTS: A total of 483,207 sepsis-related deaths occurred in individuals with DM during the study period. AAMRs declined significantly from 1999 to 2018 (APC: -1.22; p < 0.001), reversed sharply from 2018 to 2021 (APC: +18.14; p = 0.01), and declined again through 2023 (APC: -12.25; p < 0.001). Mortality was highest among older adults (AAMR: 32.63), males (9.72 vs. 7.80 in females), and non-Hispanic Black and American Indian/Alaska Native populations (AAMRs: 17.94 and 17.92, respectively). Hispanic populations showed the steepest pandemic-era increase (APC: +22.49) and subsequent decline (APC: -20.43). Rural areas consistently had higher AAMRs than urban areas (8.77 vs. 8.27), with sharper increases during the pandemic. State-level disparities widened dramatically from 2021 to 2023, and regionally, the South and Midwest exhibited the highest and most persistent mortality burdens. CONCLUSION: Sepsis-related mortality in diabetic individuals in the US has undergone dynamic shifts over the past 25 years, punctuated by COVID-19 era surges and shaped by deep-rooted demographic, geographic, and structural inequities. These findings warrant integrated diabetes-infection care models, early sepsis recognition, and equity-driven interventions to reduce mortality.
背景：糖尿病（DM）会增加感染易感性，并使脓毒症（可预防死亡的主要原因）的预后恶化。然而，美国糖尿病患者中与脓毒症相关的死亡率在人群层面的趋势仍未得到充分描述，尤其是在新冠疫情背景下。本研究评估了1999年至2023年糖尿病患者中与脓毒症相关的死亡率的全国模式、时间变化和人口统计学差异。 方法：我们使用美国疾病控制与预防中心的广泛在线流行病学研究数据（CDC WONDER）多死因数据库进行了一项回顾性分析。提取了1999年至2023年美国成年人中合并有糖尿病的与脓毒症相关的死亡病例。计算了年龄调整死亡率（AAMRs），并使用Joinpoint回归来估计年度百分比变化（APCs）并确定显著趋势。 结果：在研究期间，共有483,207例糖尿病患者发生了与脓毒症相关的死亡。年龄调整死亡率从1999年到2018年显著下降（APC：-1.22；p < 0.001），在2018年至2021年急剧逆转（APC：+18.14；p = 0.01），并在2023年再次下降（APC：-12.25；p < 0.001）。老年人的死亡率最高（AAMR：32.63），男性（9.72，女性为7.80），以及非西班牙裔黑人和美国印第安/阿拉斯加原住民群体（AAMRs分别为17.94和17.92）。西班牙裔人群在疫情期间的增幅最为显著（APC：+22.49），随后下降（APC：-20.43）。农村地区的年龄调整死亡率一直高于城市地区（8.77对8.27），在疫情期间增幅更大。从2021年到2023年，州级差异急剧扩大，在地区层面，南部和中西部地区的死亡率负担最高且持续时间最长。 结论：在过去25年中，美国糖尿病患者中与脓毒症相关的死亡率经历了动态变化，受到新冠疫情期间激增的影响，并受到根深蒂固的人口统计学、地理和结构不平等的影响。这些发现需要综合的糖尿病-感染护理模式、早期脓毒症识别以及公平驱动的干预措施来降低死亡率。
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