Demographic profiles and disparities in all liver diseases and diabetes mellitus patients - related mortality among older adults (≥ 65) in the United States, 1999 to 2020

Diabetes Mellitus (DM) and liver disease, particularly All Liver Diseases (All-LD), are increasingly interlinked public health concerns in the United States. When coexisting, these conditions contribute synergistically to increased morbidity and mortality, especially among older adults. This study examines mortality trends associated with All-LD and DM from 1999 to 2020, focusing on disparities across sex, race, region, and urban-rural classification. Using the CDC-WONDER Multiple Cause of Death database, we identified deaths among U.S. older adults (aged ≥ 65) with death certificates listing both DM and All-LD as either underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, stratified by demographic and geographic variables. From 1999 to 2020, there were 95,870 deaths related to All-LD and DM, with an overall AAMR of 10.2. The AAMR remained stable from 1999 to 2014 (APC: 0.08%), then rose markedly from 2014 to 2018 (APC: 5.47%) and surged from 2018 to 2020 (APC: 12.42%, p < 0.001). Mortality was higher in males (AAMR: 12.4) than females (8.5), and greatest among American Indian/Alaska Native (AI/AN) and Hispanic populations. Geographically, the West and South had the highest AAMRs. The mortality burden of coexisting liver disease and diabetes has intensified over the past two decades, particularly in racial minorities, rural areas, and specific states. The sharp increase from 2018 to 2020 represents a period encompassing the COVID-19 pandemic, although the upward trend began prior to its onset, suggesting contributions from additional factors such as rising prevalence of metabolic dysfunction associated steatotic liver disease and increasing alcohol consumption. These findings highlight the need for targeted, equitable public health interventions.