Trends in diabetes and cardiomyopathy related mortality in adults in the U.S, from 1999 to 2024 – insights from the CDC WONDER database

PURPOSE: To analyze long-term trends in mortality for U.S. adults aged ≥ 25 years with death certificates listing both cardiomyopathy and diabetes from 1999 to 2024, and to assess persistent disparities by sex, race, and geographic region independent of traditional cardiovascular risk factors. METHODS: A retrospective analysis was conducted using CDC WONDER death certificate data from 1999 to 2024, identifying U.S. adult decedents aged ≥ 25 years with death certificates listing both diabetes (ICD-10 codes E10-E14) and cardiomyopathy (ICD-10 codes I42.0-I42.9), per 100,000 population. Age-adjusted death rates (AAMRs), annual percent change (APC), and average annual percent change (AAPC) were compared with Joinpoint regression ( RESULTS: From 1999 to 2024, 175,707 diabetes and cardiomyopathy related deaths were recorded among US adults. Overall AAMR fell from 4.28 (1999) to 2.39 (2024); AAPC: - 2.3. Mortality rates were consistently higher in males than females over the study period, with period-average AAMRs of 4.28 in males and 2.18 in females. The highest mortality rate is observed in older adults, representing almost 72% of fatalities. Non-Hispanic (NH) Black/African American individuals had the highest AAMR rate (5.77), with Hawaii having the highest state-specific AAMR (5.86). Rural counties had slightly greater AAMR than urban counties, with overall AAMRs being (3.29; 95% CI: 3.10 to 3.48) and (3.18; 95% CI: 3.09 to 3.26) respectively. Mortality rates were highest in the Midwest (AAMR: 3.32; 95% CI: 3.15 to 3.48) and lowest in the Northeast (AAMR: 2.63 ; 95% CI: 2.48 to 2.79). CONCLUSION: Although total death rates are decreasing, there remain remarkable inequalities, particularly among NH Black/African American groups, men, and rural residents. More intensive care and research are needed to address racial and regional disparities in high-risk groups. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-01895-7.