Trends in Mortality From Co-Occurring Diabetes Mellitus and Pneumonia in the United States (1999-2022): Retrospective Analysis of the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Database
Bibliographic record
Abstract
Background: Pneumonia is the most common respiratory tract infection among patients with diabetes, affecting individuals across all age groups and sexes. Objective: This study aims to examine demographic trends in mortality among patients diagnosed with both diabetes mellitus (DM) and pneumonia. Methods: Deidentified death certificate data for DM- and pneumonia-related deaths in adults aged 25 years and older from 1999 to 2022 were obtained from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. The Joinpoint Regression Program was used to evaluate annual percentage changes (APCs) in mortality trends, with statistical significance set at P<.05. This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting. Results: Between 1999 and 2022, a total of 425,777 deaths were recorded from DM and pneumonia. The overall AAMR declined significantly (P=.001) from 98.73 in 1999 to 49.17 in 2016 (APC -4.68), and then surged to 97.66 by 2022 (APC 23.55). Men consistently experienced higher mortality than women throughout the study period. Male AAMR rose from 62.61 in 2016 to 127.05 in 2022 (APC 24.88), while female AAMR increased from 41.05 in 2017 to 75.25 in 2022 (APC 27.60). Race-based analysis demonstrated that American Indian or Alaska Native populations had the highest mortality rates among racial groups. Non-Hispanic White individuals exhibited a significant decline in AAMR (P=.002) from 89.76 in 1999 to 44.19 in 2017 (APC -4.58), followed by an increase to 83.11 by 2022 (APC 25.25). Adults aged 65 years or older bore the highest mortality burden, with rates declining steadily to 206.9 in 2017 (APC -5.15) before rising sharply to 371.3 in 2022 (APC 20.01). Nonmetropolitan areas consistently exhibited higher mortality than metropolitan areas, with particularly steep increases after 2018 (APC 64.42). Type-specific mortality revealed that type 1 DM AAMRs declined from 9.2 in 1999 to 1.4 in 2015 (APC -11.94) before rising again. By contrast, type 2 DM AAMRs surged drastically after 2017, peaking at 62.2 in 2020 (APC 58.74) before partially declining to 41.6 by 2022. Conclusions: DM is associated with an increased risk of mortality following pneumonia, particularly among men, older adults, and American Indian populations. Strengthening health care interventions and policies is essential to curb the rising mortality trend in these at-risk groups.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".