Obstructive sleep apnea and mortality among older U.S. adults with diabetes mellitus (1999-2019): a CDC WONDER longitudinal study

Background: Obstructive sleep apnea (OSA) is a commonly undiagnosed disorder with increasing prevalence and a heavy public health and economic burden. OSA shares many common risk factors with diabetes mellitus (DM). However, no prior study has yet assessed the trends in mortality rates of these two diseases in the United States. Methods: Mortality data were extracted from the CDC WONDER database between 1999 to 2019 for adults aged 65 and above with OSA and DM. Age-adjusted mortality rates (AAMR) per 100,000 and annual percentage change (APC) with 95% confidence interval were calculated and stratified according to year, sex, ethnicity, urbanization, and census regions using join point regression. Results: Over the study period, 41,111 deaths were reported among individuals with OSA and DM. Overall, AAMR increased steadily (AAPC = 12). Males had a higher increase (AAPC = 11.87) and overall higher AAMR (6.9) than females. The white population exhibited the highest AAMR (9.5) (AAPC = 12.07) by 2019. Both metropolitan (4.53) and nonmetropolitan areas (5.61) showed similar overall surges in AAMR. The Midwest region (AAPC = 12.16) reported the highest AAMR (6.1). Conclusions: Mortality rates concerning OSA and DM have increased substantially, particularly in males, whites, and in the Midwest, highlighting the need for guiding awareness efforts and targeted interventions to reduce mortality.