Disparities in heart failure deaths among people with diabetes in the United States: 1999–2020

AIMS: Heart failure is a leading cause of mortality in the United States, with significant disparities in its burden, particularly among underserved populations. A similar pattern exists for diabetes, but less is known about the mortality impact of these two comorbid conditions. This study aims to examine the risk of death from heart failure among people with diabetes, focusing on socio-demographic disparities. MATERIALS AND METHODS: We analysed data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death Database, examining patterns of heart failure deaths in which diabetes was a contributing cause. Our analysis was stratified by socio-demographic variables, including race, ethnicity and geography, and we also explored trends over time. RESULTS: Between 1999 and 2020, there were 82 617 deaths from heart failure in which diabetes was a contributing cause, with an age-adjusted mortality rate of 32.04 deaths per 1 000 000 individuals. The death rate increased by 2.18% during the study period. Death rates were higher among Black Americans compared with White Americans (age-adjusted mortality rate ratio = 1.51, 95% confidence interval: 1.49-1.53), with disparities growing over time (a 10.75% increase for Black Americans vs. a 1.11% increase for White Americans). CONCLUSIONS: Deaths from comorbid heart failure and diabetes are increasing in the United States, with significant and worsening disparities, particularly among minorities. Urgent action is needed to reduce heart failure mortality among people with diabetes, especially in underserved populations.