Introduction: Diabetes mellitus (DM) is a major cause of mortality, and its association with heart failure (HF) remains underexplored. Understanding this relationship is essential to identifying high-risk populations and developing targeted public health interventions. Aims: This study aims to analyze mortality trends and demographic disparities in DM with HF as a contributing cause. Methods: A retrospective observational study was conducted using the Centers for Disease Control and Prevention (CDC) Multiple Causes of Death (MCD) database to assess mortality trends in individuals aged 25 years and older in the United States from 1999 to 2020. The study included deaths where DM (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10): E10-14) was listed as the underlying cause and HF (ICD-10: I50) as a contributing cause. Data were analyzed by age, gender, race, geographic region, and place of death. Age-adjusted mortality rates (AAMR) and annual percent change (APC) were calculated. Results: A total of 273611 deaths were recorded. The AAMR for DM with HF showed a small increase from 1999 to 2005 (APC: +0.31), followed by a sharp, significant decline from 2005 to 2010 (APC: -5.24), and started to rise steadily from 2010 to 2020 (APC: +1.88). The highest mortality was observed in females (n = 139882, 51.10%), White individuals (n = 225333, 82.40%), and in metropolitan areas (n = 209482, 76.50%). Temporal trends showed an increasing AAMR in males (+2.66 APC post-2010) and increasing AAMR amongst Asian or Pacific Islander individuals (+1.66 APC post-2010), who had the lowest overall mortality rates, indicating evolving disparities. Conclusion: Overall, DM and HF-related mortality trends have shifted with disparities in gender, race, and location. Targeted interventions addressing comorbid management, preventive strategies, and social determinants of health are critical to mitigating excess mortality in high-risk populations concerning uptrends.

Xinyu Lu completed her MD degree at the age of 25 from Shanghai Medical College, Fudan University. She is currently working as a physician at an academic-affiliated community hospital. She has over 20 publications in various PubMed-indexed, open-access journals.