{
  "abstract": "Objective: To examine U.S. trends and underlying-cause patterns among deaths with diabetes recorded as a non-underlying cause (DM-nonUCD).\n\nMethods: We used CDC WONDER Multiple Cause of Death data from 1999 to 2024. DM-nonUCD was defined as deaths with ICD-10 codes E10-E14 in multiple-cause fields, excluding deaths with diabetes as the underlying cause. Analyses were performed overall and for type 1 diabetes (E10) and type 2 diabetes (E11). Death counts, age-adjusted mortality rates (AAMRs), and Joinpoint trends were assessed.\n\nResults: DM-nonUCD occurred in 4,794,136 deaths and increased from 141,371 in 1999 to 246,426 in 2024. The leading underlying causes were circulatory diseases (2,294,799; 47.87%), malignant neoplasms (725,592; 15.13%), and respiratory diseases (449,837; 9.38%). Circulatory diseases remained dominant but declined from 60.51% to 44.48%, with decreasing AAMR (average annual percent change [AAPC], -1.01%; 95% CI, -1.21 to -0.88). Shares increased for malignant neoplasms (14.01% to 16.30%), nervous system diseases (2.67% to 7.56%), and mental and behavioral disorders (1.05% to 4.41%). Within circulatory causes, ischemic heart disease AAMR declined (AAPC, -2.04%; 95% CI, -2.23 to -1.92), whereas hypertensive disease AAMR increased (AAPC, 3.21%; 95% CI, 2.94 to 3.56). Subtype analyses showed similar cause-distribution shifts for E10- and E11-nonUCD, with declining circulatory shares and increasing nervous system and mental and behavioral shares.\n\nConclusions: DM-nonUCD represents a substantial proportion of deaths in which diabetes was recorded on the death certificate. The underlying-cause profile is shifting from coronary-dominated mortality toward broader multimorbidity, supporting surveillance and health-system planning that consider competing causes beyond ischemic heart disease.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Dermatology, The First Affiliated Hospital of Gannan Medical University , ,",
    "The First Clinical Medical College, Gannan Medical University , ,",
    "Department of Emergency Medicine, The First Affiliated Hospital of Gannan Medical University , , ,",
    "Department of Rheumatology and Immunology, The First Affiliated Hospital of Gannan Medical University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Yanhua Xiao"
    },
    {
      "affs": [
        1
      ],
      "name": "Qian Zhou"
    },
    {
      "affs": [
        1
      ],
      "name": "Xi Yan"
    },
    {
      "affs": [
        1
      ],
      "name": "Lihui Gan"
    },
    {
      "affs": [
        1
      ],
      "name": "Tong Chen"
    },
    {
      "affs": [
        1
      ],
      "name": "Kaiyi Zhang"
    },
    {
      "affs": [
        2
      ],
      "name": "Renqing Zeng"
    },
    {
      "affs": [
        3
      ],
      "name": "Dibin Guo"
    },
    {
      "affs": [
        1
      ],
      "name": "Xuezhi Hong"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dpd2jwj59w1zp.bib",
  "cited_by": 0,
  "doi": "10.3389/fendo.2026.1957392",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661304/?tool=EBI",
  "id": "dpd2jwj59w1zp",
  "issns": [
    "1664-2392"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13661304",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Diabetes, Cardiovascular Risks, and Lipoproteins"
    ]
  ],
  "openalex": "W7214938070",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661304/pdf/?tool=EBI",
  "pmcid": "PMC13661304",
  "pmid": null,
  "published": "2026-09-30",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dpd2jwj59w1zp.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:21Z",
      "native_id": "PMC:PMC13661304",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13661304"
    },
    {
      "first_seen": "2026-10-30T12:20:20Z",
      "native_id": "10.3389/fendo.2026.1957392",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fendo.2026.1957392/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Diabetes, Cardiovascular Risks, and Lipoproteins",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "Shifting competing underlying causes of death among U.S. decedents with diabetes recorded as a non-underlying cause, 1999–2024",
  "title_text": "Shifting competing underlying causes of death among U.S. decedents with diabetes recorded as a non-underlying cause, 1999–2024",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:20Z",
  "url": "https://research.draconitic.com/paper/dpd2jwj59w1zp",
  "venue": "Frontiers in endocrinology",
  "versions": []
}