{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:56:21Z","timestamp":1791291381849,"version":"4.3.0"},"reference-count":39,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes is a well\u2010established risk factor for cognitive decline and dementia; however, the extent to which diabetes is documented as a contributing cause on death certificates among decedents with dementia remains poorly characterized. This study aimed to evaluate temporal trends and demographic disparities in diabetes as a contributing condition among dementia\u2010related deaths in older adults in the United States.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed multiple\u2010cause\u2010of\u2010death data from the CDC WONDER database for adults aged \u2265\u00a065 years with dementia listed as an underlying or contributing cause of death between 1999 and 2020. Diabetes was identified using ICD\u201010 codes E10\u2013E14. We calculated age\u2010adjusted mortality rates (AAMR), crude death rates (CDR), annual percentage changes (APC) using Joinpoint regression, and the proportion of dementia deaths with coexisting diabetes. Analyses were stratified by age, sex, race, and state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 3,818,272 dementia\u2010related deaths, 234,793 (6.2%) had diabetes documented as a contributing condition. The AAMR for dementia with diabetes increased from 8.7 per 100,000 in 1999 to 36.1 per 100,000 in 2020. Joinpoint regression identified a sharp increase from 1999 to 2009 (APC: +13.09%, 95% CI: 11.47\u201314.94,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001), followed by a stable trend from 2009 to 2020 (APC: +0.84%, 95% CI: \u22120.55\u20132.11,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.187). Both dementia alone and dementia with diabetes demonstrated a sharp spike in 2020. The proportion of dementia deaths with coexisting diabetes was highest among decedents aged 65\u201374 years (8.5%) and decreased with age (85+ years: 5.3%). By race, American Indian\/Alaska Native decedents had the highest proportion (10.4%), followed by Asian\/Pacific Islander (9.2%), Black\/African American (9.0%), and White (5.8%). Substantial state\u2010level variation was observed across the United States.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The burden of diabetes, documented as a contributing condition among dementia\u2010related deaths, increased substantially from 1999 to 2009 and remained relatively stable thereafter. Significant racial, age, and geographic disparities exist, with American Indian\/Alaska Native decedents showing the highest proportion of coexisting diabetes. These findings highlight the burden of metabolic comorbidity among older adults with dementia and underscore the importance of continued surveillance and targeted public health strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71616","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T06:41:38Z","timestamp":1784875298000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Burden of Diabetes as a Contributing Cause in Dementia Mortality Among Older Adults in the United States, 1999\u20132020"],"prefix":"10.1002","volume":"16","author":[{"given":"Aasim","family":"Ali","sequence":"first","affiliation":[{"name":"Neurology Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayisha","family":"maqsood","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aswad","family":"Mustafa","sequence":"additional","affiliation":[{"name":"Neurology Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Hussain","sequence":"additional","affiliation":[{"name":"Warwick Medical School University of Warwick  Coventry UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areeba","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameen","family":"Sarfaraz","sequence":"additional","affiliation":[{"name":"Neurology Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Butt","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Shamoon","sequence":"additional","affiliation":[{"name":"Neurology Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Labeeba Abdul","family":"Ghafoor","sequence":"additional","affiliation":[{"name":"Neurology Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammad","family":"Azam","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimen Anwaar","family":"Pannun","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Asad","family":"Shabbir","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armaghana","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Allied Hospital Faisalabad  Faisalabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7424-6327","authenticated-orcid":false,"given":"Mukesh Kumar","family":"Sharma","sequence":"additional","affiliation":[{"name":"Neurology Department Dhankuta District Hospital  Dhankuta Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13016"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-S009"},{"issue":"10","key":"e_1_2_11_4_1","first-page":"1995","article-title":"Guiding Principles for the Care of Older Adults With Multimorbidity","volume":"67","author":"American Geriatrics Society","year":"2019","journal-title":"Journal of the American Geriatrics Society"},{"issue":"172","key":"e_1_2_11_5_1","first-page":"1","article-title":"The Validity of Race and Hispanic\u2010Origin Reporting on Death Certificates in the United States: An Update","volume":"1","author":"Arias E.","year":"2016","journal-title":"Vital and Health Statistics"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2017.185"},{"issue":"3","key":"e_1_2_11_7_1","first-page":"862","article-title":"Racial and Ethnic Disparities in Dementia","volume":"28","author":"Barnes L. L.","year":"2022","journal-title":"Continuum"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41574\u2010018\u20100048\u20107"},{"issue":"3","key":"e_1_2_11_9_1","first-page":"453","article-title":"Developing Dementia\u2010Capable Health Care Systems: A 12\u2010Step Program","volume":"33","author":"Borson S.","year":"2017","journal-title":"Clinics in Geriatric Medicine"},{"key":"e_1_2_11_10_1","unstructured":"Centers for Disease Control and Prevention.National Diabetes Statistics Report 2022.CDC.2022."},{"key":"e_1_2_11_11_1","unstructured":"Centers for Disease Control and Prevention.2026. \u201cCDC WONDER: About Multiple Cause of Death 1999\u20132020.\u201d Accessed April 3.https:\/\/wonder.cdc.gov\/mcd\u2010icd10.html."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15\u20101588"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.19365"},{"issue":"4","key":"e_1_2_11_14_1","first-page":"923","article-title":"Diversity and Disparity in Dementia Diagnosis and Care","volume":"38","author":"Chin A. 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K.","year":"2021","journal-title":"JAMA Network Open"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2014.01.004"},{"issue":"7","key":"e_1_2_11_40_1","first-page":"1589","article-title":"Impact of Age, Age at Diagnosis, and Duration of Diabetes on the Risk of Dementia","volume":"44","author":"Zoungas S.","year":"2021","journal-title":"Diabetes Care"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71616","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.71616","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71616","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T12:15:00Z","timestamp":1791288900000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.71616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":39,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/brb3.71616"],"URL":"https:\/\/doi.org\/10.1002\/brb3.71616","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-04-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71616"}}