{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:55:37Z","timestamp":1791186937790,"version":"4.1.0"},"reference-count":57,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T00:00:00Z","timestamp":1788739200000},"content-version":"vor","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"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":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Type 2 Diabetes Mellitus (T2DM) is a growing health burden globally, and its concurrence with Congestive Heart Failure (CHF) significantly increases morbidity and mortality. However, long\u2010term mortality trends remain underexplored. This study aims to assess temporal trends in mortality from comorbid T2DM and CHF in the United States (U.S.) from 1999 to 2020, with emphasis on demographic and geographical disparities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed U.S. mortality data from 1999 to 2020 for adults aged \u2265\u200925 years with coexisting T2DM and CHF using the CDC WONDER Multiple Cause of Death database. Cases were identified using the ICD\u201010 codes E11 and I50.0 for T2DM and CHF, respectively. Temporal trends in crude mortality rates (CMRs) and age\u2010adjusted mortality rates (AAMRs) per 100,000 population were stratified by demographic and geographic characteristics and were used to estimate the annual percent change (APC) and average annual percent change (AAPC) using Jointpoint regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 1999 and 2020, 292,452 deaths related to T2DM, and CHF were recorded among U.S. adults, with most deaths occurring in medical facilities. The overall AAMR increased from 4.33 in 1999 to 8.98 in 2020, with a significant rise after 2014. (APC: 7.31) AAMRs varied substantially by age, sex, race, and urbanization level. AAMRs were 27.96 among adults aged \u2265\u200965 years versus 0.93 among those aged 25\u201364 years and 7.47 among males versus 5.24 among females. Across racial groups, AAMRs were highest among American Indian\/Alaska Native populations at 11.53, followed by Hispanic\/Latino populations at 6.76, Black\/African American populations at 6.53, non\u2010Hispanic White populations at 6.06, and Asian\/Pacific Islander populations at 4.07. AAMRs were also higher in non\u2010metropolitan regions at 8.58 compared with 5.62 in metropolitan regions. Geographically, the highest mortality rate was observed in West Virginia at 11.27, with the Western region also exhibiting the highest regional mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>T2DM and CHF\u2010related mortality have increased substantially over the past two decades, with marked increases after 2014. Increased susceptibility among certain demographic and geographical groups highlight the need for integrated strategies to combine personalized care, treatment adherence, and population\u2010level risk factor management to reduce mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73193","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:00:51Z","timestamp":1788778851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal Trends and Disparities in Type 2 Diabetes Mellitus and Congestive Heart Failure Mortality in the United States From 1999\u20132020: A CDC WONDER Analysis"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3726-7330","authenticated-orcid":false,"given":"Syeda Sameen","family":"Afzal","sequence":"first","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2419-7085","authenticated-orcid":false,"given":"Ittiqa","family":"Khatri","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2878-4033","authenticated-orcid":false,"given":"Mariam","family":"Bahzad","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeniha","family":"Fatima","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aeman","family":"Wadood","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1817-7800","authenticated-orcid":false,"given":"Hasibullah","family":"Aminpoor","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kabul University of Medical Sciences \u201cAbu Ali Ibn Sina\u201d Kabul Afghanistan"},{"name":"Department of Internal Medicine Rabia Balkhi National Complex Hospital Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-3544-3513","authenticated-orcid":false,"given":"Maryam","family":"Sajid","sequence":"additional","affiliation":[{"name":"Department of Medicine Dow University of Health Sciences Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,7]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-022-03125-5"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.15797"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci23-0085"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.151"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2022.28.2.157"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.01.28"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1979.03290450033020"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.27.8.1879"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs156"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-018-9685-0"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.24.9.1614"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.4103\/sja.SJA_543_18"},{"issue":"166","key":"e_1_2_14_14_1","first-page":"1","article-title":"2013 NCHS Urban\u2010Rural Classification Scheme for Counties","volume":"1","author":"Ingram D. 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