{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:59:07Z","timestamp":1781240347432,"version":"3.54.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To characterize U.S. mortality trends for diabetes mellitus (DM), proxy-defined metabolic dysfunction\u2013associated steatotic liver disease (MASLD), and deaths listing both conditions, and to present exploratory conditional overlap extrapolations through 2040.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed CDC WONDER multiple-cause-of-death data from 1999\u20132023 among adults aged \u226525 years. DM was identified by ICD-10 codes E10\u2013E14 and steatotic liver disease by K75.8 or K76.0. Because clinical MASLD cannot be directly ascertained in CDC WONDER, MASLD was defined using a death-certificate proxy combining steatotic liver disease codes with recorded cardiometabolic conditions. Age-adjusted mortality rates were assessed using Joinpoint regression. Prophet models generated conditional extrapolations through 2040. Sensitivity analyses used K76.0-only coding, K75.8-only coding, restriction to 1999\u20132019, and an underlying-cause-of-death-only analysis requiring K76.0 to be listed as the underlying cause of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>DM-involved mortality changed little from 1999 to 2023 (118.47 to 122.61 per 100,000; average annual percent change [AAPC], \u22120.03%). In contrast, overlap mortality increased from 0.08 to 0.84 per 100,000 (AAPC, 11.20%), and proxy-defined MASLD mortality increased from 0.13 to 1.29 per 100,000 (AAPC, 9.83%), although absolute rates remained low. Sensitivity analyses using K76.0-only coding, restriction to 1999\u20132019, and an underlying-cause-of-death-only definition showed directionally consistent increases, whereas K75.8-only overlap deaths were sparse, zero, or suppressed. The underlying-cause-only analysis also showed a directionally consistent increase from 2000 to 2023 (AAPC, 14.46%; 95% CI, 13.46 to 21.51). Conditional extrapolations suggested continued growth through 2040 but were inherently uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Proxy-based mortality involving co-recorded DM and steatotic liver disease increased substantially in U.S. death-certificate data. These findings were directionally consistent across alternative coding, period-restricted, and underlying-cause-only sensitivity analyses but remain limited by under-ascertainment, misclassification, and evolving death-certificate documentation. They should be interpreted as descriptive surveillance patterns rather than evidence of biological expansion or causal mechanisms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1828354","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T04:44:06Z","timestamp":1781239446000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mortality trends in diabetes with proxy-defined steatotic liver disease in the United States, 1999\u20132023"],"prefix":"10.3389","volume":"17","author":[{"given":"Hongzhou","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ru","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Beijing Jishuitan Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liqin","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linlin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yangfan","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaide","family":"Xia","sequence":"additional","affiliation":[{"name":"Guiyang Maternal and Child Health Care Hospital, Guiyang Children\u2019s Hospital","place":["Guiyang, Guizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S002","article-title":"2. diagnosis and classification of diabetes: Standards of care in diabetes-2024","volume":"47","year":"2024","journal-title":"Diabetes Care"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2026.113107","article-title":"Cardiovascular mortality trends and disparities among older 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