Trends and disparities in diabetes mortality among adults in China, 2013-2021

Trends and disparities in diabetes mortality among adults in China, 2013-2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Trends and disparities in diabetes mortality among adults in China, 2013-2021 Nannan Wang, Dong Wei, Chenxi Xia, Yuan Zhong, Yan Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8680271/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Diabetes is a major contributor to premature mortality, yet updated national evidence on diabetes mortality trends and inequalities in China is scarce. We assessed trends in diabetes mortality among adults in China from 2013 to 2021 and quantified disparities by sex, region, and urban–rural residence. Methods We conducted a population-based analysis using national mortality surveillance data for adults aged ≥ 20 years, 2013–2021. We calculated annual CMR and ASMR per 100,000 using direct age standardization. Temporal trends were evaluated using age-adjusted Poisson regression models with calendar year as a continuous variable, reporting APCs with 95% CIs. We tested heterogeneity in trends using interaction terms. Results Diabetes deaths nearly doubled from 26,842 in 2013 to 50,548 in 2021. National ASMR increased from 13.67 (95% CI 13.51–13.84) to 16.27 (16.12–16.41) per 100,000; the overall APC was 1.89% per year (95% CI 1.76–2.03). Mortality rose more rapidly among males than females (APC 3.01% vs 0.90%), producing a widening sex gap. Regional disparities were pronounced: the West showed the steepest increase (APC 3.85%), followed by the Central region (2.44%), while the East increased minimally (0.36%). Urban areas consistently exhibited higher ASMR levels, but rural areas experienced faster increases (APC 2.68% vs 0.37%), narrowing the urban–rural differential over time. Age-specific mortality rose sharply with advancing age, and intersectional analyses highlighted particularly high mortality among males residing in Central and Western China. Conclusions Diabetes mortality among adults in China increased substantially between 2013 and 2021, accompanied by widening disparities by sex and geography and accelerating increases in rural areas. Strengthening equitable chronic disease prevention and management—especially for high-burden, rapidly worsening subpopulations—is essential to curb rising diabetes mortality and reduce inequalities. Diabetes mellitus Mortality trends Age-standardized mortality rate Health disparities Urban–rural differences Regional inequalities Sex differences. Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryMethods.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 11 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 01 Apr, 2026 Editor invited by journal 12 Mar, 2026 Editor assigned by journal 04 Feb, 2026 Submission checks completed at journal 04 Feb, 2026 First submitted to journal 23 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8680271","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618222197,"identity":"a6f9c343-b722-4600-a108-0f21a93b5553","order_by":0,"name":"Nannan 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diabetes mellitus, Mortality trends, Age-standardized mortality rate, Health disparities, Urban–rural differences, Regional inequalities, Sex differences.","lastPublishedDoi":"10.21203/rs.3.rs-8680271/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8680271/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDiabetes is a major contributor to premature mortality, yet updated national evidence on diabetes mortality trends and inequalities in China is scarce. We assessed trends in diabetes mortality among adults in China from 2013 to 2021 and quantified disparities by sex, region, and urban\u0026ndash;rural residence.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a population-based analysis using national mortality surveillance data for adults aged\u0026thinsp;\u0026ge;\u0026thinsp;20 years, 2013\u0026ndash;2021. We calculated annual CMR and ASMR per 100,000 using direct age standardization. Temporal trends were evaluated using age-adjusted Poisson regression models with calendar year as a continuous variable, reporting APCs with 95% CIs. We tested heterogeneity in trends using interaction terms.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eDiabetes deaths nearly doubled from 26,842 in 2013 to 50,548 in 2021. National ASMR increased from 13.67 (95% CI 13.51\u0026ndash;13.84) to 16.27 (16.12\u0026ndash;16.41) per 100,000; the overall APC was 1.89% per year (95% CI 1.76\u0026ndash;2.03). Mortality rose more rapidly among males than females (APC 3.01% vs 0.90%), producing a widening sex gap. Regional disparities were pronounced: the West showed the steepest increase (APC 3.85%), followed by the Central region (2.44%), while the East increased minimally (0.36%). Urban areas consistently exhibited higher ASMR levels, but rural areas experienced faster increases (APC 2.68% vs 0.37%), narrowing the urban\u0026ndash;rural differential over time. Age-specific mortality rose sharply with advancing age, and intersectional analyses highlighted particularly high mortality among males residing in Central and Western China.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDiabetes mortality among adults in China increased substantially between 2013 and 2021, accompanied by widening disparities by sex and geography and accelerating increases in rural areas. Strengthening equitable chronic disease prevention and management\u0026mdash;especially for high-burden, rapidly worsening subpopulations\u0026mdash;is essential to curb rising diabetes mortality and reduce inequalities.\u003c/p\u003e","manuscriptTitle":"Trends and disparities in diabetes mortality among adults in China, 2013-2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-07 10:25:11","doi":"10.21203/rs.3.rs-8680271/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-13T06:55:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122655652977112062272905201002643116673","date":"2026-04-11T04:39:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24857679909446655947501816325549229406","date":"2026-04-06T12:04:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-01T20:57:01+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-12T07:27:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-04T23:25:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T23:23:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Endocrine Disorders","date":"2026-01-23T14:20:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-endocrine-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bend","sideBox":"Learn more about [BMC Endocrine Disorders](http://bmcendocrdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bend/default.aspx","title":"BMC Endocrine Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29574e54-8d1c-4476-a825-f30c9ddde323","owner":[],"postedDate":"April 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T10:25:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-07 10:25:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8680271","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8680271","identity":"rs-8680271","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}