Trends in Cause-Specific Mortality by Race and Hispanic Origin, 1999–2019

Endocrine, Nutritional, and Metabolic Diseases

As discussed earlier, the share of deaths caused by endocrine, nutritional, and metabolic diseases increased over the observation period, accounting in 2019 for 4.5 percent of all deaths in the WNH community and 6.5 percent of deaths among the Hispanic and Black populations. This section discusses the five endocrine, nutritional, and metabolic disease subcategories listed in Box 7.

Chart 26 shows the number and percentage distribution of endocrine, nutritional, and metabolic disease–related deaths by subcategory for 1999 and 2019, with detail by RE group and age. The leading cause of endocrine, nutritional, and metabolic disease–related death, by far, is diabetes mellitus, which in 1999 accounted for 71.0 percent of all deaths in that category among WNH individuals, 79.6 percent of those deaths among the Black population, 81.8 of such deaths among API people, and 85.8 percent of those deaths in the Hispanic community. The percentage of endocrine, nutritional, and metabolic disease deaths caused by diabetes typically peaks toward the end of the midlife ages, in the 50s and early 60s. It declined over the 1999–2019 period, as other diseases such as obesity, malnutrition, and metabolic disorders accounted for rising shares of deaths in the category.

Chart 27 shows age-adjusted death rates for 1999–2019 by RE group, sex, and age group. Panel A shows the rates for endocrine, nutritional, and metabolic diseases overall.

Chart 27, Panel B shows that in 2019, the all-ages diabetes death rate was highest for Black males (45.1), followed by Hispanic males (31.2) and Black females (31.1). Prior to 2019, however, the diabetes death rate for Black females had exceeded that of Hispanic males. Similarly, Hispanic females had higher all-ages diabetes mortality rates than WNH males from 1999 until 2013. API and WNH females had the lowest all-ages diabetes mortality rates in 2019 (about 14). From 1999 to 2019, all-ages diabetes mortality rates declined for all RE/sex groups other than API males, dropping most sharply for Hispanic and Black females. For instance, during this period, the all-ages diabetes mortality rate for Black females declined from 49.5 to 31.1, driven largely by a steep drop in the 65 or older age group. During the second half of the period (2010–2019), the death rate associated with diabetes rose among people aged 25–64 in every RE/sex group. Notably, diabetes mortality rates during the 1999–2019 period improved much faster among females than males, widening a preexisting mortality gap. For instance, the WNH male-to-female mortality ratio for diabetes was 1.3 in 1999 and 1.7 by 2019.

Metabolic disorders represent the second leading cause of endocrine, nutritional, and metabolic disease deaths after diabetes. In 2019, about 51 percent of deaths in this subcategory involved disorders of lipoprotein metabolism (such as hyperlipidemia), while another 20.5 percent entailed other disorders of fluid, electrolyte, and acid-base balance (such as acidosis, wherein the body fluids are too acidic). The share of endocrine, nutritional, and metabolic disease deaths that was caused by metabolic disorders increased substantially over the observation period and by 2019, for all ages combined, it ranged from 14.5 percent in the Hispanic community to 23.0 percent in the WNH population. Metabolic disorders account for higher percentages of endocrine, nutritional, and metabolic disease deaths at ages 65 or older than in the midlife years, yet the highest shares affect the young. For the 0–24 age group, metabolic disorders are the leading cause of death in this category, causing about 40 percent of those among Black people, more than half of such deaths among the WNH and Hispanic communities, and two-thirds of those among API individuals.

Chart 27, Panel C shows that from 1999 to 2019, mortality rates for metabolic disorders rose significantly in the midlife and older age groups for all RE/sex groups (except API women aged 25–64). The all-ages metabolic disorder death rate in 2019 was highest for Black males (11.3), followed by WNH males (9.0) and Black females (7.7). WNH females had higher all-ages metabolic disorder mortality rates than Hispanic males until 2019, when the two rates converged at about 6. Hispanic and API females had the lowest all-ages metabolic disorder mortality rates (4.3 and 3.2, respectively).

From 1999 to 2019, the percentage of endocrine, nutritional, and metabolic disease deaths caused by obesity and other hyperalimentation disorders more than doubled for every RE group. In 2019, the share of deaths in this category that were associated with obesity ranged from 1.5 percent among API people to 6.9 percent in the Black community. The proportion of endocrine, nutritional, and metabolic disease deaths caused by obesity peaked in the midlife years, accounting in 2019 for 15 percent of those deaths among WNH people and 14 percent of such deaths among Black people in this age group.

Chart 27, Panel D shows that the all-ages obesity mortality rate in 2019 was highest for Black females (3.6), followed by Black males (3.4), WNH males (2.6), and WNH females (2.0). During the 1999–2019 period, all-ages obesity mortality rates rose by a factor of 1.8 among Black females, more than doubled for males in all RE groups and for WNH and Hispanic females, and tripled for API females. Obesity mortality rates rose for all RE/sex groups in the midlife ages and, especially, for the aged. For instance, the obesity death rate for WNH men aged 65 or older rose from 1.6 in 1999 to 6.2 in 2019, a factor of 3.9. At ages 25–64, men typically had higher obesity mortality rates than women in the same RE group. At older ages, however, the pattern generally reversed, with women experiencing higher death rates than men. Note also that in the midlife ages, Black men and women were the two RE/sex groups with the highest obesity mortality rates, while at ages 65 or older, WNH men and women had higher obesity mortality rates than Black men (but not Black women). Further, in the latter years of the observation period, the gender gap in obesity mortality narrowed in the Black population but widened among WNH and Hispanic people.

Malnutrition is a serious health issue, especially among the aged. Appetite tends to decline with age, and illness and certain medications can further diminish appetite. Aged individuals are also more likely to have poor dental health and more difficulty chewing and swallowing, which impairs their ability to eat. Other factors more prevalent among the aged, such as loneliness, failing health, and lack of mobility can lead to depression and poor or irregular eating habits. In addition, Alzheimer's disease, dementia, and other cognitive disorders affecting memory and behavior can result in forgetting to eat or even how to swallow. The percentage of endocrine, nutritional, and metabolic disease deaths that were associated with malnutrition increased over the observation period and peaked at the oldest ages. Typically, malnutrition accounts for a higher share of this category's deaths among females than males and among the WNH population than in the other RE groups. Over all ages combined, malnutrition caused 9.2 percent of endocrine, nutritional, and metabolic disease deaths among WNH individuals and 5–6 percent of such deaths among the other RE groups in 2019. For women aged 85 or older, malnutrition's share of such deaths in 2019 ranged from 11.8 percent in the API population to 22.7 percent among the WNH group.

Chart 27, Panel E shows that malnutrition mortality rates were highest among Black males, followed by Black females, WNH females, and WNH males. Mortality rates broadly declined from 1999 to 2010 but increased afterward, resulting in a higher all-ages death rate in 2019 than in 1999 among all RE/sex groups. From 2010 to 2019, the all-ages malnutrition death rate more than doubled for Black females, API males, and Hispanic males and females; it more than tripled among WNH males and females, Black males, and API females.

The residual subcategory “all other endocrine, nutritional, and metabolic diseases” includes disorders of the thyroid gland, other disorders of glucose regulation and pancreatic internal secretion, disorders of other endocrine glands, and other nutritional deficiencies. This subcategory's share of all endocrine, nutritional, and metabolic disease deaths ranged from 1.8 percent in the Hispanic population to 2.9 percent among WNH individuals. Chart 27, Panel F shows that from 1999 to 2019, the all-ages death rate for all other endocrine, nutritional, and metabolic diseases declined for every RE/sex group except API females. In 2019, Black females had the highest all-ages mortality rates in this subcategory, followed by Black males and WNH females. At ages 65 or older, however, mortality rates were higher for WNH women than for Black men.

Chart 28 shows the all-ages endocrine, nutritional, and metabolic disease mortality rates by cause-of-death subcategory, RE group, and sex in 1999 and 2019. In both years, the mortality rate associated with diabetes mellitus was higher in the Black population than the death rate from all endocrine, nutritional, and metabolic diseases combined for the other RE groups, regardless of sex. Likewise, the death rate from diabetes among Hispanic males and females in 1999 was higher than the mortality from all endocrine, nutritional, and metabolic diseases among the WNH and API communities that year. Over the observation period, the death rates associated with metabolic disorders, obesity, and malnutrition rose in all RE/sex groups, but the diabetes mortality rate declined in every group other than API males. As a result, the endocrine, nutritional, and metabolic disease mortality rate rose for WNH, Black, and API males, while it declined for Hispanic males and for females in all RE groups.