Closing the Gap: A Binational Analysis of Diabetes Mortality and Disability across the USA-Mexico Border Region

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Abstract
Aims: This study characterizes the diabetes burden across USA–Mexico border states (1990–2021) by examining current patterns, temporal trends, binational comparisons, and demographic variations. Methods: Using Global Burden of Disease 2021 estimates, we calculated age-standardized rates for mortality, prevalence, incidence, and DALYs. We applied joinpoint regression, age-period-cohort models, and decomposition analyses to characterize trends and identify drivers of burden change, comparing border versus non-border states within and between countries. Results: Border states showed 9-14% higher burden than non-border states. Despite similar prevalence (9,010 vs 8,298 per 100,000) and incidence (435 vs 426 per 100,000), Mexican border states had nearly five times higher mortality (67.2 vs 12.0 per 100,000) and three times higher DALYs (2,355 vs 896 per 100,000) than USA counterparts. YLLs comprised 64.3% of Mexican burden versus 31.4% in USA. From 1990-2021, USA border states showed rising incidence (+3.04% annually) with declining mortality (- 1.28%), while Mexican states demonstrated stable-to-declining incidence (-0.15%) with plateauing mortality post-2009. Males experienced higher mortality in both countries. Conclusions: Diabetes occurrence has converged across the border, yet outcomes remain profoundly unequal. This demands coordinated binational surveillance and policy action. Focus on prevention in the US and diabetes care management in Mexico to reduce health disparities.

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