Abstract 4342870: Hypertension-Associated Cancer Mortality: A 20-Year United States Comorbid Mortality Analysis From 1999 to 2020

Introduction: Hypertension is a common comorbidity in cancer patients and may worsen prognosis. Despite its relevance, long-term trends in hypertension-associated cancer mortality remain underexplored. Hypothesis: We hypothesized that hypertension-associated cancer mortality increased over time and varied significantly by demographic and geographic subgroups among U.S. adults aged ≥25 years from 1999 to 2020. Methods: CDC WONDER data (1999–2020) were used to identify deaths with malignant neoplasms (ICD-10: C00–C97) as the underlying cause and hypertensive diseases (I10–I15) among multiple causes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated . Joinpoint regression estimated annual and average annual percent changes (APC, AAPC) with 95% confidence intervals, stratified by age, sex, race/ethnicity, region, and urbanization. Results: Between 1999 and 2020, 784,885 hypertension-associated cancer deaths were recorded in the United States. The AAMR increased from 9.666 to 20.637. In 1999, the Midwest had the highest AAMR (10.992) and the South the lowest (8.604); by 2020, the South was highest (24.090) and the Northeast lowest (15.493). Non-Hispanic Black individuals had the highest AAMRs in both 1999 (20.180) and 2020 (27.971), while the lowest rates were seen in Non-Hispanic American Indian/Alaska Natives in 1999 (6.637) and Non-Hispanic Asian/Pacific Islanders in 2020 (13.581). Rural areas consistently showed higher mortality rates than urban areas (10.089 vs. 9.572 in 1999; 26.312 vs. 19.551 in 2020). Males had higher AAMRs than females (1999: 10.854 vs. 8.883; 2020: 25.366 vs. 17.028). The highest regional AAPC was observed in the South (4.6365%, 95% CI: 3.6137–5.6695), and the lowest in the Northeast (1.7282%, 95% CI: 0.3555–3.1198). By race, Non-Hispanic American Indian/Alaska Natives had the highest AAPC (4.2363%), and Non-Hispanic Black individuals the lowest (1.3504%). Rural areas exhibited a greater AAPC (4.2330%) compared to urban areas (3.1926%). Crude mortality rates were highest among adults aged ≥85 in both years and lowest among the 25–34 group in 2020. The 35–44 age group showed the greatest AAPC increase (5.004%). Conclusion: Hypertension-associated cancer mortality nearly doubled over two decades, with the sharpest rises in rural areas, the South, older adults, and underserved racial groups. Post-2018 acceleration highlights widening disparities, calling for urgent, equity-driven interventions to prevent avoidable deaths.