National trends and disparities in primary (essential) hypertension and pulmonary embolism-related mortality in the United States from 1999-2023: A CDC wonder database analysis abstract

Abstract Background: Chronic elevation of blood pressure, also known as Primary (essential) hypertension, is one of the most occurring causes of cardiovascular diseases while pulmonary embolism is the obstruction of the pulmonary vessels by a thrombus. Although two separate conditions, when paired together causes a significant surge in morbidity and mortality. This study assesses the trends in mortality in patients with Primary (essential) hypertension and Pulmonary embolism in the United States from 1999-2023. Methods: We analyzed death certificates of adults aged> 25 years' from the CDC-WONDER database with Primary (essential) hypertension (ICD-10 codes: I10) and Pulmonary embolism (ICD-10 codes: I26) from 1999-2023. Age-adjusted mortality rates (AAMR) per 100,000 population were stratified by gender, race, census region, year and age. Join-Point analysis was performed to estimate annual percent change (APC) and average annual percent change (AAPC) in mortality trends, along with 95% confidence intervals (CIs). Results: Between 1999 and 2023, Primary (essential) hypertension and Pulmonary embolism caused 97,998 deaths in patients aged>25 years. The total AAMR witnessed a significant surge from 0.6 in 1999 to 2.6 in 2023. Demographically, AAMR among the men decreased significantly from 0.6 to 2.8 (AAPC: 6.25; 95% CI: -19.65 to 40.50). Similarly, females experienced a decline in mortality from 0.7 to 2.5(AAPC: 4.67; 95% CI: 2.16 to 7.24). Racially, a great increase in AAMR was witnessed in the mortality of Non-Hispanic (NH) Black or African Americans from 1.6 to 5.1 (AAPC:4.18 ; 95% CI:1.35 to 7.10), moreover the AAMR in the American indians increased from 1.3 to 1.6 (AAPC: 6.41; 95% CI: 1.25 to 11.84) while those among the Asians increased from 0.4 to 1 (AAPC: 4.18 ; 95% CI: -0.07 to 8.61).Geographically, regions in the South showed the highest overall AAMR (1.87), followed by the Midwest(1.75),West(1.55) and areas in the Northeast (1.42). Higher AAMRs were witnessed in Nonmetropolitan areas(1.86) than they were in Metropolitan areas(1.61). When stratified by states, AAMRs varied highly from the highest in Minnesota (6.6) to the lowest in Maine(0.7). Conclusion: The overall mortality rates for Primary (essential) hypertension and Pulmonary embolism increased between the years 1999-2023. The greatest AAMR was seen in males, regions in the south, racially in American indians and Non metropolitan areas.