S1392 Upper Gastrointestinal Bleeding Related Mortality in US Adults With Comorbid Hypertension: A 25-Year Retrospective Study

Introduction: Upper gastrointestinal bleeding (UGIB) remains a leading cause of emergency hospitalization and death among United States adults. Hypertension (HTN), a common comorbidity in aging populations, may exacerbate the risk and severity of UGIB through vascular fragility, anticoagulant use, and impaired hemodynamic compensation. Despite this biologically plausible synergy, little is known about the long-term burden and mortality trends of UGIB in hypertensive individuals, especially among older adults. This study investigates UGIB and HTN-related mortality trends in the U.S. from 1999 to 2023, with a focus on disparities across age, sex, race/ethnicity, and geography. Methods: CDC WONDER (1999–2023) provided mortality data using ICD-10 codes for UGIB and HTN. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression was used to determine annual percent change (APC) and Average Annual Percent Change (AAPC). Statistical significance was defined as P < 0.05. Results: A total of 92,439 deaths were attributed to UGIB and HTN over the study period, with 41% occurring in hospital settings. The overall AAMR increased by 144%, from 0.81 in 1999 to 1.98 in 2023 (AAPC: 3.0%, 95% CI: 2.0–3.9, P < 0.000001). Men had slightly higher AAMRs than women (1.8 vs 1.4) and a steeper increase over time (AAPC: 3.2% vs 2.3%). Adults aged 75+ had the highest AAMR (11.7), followed by those aged 55–74 (1.7), and 25–54 (0.1); however, younger adults had the sharpest rise (AAPC: 4.4% vs 3.7% vs 2.8%). Non-Hispanic (NH) American Indians had the highest AAMR (2.6), while NH Whites had the fastest-growing trend (AAPC: 3.9%, P < 0.000001). Regionally, the South recorded the highest AAMR (1.67) and the greatest increase over time (AAPC: 0.9%, P < 0.000001). States in the top 90th percentile included Mississippi, South Carolina, Wyoming, Rhode Island, and Oklahoma. Rural areas showed both higher AAMRs than urban areas (1.8 vs 1.4) and a steeper rise in mortality (AAPC: 4.5% vs 3.0%). Conclusion: UGIB-related mortality in adults with comorbid HTN is rising, especially among younger adults, NH American Indians, rural residents, and those in the South. These disparities may reflect gaps in blood pressure control, timely GI evaluation, or healthcare access. Targeted prevention and early intervention strategies are urgently needed to reduce this growing burden.