Mortality Trends in Essential Hypertension and Type 2 Diabetes Among Older Adults in the United States

<p><strong>Background:</strong> Essential hypertension and type 2 diabetes mellitus frequently coexist in older adults, increasing<br />cardiovascular morbidity and mortality risks. Despite advancements in care, recent evidence shows that<br />cardiovascular mortality has plateaued, with increased hypertension-related deaths in the U.S. This study<br />aims to analyze mortality trends in older adults (≥65) with both conditions and examine disparities based on<br />demographics and geography.<br /><strong>Hypothesis:</strong> We hypothesized that age-adjusted mortality rates (AAMRs) for older adults with coexisting<br />hypertension and diabetes significantly increased from 1999 to 2024, with variations by sex, race/ethnicity,<br />region, and urbanization.<br /><strong>Methods:</strong> We conducted a retrospective analysis using the CDC WONDER database, identifying deaths from<br />1999-2024 where essential hypertension (ICD-10 I10) and type 2 diabetes (ICD-10 E11.x) were listed as causes. Mortality rates were calculated per 100,000, and Joinpoint regression analyzed trends.<br /><strong>Results:</strong> From 1999 to 2024, there were 331,823 eligible deaths (aggregate AAMR 60.3/100,000). The AAMR<br />rose sharply from 10.1 in 1999 to 106.1 in 2021, before slight declines in 2022-2024. Males had higher mortality rates than females and experienced steeper increases. Significant racial/ethnic disparities were observed, with American Indian/Alaska Native and Hispanic seniors seeing notable declines post-2021, while rates for White and Black seniors plateaued. Regionally, the West and South showed the highest increases, with rural counties experiencing a greater surge than metropolitan areas.<br /><strong>Conclusions:</strong> Mortality due to coexisting hypertension and diabetes among U.S. older adults rose dramatically<br />from 1999 to 2021, with significant demographic and regional disparities. A recent plateau in mortality trends<br />suggests potential shifts, highlighting the need for targeted public health interventions for high-risk groups to<br />address this dual epidemic in an aging population.</p>