Disparity trends in coexisting renal failure- and pulmonary hypertension-related mortality in the United States (1999–2020): CDC WONDER database study

Renal failure (RF) and pulmonary hypertension (PH) are major contributors to mortality in the United States (U.S.). Globally, RF affects around 11–13% of the population and is the 10th leading cause of death. In the U.S., 15% of adults are estimated to have CKD, with almost 90% undiagnosed. PH affects about 1% of the global population, rising significantly in older adults. RF and PH frequently coexist, especially in end-stage renal disease, amplifying mortality risk. We analyzed annual death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (1999–2020), identifying deaths with the International Statistical Classification of Diseases and Related Health Problems – 10th Revision codes N17–N19 (RF) and I27.x (PH). We calculated crude and age-adjusted mortality rates (AAMRs) per 100 000 and assessed temporal trends using Joinpoint regression. Analyses were stratified by sex, race/ethnicity, geographic region, and urban–rural status. Between 1999 and 2020, 63 394 deaths were attributed to combined RF–PH. Overall, AAMR rose from 7.17 to 18.11 per 100 000, with two joinpoints: a sharp rise until ~2012 [annual percentage change (APC) ~+5.8%], a dip through ~2015 (–6.7%), then a rebound (APC ~+5.9%). Increases were observed across sexes, races, regions, and urbanization, but were most pronounced among Black individuals (AAMR 14.07 → 31.29), rural populations, and Western states. From 1999 to 2020, RF- and PH-related mortality in the U.S. nearly tripled, with persistent disparities by race, geography, and urbanization. These findings highlight the need for targeted screening and interventions, especially in high-burden communities, to mitigate risk in vulnerable groups.