Hypertension and myocardial disease: a nationwide mortality trend analysis (1999– 2020) using CDC WONDER

Background

Hypertension is a well known risk factor for myocardial disease which is a leading cause of morbidity and mortality worldwide. It is crucial to look for the long term effects of hypertension to reveal any critical disparities across populations.

The purpose of this study is to evaluate nationwide mortality trends from 1999 to 2020.

Purpose

The purpose of this study was to analyze nationwide trends in hypertension related myocardial disease mortality in the United States from 1999 to 2020 and to identify disparities across sex, race/ethnicity, age groups, geographic regions, and levels of urbanization in order to better understand vulnerable populations and inform targeted public health interventions.

Methods

This retrospective study analyzed mortality data from the CDC WONDER database 1999 to 2020, focusing on hypertension related myocardial disease deaths, identified by using ICD-10 codes. Crude and age-adjusted mortality rates (AAMR) per 100,000population were calculated. JoinPoint was applied to evaluate annual percent change (APC) and assess trends by sex, race, age, region, and urbanization.

Results

This retrospective study revealed significant disparities across demographic and geographic subgroups. There was notable increase in mortality rates in men with APC 1.5904 (95% CI: 0.7362 to 2.4519, p < 0.001), while women showed a non statistically significant decline with APC -0.3681 (95% CI: -1.2957 to 0.5683, p = 0.421). Region wise the Northeast and Midwest exhibited significant increases in mortality with APC of 1.1302 (95% CI: 0.3216 to 1.9453, p = 0.008) and APC of 1.4217 (95% CI: 0.5163 to 2.3353, p = 0.004) respectively. Ethnicity showed remarkable role, with American Indian or Alaska Native populations experiencing the highest rise with APC 3.1202 (95% CI: 2.0399 to 4.212, p < 0.001), while Asian or Pacific Islander with APC -1.2204(95% CI: -2.0593 to -0.3743, p = 0.007) and Black or African American with APC -1.1424 (95% CI: -1.9589 to -0.319, p = 0.009) populations saw significant declines in mortality related to hypertension induced myocardial disease. White populations had a significant increase with APC 1.3799 (95% CI: 0.4305 to 2.3383, p = 0.006). Significant increase in mortality was observed in young and older adults, aged 25 to 34 with APC 1.358 (95% CI: 0.0857 to 2.6465, p = 0.038) ; 35 to 44 years with APC 2.0444 (95% CI: 1.4948 to 2.597, p < 0.001) and older adults 85+ had AAPC 4.0848 (95% CI: 1.5163 to 6.7183, p = 0.002). Rural areas demonstrated a significant rise in mortality APC 1.0137 (95% CI: 0.4484 to 1.5822, p = 0.001) which suggests disparities in health care access.

Conclusion

This study highlights persistent disparities in hypertension related myocardial disease mortality, with significant increases among males, younger and older adults, American Indian/Alaska Native populations, and non-metro areas.