To identify trends and disparities in cerebrovascular disease mortality in hypertensive patients in the US from 1999 to 2020.
Hypertension is a leading modifiable risk factor for cerebrovascular diseases. Uncontrolled hypertension leads to stroke, causes lasting neurological damage, and significantly increases the risk of cerebrovascular mortality.
CDC WONDER mortality database was used to evaluate cerebrovascular disease-related mortality in middle-aged and older adults (45+ years) with hypertension from 1999 to 2020. We calculated the age-adjusted mortality rate (AAMR) per 100,000 followed by an assessment of mortality trends via annual percentage change (APC) and average APC (AAPC) using Joinpoint regression analysis. The data was stratified based on demographic (gender, race/ethnicity) and regional subgroups.
A total of 83,414 cerebrovascular disease-related deaths occurred in hypertensive adults in the US from 1999 to 2020. Following a reduction in AAMR from 1999 to 2014 [APC: 4.2% (2.7 to 5.6)], AAMR increased sharply from 2014 to 2020 [APC, 13.3% (11.2 to 15.1)] with an overall annual percentage decrease of -0.5% (-0.7 to -0.4). Males experienced a higher mortality burden (AAMR: 3.19) than females (3.15). Non-Hispanic (NH) Blacks had the highest AAMR (8.5), followed by Hispanics (3.2), NH Asians (3.1), and NH Whites (2.6). Regionally, the South had the highest mortality (3.9) and the Northeast had the lowest (2.4). Urban areas surpassed rural areas (3.22 vs 3.14). The District of Columbia had the highest mortality burden (15.8) while Massachusetts exhibited the lowest (1.5).
These results show a decline in cerebrovascular disease-related mortality in hypertensive adults from 1999 to 2014, following a significant sharp rise from 2014 to 2020, with males, NH Blacks, the Southern region, and urban areas being the most affected. This highlights the need for targeted interventions to address these disparities.