Authors: Sajan Sawai Suthar , Parshant Dileep Bhimani , Mahnoor Khali , Salih Abdella Yusuf

Abstract

Background: Essential hypertension and type 2 diabetes mellitus frequently coexist in older adults, increasing
cardiovascular morbidity and mortality risks. Despite advancements in care, recent evidence shows that
cardiovascular mortality has plateaued, with increased hypertension-related deaths in the U.S. This study
aims to analyze mortality trends in older adults (≥65) with both conditions and examine disparities based on
demographics and geography.
Hypothesis: We hypothesized that age-adjusted mortality rates (AAMRs) for older adults with coexisting
hypertension and diabetes significantly increased from 1999 to 2024, with variations by sex, race/ethnicity,
region, and urbanization.
Methods: We conducted a retrospective analysis using the CDC WONDER database, identifying deaths from
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.
Results: From 1999 to 2024, there were 331,823 eligible deaths (aggregate AAMR 60.3/100,000). The AAMR
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.
Conclusions: Mortality due to coexisting hypertension and diabetes among U.S. older adults rose dramatically
from 1999 to 2021, with significant demographic and regional disparities. A recent plateau in mortality trends
suggests potential shifts, highlighting the need for targeted public health interventions for high-risk groups to
address this dual epidemic in an aging population.

Keywords: Mortality, Essential Hypertension, Type 2 Diabetes, United States