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

Abstract

Background: Essential hypertension and obesity are leading, interrelated risk factors for cardiovascular morbidity and mortality. The joint mortality burden of these conditions appears to be rising in the US, but detailed trend analyses are limited. We analyzed national mortality involving essential (primary) hypertension with obesity to assess temporal trends and demographic and geographic disparities from 1999 to 2020.

Methods: We used the CDC WONDER multiple-cause-of-death database (1999–2020) to identify deaths listing essential hypertension (ICD-10 I10) and obesity (ICD-10 E66) on the death certificate. Annual age-adjusted mortality rates (AAMRs) per 100,000 population (2000 US standard) were calculated. Trends were stratified by sex, race/ethnicity, U.S. Census region, state, and urban vs. rural residence. Joinpoint regression identified trend inflection points and was used to estimate annual percent change (APC) and average annual percent change (AAPC) in AAMRs.

Results: From 1999 to 2020 there were 162,274 deaths (54% in men) involving co-listed essential hypertension and obesity. The national AAMR increased from 1.4 in 1999 to 12.7 per 100,000 in 2020. Mortality rose gradually through 2018 (AAPC 5% annually) then surged after 2018, reaching an APC of +26.5% per year during 2018–2020. The late acceleration was most pronounced in Hispanic and American Indian/Alaska Native (AI/AN) populations (APCs 77% and 43%/year in 2018–2020). Non-Hispanic Black and Asian/Pacific Islander groups also saw sharp increases (37–40%/year) versus +24% in non-Hispanic Whites. Female AAMRs, while lower than male, rose faster in 2018–2020 (+33%/year vs +20%/year in males). By 2020 the rural mortality rate (18.1 per 100k) exceeded the metropolitan rate (12.8), with rural areas showing an earlier upward inflection. All four major U.S. regions experienced marked late increases (APCs 20–26%/year post-2018) after modest pre-2018 growth. Mortality shifts were accompanied by changes in place-of-death: in-hospital deaths for this cause subset more than doubled in 2020, and a greater share of deaths occurred at home in 2020 (50% of the subset) compared to prior years (30–40%).

Conclusions: Mortality involving co-existing essential hypertension and obesity climbed dramatically in recent years, particularly among Hispanic and Indigenous (AI/AN) communities, women, and rural populations. These widening disparities highlight critical gaps in prevention and care for individuals with both obesity and hypertension. Intensified, targeted public health interventions are urgently needed especially in the most affected groups and regions to improve cardiometabolic health equity and reduce preventable deaths attributable to the combined effects of hypertension and obesity.

Keywords: Mortality, Essential Hypertension, Obesity, United States