National trends in aortic aneurysm and dissection related mortality and its association with hypertension: a 21 year CDC WONDER analysis 1999 to 2020

Abstract Background Aortic aneurysm and dissection (AAD) are life-threatening emergencies, with hypertension being a major modifiable risk factor. Despite advancements in hypertension management, the impact on AAD mortality remains unclear. Analyzing trends and disparities can improve prevention and treatment. Purpose To evaluate national trends in hypertension-associated AAD mortality in the United States from 1999 to 2020, assessing demographic, geographic, and age-related variations. Methods Mortality data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) were analyzed from 1999 to 2020. International Classification of Diseases, 10th Revision (ICD-10) codes for AAD-related deaths (I71.0–I71.9) and hypertension-related conditions (I10–I15) as contributing causes were extracted. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression analysis was used to determine annual percentage changes (AAPC). Subgroup analyses examined trends across sex, race, geographic region, urban-rural status, and age groups. Results A total of 53,626 hypertension-associated AAD deaths were recorded over 21 years, with an overall AAMR of 1.16 per 100,000 and a significant decline (AAPC: -2.17, p0.000001). Males had a higher AAMR (1.49) than females (0.82), but both demonstrated declining trends (AAPC: -2.08 and -2.79, respectively, p0.000001). Black individuals exhibited the highest AAMR (1.63, AAPC: -2.11, p=0.0004), followed by Asian/Pacific Islanders (AAMR: 1.08, AAPC: -4.25, p0.000001), White individuals (AAMR: 1.07, AAPC: -2.25, p0.000001), and Hispanic/Latino populations (AAMR: 0.76, AAPC: -2.31, p=0.0104). The West had the highest AAMR (1.32, AAPC: -2.39, p0.000001), while the South had the lowest (1.00, AAPC: -1.71, p=0.0024). Rural areas had a higher AAMR (1.16) than urban areas (1.10), with a slower mortality decline in rural regions (AAPC: -1.54 vs. -2.34, p0.000001). Older adults (65+ years) had a significantly higher AAMR (4.06) compared to younger adults (25–65 years, AAMR: 0.44), but while mortality declined in older adults (AAPC: -3.70, p0.000001), it increased in younger adults (AAPC: 1.55, p=0.0320). State-level variations showed the highest AAMR in Vermont (2.3) and the lowest in Virginia (0.7). Conclusion(s) Hypertension-associated AAD mortality declined significantly from 1999 to 2020; however, disparities persist. Males and Black individuals had the highest AAMRs, and younger adults (25–65 years) exhibited a rising mortality trend. Geographic and urban-rural differences highlight the need for targeted healthcare interventions. Early hypertension detection and management are crucial for reducing AAD mortality, particularly among high-risk populations. Public health strategies should prioritize screening, lifestyle modifications, and adherence to antihypertensive therapies to mitigate these disparities and improve outcomes.Central Illustration