Key result
Mortality from coexisting HTN and T2D rises ~10-fold in older U.S. adults since 1999.
Why the study?
Despite care advancements, cardiovascular mortality has plateaued with increased hypertension-related US deaths, prompting analysis of mortality trends and demographic or geographic disparities in older adults with coexisting hypertension and diabetes.
Observational (n=331,823)
Yes
Effect estimate: Ten-fold increase in AAMR from 10.1 in 1999 to 95.9 in 2024
Absolute Event Rate: 95.9% vs 10.1%
Mortality from coexisting hypertension and type 2 diabetes in older U.S. adults increased dramatically from 1999 to 2021, highlighting a growing dual epidemic with significant demographic and regional disparities.
Rising dual-disease mortality warrants clinical vigilance in older adults; hypothesis-generating for drivers and interventions.
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.
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Suthar et al. (2025) conducted an observational in Older adults (age ≥65) in the United States with coexisting essential hypertension and type 2 diabetes mellitus (n=331,823). Mortality from coexisting essential hypertension and type 2 diabetes in U.S. adults aged ≥65 rose approximately ten-fold from an AAMR of 10.1 per 100,000 in 1999 to 95.9 in 2024, peaking at 106.1 in 2021 before a slight, non-significant decline.
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