What is the clinical evidence from this study?

Study design: Observational. Population: Older adults (age ≥65) in the United States with coexisting essential hypertension and type 2 diabetes mellitus (n=331823). Primary outcome: Annual age-adjusted mortality rate (AAMR) per 100,000 population involving both essential hypertension and type 2 diabetes (Ten-fold increase in AAMR from 10.1 in 1999 to 95.9 in 2024).

What question did this study set out to answer?

The study analyzes mortality trends in older adults with essential hypertension and type 2 diabetes, exploring demographic and regional disparities.

February 19, 2026Open Access

Mortality Trends in Essential Hypertension and Type 2 Diabetes Among Older Adults in the United States

Key Result

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.

Key Points

The study analyzes mortality trends in older adults with essential hypertension and type 2 diabetes, exploring demographic and regional disparities.
Conducted a retrospective analysis using CDC WONDER database from 1999 to 2024.
Identified deaths with essential hypertension and type 2 diabetes as causes.
Calculated mortality rates per 100,000, using Joinpoint regression to analyze trends.
Identified 331,823 eligible deaths with an aggregate age-adjusted mortality rate (AAMR) of 60.3/100,000.
AAMR increased from 10.1 in 1999 to 106.1 in 2021, with slight declines noted in 2022-2024.
Males showed higher mortality rates, with significant increases compared to females.
American Indian/Alaska Native and Hispanic seniors experienced notable declines post-2021.

Study Design

Type

Observational (n=331,823)

Multicenter

Yes

Structured PICO

Population

331,823 U.S. adults aged ≥65 years whose death certificates listed both essential hypertension (ICD-10 I10) and type 2 diabetes mellitus (ICD-10 E11.x) as causes of death between 1999 and 2024.

Outcome

Annual age-adjusted mortality rate (AAMR) for deaths involving both hypertension and diabetes, expressed per 100,000 populationhard clinical

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.

Main Result

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%

Limitations

Ecological analysis subject to accuracy and changes in death certificate coding over time
Cannot distinguish underlying cause versus contributing cause of death
Restricted to age ≥65 years, excluding younger adults
Small numbers and possible racial misclassification affecting some subgroups (AI/AN, Hispanic)
Provisional data for 2021–2024 may be revised
Lack of individual-level clinical or treatment data prevents causal inference

Abstract

Background: Essential hypertension and type 2 diabetes mellitus frequently coexist in older adults, increasingcardiovascular morbidity and mortality risks. Despite advancements in care, recent evidence shows thatcardiovascular mortality has plateaued, with increased hypertension-related deaths in the U.S. This studyaims to analyze mortality trends in older adults (65) with both conditions and examine disparities based ondemographics and geography.Hypothesis: We hypothesized that age-adjusted mortality rates (AAMRs) for older adults with coexistinghypertension 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 from1999-2024 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 AAMRrose 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 dramaticallyfrom 1999 to 2021, with significant demographic and regional disparities. A recent plateau in mortality trendssuggests potential shifts, highlighting the need for targeted public health interventions for high-risk groups toaddress this dual epidemic in an aging population.

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