Ovarian cancer and hypertension: Changes in comorbidity-related mortality among U.S. women aged ≥45 years, 1999–2023.

e17591 Background: Ovarian cancer causes over 200,000 deaths globally each year, while diabetes mellitus affects more than 450 million adults worldwide and contributes substantially to mortality. Coexisting diabetes is associated with increased ovarian cancer risk, worse prognosis, and greater healthcare burden. Methods: This STROBE-adherent study analyzed diabetes mellitus (DM)–related mortality among U.S. adults aged 45–85 years with ovarian cancer (OC) from 1999 to 2023 using CDC WONDER multiple cause of death data. Deaths were identified using ICD-10 codes for OC (C56) and DM (E10–E14). Analyses were stratified by census region and race/ethnicity. Crude and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to assess temporal trends, reporting annual percent changes (APCs) and average annual percent changes (AAPCs) with 95% confidence intervals. Results: From 1999 to 2023, DM-related mortality among patients with ovarian cancer demonstrated variable trends. Mortality declined from 1999 to 2018 (APC −1.13%, 95% CI −1.60 to −0.65, p<0.001), followed by a sharp increase from 2018 to 2021 (APC 10.59%, 95% CI 5.69 to 15.85, p<0.001), and a subsequent decline through 2023 (APC −4.81%, 95% CI −11.26 to 1.94, p=0.14). Annual deaths increased from approximately 360 in 1999 to a peak of about 740 in 2021. In the Southern U.S., mortality increased from 1999 to 2005 (APC 4.10%, 95% CI 0.71 to 7.62, p=0.02), declined from 2005 to 2015 (APC −2.66%, 95% CI −4.35 to −0.93, p=0.005), and rose again from 2015 to 2023 (APC 5.24%, 95% CI 3.12 to 7.40, p<0.001). The Midwest showed no significant change from 2021 to 2023 (APC −1.06%, 95% CI −11.77 to 10.96, p=0.85), while the West remained stable from 1999 to 2023 (APC 0.04%, 95% CI −0.26 to 0.35, p=0.78). Among racial groups, non-Hispanic White patients had stable mortality from 1999 to 2018 (APC −0.44%, 95% CI −0.65 to −0.23, p<0.001), followed by a significant increase from 2018 to 2023 (APC 6.94%, 95% CI 4.32 to 9.63, p<0.001). The sharp rise observed between 2018 and 2021 may partly reflect the impact of the COVID-19 pandemic on healthcare access and chronic disease management. Conclusions: DM-related mortality among patients with ovarian cancer has increased notably since 2018, with the greatest burden observed in the Southern United States and among non-Hispanic White populations. These findings indicate emerging regional and racial disparities and highlight the need for targeted strategies to improve diabetes management and integrate cardiometabolic care into oncology practice for vulnerable populations.