What is the clinical evidence from this study?

Study design: Observational. Population: Hypertension-associated breast cancer (n=107759). Primary outcome: Age-adjusted mortality rates (AAMRs) per 100,000 populations.

What does this research mean for the field?

From 1999 to 2020, U.S. age-adjusted mortality rates for hypertension-associated breast cancer increased from 3.8 to 8.8 per 100,000, with the highest burden observed in older women, non-Hispanic Black populations, and rural residents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate trends and disparities in breast cancer mortality associated with hypertension in the U.S. from 1999 to 2020.

May 30, 2026

Temporal and demographic trends in hypertension-associated breast cancer mortality in the United States: A CDC WONDER analysis (1999–2020).

Key Result

From 1999 to 2020, U.S. age-adjusted mortality rates for hypertension-associated breast cancer increased from 3.8 to 8.8 per 100,000, with the highest burden in older women and NH Black populations.

Key Points

This research aims to evaluate trends and disparities in breast cancer mortality associated with hypertension in the U.S. from 1999 to 2020.
Analyzed mortality data from the CDC WONDER Multiple Cause of Death database (1999-2020).
Included deaths where both breast cancer and hypertensive disease were listed in adults aged ≥55 years.
Used Joinpoint regression to assess annual percent change in mortality rates.
107,759 breast cancer-related deaths recorded, with age-adjusted mortality rates increasing from 3.8 to 8.8 per 100,000.
Non-Hispanic Black individuals had the highest age-adjusted mortality rates (13.8 per 100,000).
Sharp increases were seen in females aged 55-64, particularly from 2018 to 2020 (APC 20.8%, 95% CI 8.47-30.2; p < 0.001).

Study Design

Type

Observational (n=107,759)

Multicenter

Yes

Structured PICO

Population

107,759 adults aged ≥55 years in the U.S. with deaths attributed to both breast cancer (ICD-10 C50) and hypertensive disease (ICD-10 I10–I15) as contributing causes from 1999–2020.

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 population for hypertension-associated breast cancer deathshard clinical

Hypertension-associated breast cancer mortality in the U.S. has more than doubled from 1999 to 2020, highlighting significant racial and geographic disparities that require targeted public health interventions.

Abstract

e13097 Background: Hypertension is the most common comorbidity among breast cancer survivors and is independently associated with higher breast cancer specific mortality. However, population-level trends and disparities when both conditions co-occur remain poorly described. This study examined temporal trends, demographic disparities, and geographic variation in hypertension-associated breast cancer mortality in the U.S. Methods: Mortality data were obtained from the CDC WONDER Multiple Cause of Death database from 1999–2020. Deaths were included when both breast cancer (ICD-10 C50) and hypertensive disease (ICD-10 I10–I15) were listed as contributing causes among adults aged ≥55 years. Age-adjusted mortality rates (AAMRs) per 100,000 populations were calculated using the 2000 U.S. standard population. Temporal trends were assessed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by age, sex, race/ethnicity, urbanization level, census region, and U.S. state. Results: From 1999–2020, 107,759 deaths were attributed to breast cancer in the U.S., with AAMRs rising from 3.8 to 8.8 per 100,000. Joinpoint regression identified rapid increase 1999–2001 (APC 20.4%, 95% CI 9.77–30.0; p < 0.001), moderate rise 2001–2007 (APC 1.88%, 95% CI 0.04–4.52; p = 0.046), slight decline 2007–2018 (APC −0.59%, 95% CI −4.01–−0.05), and sharp increase 2018–2020 (APC 14.6%, 95% CI 7.7–19.9). Mortality was highest in adults ≥85 years (47 per 100,000 in 2020). Ages 55–64 showed rapid rise 1999–2003 (APC 12.5%, 95% CI 6.17–27.8; p < 0.01), stability 2003–2018, and sharp increase 2018–2020 (APC 20.8%, 95% CI 8.47–30.2; p < 0.001). Females had higher mortality than males (15.1 vs. 0.2), with male rates stable (APC 0.92%, 95% CI −0.72–2.86; p = 0.22). Female rates rose steeply 1999–2001 (APC 26.8%), moderately 2001–2008 (APC 1.92%), and sharply 2018–2020 (APC 15.5%). Non-Hispanic (NH) Black individuals had the highest AAMRs (13.8), NH Asian/Pacific Islander the lowest (4.7). NH White rates rose 1999–2001 (APC 26.8%), stable 2001–2018, then rose 2018–2020 (APC 12.8%). NH American Indian/Alaska Native rates rose steadily (APC 2.48%). States with age-adjusted mortality rates above the 90th percentile included District of Columbia (12.2), Nebraska (11.2), Mississippi (11.1), Oklahoma (11.1), and Ohio (10.6). Nonmetro (10.0) and micropolitan (9.6) areas had higher mortality. Large central metros rose rapidly 1999–2001 (APC 20.8%), modestly through 2010, declined 2010–2018, and rose again 2018–2020 (APC 12.6%). Conclusions: Hypertension-associated breast cancer mortality has risen over the past two decades, especially among older women, NH Black populations, and residents of rural or high-burden states which underscore the need for targeted public health interventions to reduce disparities.

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