What is the clinical evidence from this study?

Study design: Observational. Population: Adults aged ≥45 years in the United States with coexisting essential hypertension and obesity (n=162274). Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 population for deaths with both essential hypertension and obesity listed as causes (807% relative increase in AAMR from 1999 to 2020).

What does this research mean for the field?

Mortality involving coexisting essential hypertension and obesity in US adults increased from 1.4 to 12.7 per 100,000 from 1999 to 2020, representing an 807% increase with a sharp 26.5% annual rise after 2018. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research examines mortality trends related to essential hypertension and obesity in the US from 1999 to 2020, focusing on disparities among different demographics.

February 19, 2026Open Access

Mortality Trends and Disparities for Essential Hypertension with Obesity in the United States (19992020)

Key Result

Mortality involving coexisting essential hypertension and obesity in US adults aged ≥45 increased from 1.4 to 12.7 per 100,000 from 1999 to 2020, an 807% increase with a 26.5% annual rise after 2018.

Key Points

This research examines mortality trends related to essential hypertension and obesity in the US from 1999 to 2020, focusing on disparities among different demographics.
Utilized the CDC WONDER database for mortality records (1999-2020)
Calculated annual age-adjusted mortality rates per 100,000 population
Stratified trends by sex, race/ethnicity, region, state, and residence type
Applied joinpoint regression to identify trend changes and calculate annual percent changes.
Identified 162,274 deaths involving essential hypertension and obesity (54% men)
National age-adjusted mortality rate rose from 1.4 in 1999 to 12.7 per 100,000 in 2020
Mortality surged after 2018, especially among Hispanic (77%/year) and AI/AN (43%/year) populations
Female mortality rates rose faster post-2018 (+33%/year), while rural areas showed higher mortality than urban areas by 2020
Notable increases in all US regions with significant growth in hospital deaths and home deaths in 2020.

Study Design

Type

Observational (n=162,274)

Multicenter

Yes

Structured PICO

Population

162,274 U.S. resident decedents aged 45 years or older with both essential (primary) hypertension (ICD-10 I10) and obesity (ICD-10 E66) listed as causes on the death certificate between 1999 and 2020.

Outcome

Annual age-adjusted mortality rates (AAMRs) per 100,000 population for deaths involving co-listed essential hypertension and obesityhard clinical

Mortality involving co-existing essential hypertension and obesity in the US increased dramatically from 1999 to 2020, with a sharp acceleration after 2018 that disproportionately affected Hispanic, Indigenous, rural populations, and women.

Main Result

Effect estimate: 807% relative increase in AAMR from 1999 to 2020

Absolute Event Rate: 12.7% vs 1.4%

Limitations

Potential under- or over-reporting of obesity and hypertension on death certificates.
Lack of individual-level data on comorbidities beyond hypertension and obesity.
Demographic subgroup analyses do not account for overlap between categories (e.g., race and rural status).
2020 data reflects acute influences of COVID-19 pandemic, limiting extrapolation.
Possible joinpoint regression overfitting but 2018 inflection strongly supported.
Secondary hypertension (I11-I15) with obesity not analyzed, limiting generalizability.

Abstract

Background: Essential hypertension and obesity are leading, interrelated risk factors for cardiovascular morbidity and mortality. The joint mortality burden of these conditions appears to be rising in the US, but detailed trend analyses are limited. We analyzed national mortality involving essential (primary) hypertension with obesity to assess temporal trends and demographic and geographic disparities from 1999 to 2020. Methods: We used the CDC WONDER multiple-cause-of-death database (19992020) to identify deaths listing essential hypertension (ICD-10 I10) and obesity (ICD-10 E66) on the death certificate. Annual age-adjusted mortality rates (AAMRs) per 100,000 population (2000 US standard) were calculated. Trends were stratified by sex, race/ethnicity, U.S. Census region, state, and urban vs. rural residence. Joinpoint regression identified trend inflection points and was used to estimate annual percent change (APC) and average annual percent change (AAPC) in AAMRs. Results: From 1999 to 2020 there were 162,274 deaths (54% in men) involving co-listed essential hypertension and obesity. The national AAMR increased from 1.4 in 1999 to 12.7 per 100,000 in 2020. Mortality rose gradually through 2018 (AAPC 5% annually) then surged after 2018, reaching an APC of +26.5% per year during 20182020. The late acceleration was most pronounced in Hispanic and American Indian/Alaska Native (AI/AN) populations (APCs 77% and 43%/year in 20182020). Non-Hispanic Black and Asian/Pacific Islander groups also saw sharp increases (3740%/year) versus +24% in non-Hispanic Whites. Female AAMRs, while lower than male, rose faster in 20182020 (+33%/year vs +20%/year in males). By 2020 the rural mortality rate (18.1 per 100k) exceeded the metropolitan rate (12.8), with rural areas showing an earlier upward inflection. All four major U.S. regions experienced marked late increases (APCs 2026%/year post-2018) after modest pre-2018 growth. Mortality shifts were accompanied by changes in place-of-death: in-hospital deaths for this cause subset more than doubled in 2020, and a greater share of deaths occurred at home in 2020 (50% of the subset) compared to prior years (3040%). Conclusions: Mortality involving co-existing essential hypertension and obesity climbed dramatically in recent years, particularly among Hispanic and Indigenous (AI/AN) communities, women, and rural populations. These widening disparities highlight critical gaps in prevention and care for individuals with both obesity and hypertension. Intensified, targeted public health interventions are urgently needed especially in the most affected groups and regions to improve cardiometabolic health equity and reduce preventable deaths attributable to the combined effects of hypertension and obesity.

Bookmark

View Full Paper