Trends and disparities in mortality due to hypertensive disease and coexisting obesity in the USA: 1999–2023

Hypertensive disease and obesity frequently coexist and synergistically increase the risk of cardiovascular morbidity and mortality in the USA. Despite this intersection, national trends and disparities in mortality attributable to both conditions remain underexplored. We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database. Hypertensive disease-related deaths with co-listed obesity were extracted for US adults between 1999 and 2023. Age-adjusted mortality rates (AAMRs) were calculated, and Joinpoint regression was used to estimate annual percentage changes (APCs) and identify significant trends. A total of 412,767 deaths were attributed to hypertensive disease and coexisting obesity from 1999 and 2023. The AAMRs rose nearly tenfold, from 1.3 per 100,000 in 1999 to 13.23 in 2023. While mortality rates increased overtime for both sexes, men consistently exhibited higher rates than women (AAPC: 10.38 vs. 8.15). Older adults (AAMR: 32.63) had the highest mortality, followed by middle-aged (5.56) and young adults (0.71), though young adults saw the steepest relative rise (AAPC: 9.63). Non-Hispanic (NH) Black individuals had the highest mortality (AAPC: 7.78), followed by NH American Indian/Alaska Native (8.76), NH White (9.90), Hispanic (6.48) and NH Asian/Pacific Islander populations (6.51). Geographic disparities widened over time. The South and Midwest bore the heaviest regional burden, while urban-rural analyses showed a higher and quicker rise in mortality in non-metropolitan areas (AAPC: 12.13 vs. 10.73 in metro areas). Mortality due to hypertensive disease with coexisting obesity has escalated sharply across USA over the past 2 decades. These results highlight the need for further investigation into the factors contributing to the observed disparities and trends.