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Background <p>Alzheimer’s disease (AD) and hypertension (HTN) are significant contributors to morbidity and mortality in the United States. Although each condition independently increases mortality risk, long-term national trends in deaths involving their coexistence have not been well characterized. Characterizing these patterns is critical for informing prevention strategies and addressing health disparities at the population level.</p> Methods <p>U.S. death certificate data from 1999 to 2020 were analyzed using the CDC WONDER Multiple Cause of Death database. Deaths were classified as AD-only, HTN-only, or coexisting AD–HTN based on ICD-10 codes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. Standard Population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age group, race/ethnicity, U.S. census region, state, metropolitan status, and place of death. A sensitivity analysis excluding 2020 was conducted to assess pre–COVID-19 trends.</p> Results <p>From 1999 to 2020, there were 2,529,075 AD-related deaths, 8,145,940 HTN-related deaths, and 411,510 deaths involving both conditions. The AAMR for coexisting AD–HTN mortality increased from 2.85 to 13.56 per 100,000 adults, with an overall AAPC of 5.42%. The highest mortality burden was observed among women, adults aged 65 years and older, and non-Hispanic Black individuals. The West and South regions had the highest AAMRs. At the same time, nonmetropolitan areas experienced faster growth than metropolitan areas; over half of AD–HTN deaths occurred in nursing homes or long-term care facilities. Excluding 2020 did not materially alter long-term trends, indicating that the increase in mortality predated the COVID-19 pandemic.</p> Conclusions <p>Mortality involving Alzheimer’s disease, hypertension, and their coexistence increased substantially in the United States from 1999 to 2020, with pronounced demographic and geographic disparities. These results underscore the need for integrated cardiovascular and cognitive health strategies, enhanced chronic disease management, and targeted interventions for high-risk and underserved populations.</p>

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Trends in Alzheimer’s Disease and Hypertensive Disease-Related Mortality in the United States From 1999 to 2020: A CDC WONDER Analysis

  • 期刊论文

  • 发表日期：

    2026年3月17日

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  • Ayesha Hussain,
  • Haseeba Khalid,
  • Osama Taj,
  • Nazia Zafar,
  • Hammad Mudassar,
  • Syed Muhammad Ali Akbar

摘要

Background

Alzheimer’s disease (AD) and hypertension (HTN) are significant contributors to morbidity and mortality in the United States. Although each condition independently increases mortality risk, long-term national trends in deaths involving their coexistence have not been well characterized. Characterizing these patterns is critical for informing prevention strategies and addressing health disparities at the population level.

Methods

U.S. death certificate data from 1999 to 2020 were analyzed using the CDC WONDER Multiple Cause of Death database. Deaths were classified as AD-only, HTN-only, or coexisting AD–HTN based on ICD-10 codes. Age-adjusted mortality rates (AAMRs) were calculated using the 2000 U.S. Standard Population. Temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Analyses were stratified by sex, age group, race/ethnicity, U.S. census region, state, metropolitan status, and place of death. A sensitivity analysis excluding 2020 was conducted to assess pre–COVID-19 trends.

Results

From 1999 to 2020, there were 2,529,075 AD-related deaths, 8,145,940 HTN-related deaths, and 411,510 deaths involving both conditions. The AAMR for coexisting AD–HTN mortality increased from 2.85 to 13.56 per 100,000 adults, with an overall AAPC of 5.42%. The highest mortality burden was observed among women, adults aged 65 years and older, and non-Hispanic Black individuals. The West and South regions had the highest AAMRs. At the same time, nonmetropolitan areas experienced faster growth than metropolitan areas; over half of AD–HTN deaths occurred in nursing homes or long-term care facilities. Excluding 2020 did not materially alter long-term trends, indicating that the increase in mortality predated the COVID-19 pandemic.

Conclusions

Mortality involving Alzheimer’s disease, hypertension, and their coexistence increased substantially in the United States from 1999 to 2020, with pronounced demographic and geographic disparities. These results underscore the need for integrated cardiovascular and cognitive health strategies, enhanced chronic disease management, and targeted interventions for high-risk and underserved populations.