Hypertension related vs diabetes related cardiovascular deaths which is the bigger killer? a USA mortality trend analysis using CDC WONDER

Abstract Background Cardiovascular (CV) mortality remains a leading cause of death worldwide, with hypertension and diabetes mellitus being two of the primary risk factors. Over the past few decades, significant changes in lifestyle and public health interventions have altered the epidemiological landscape of chronic diseases. Methods This descriptive study utilized the Multiple Cause of Death Public Use Record Death Certificates to identify hypertension and diabetes related CV deaths from 1999-2023. We extracted data from CDC WONDER using International Classification of Diseases, Tenth Revision (ICD-10) codes: I00-I99 (Cardiovascular mortality), E10-E14 (Diabetes Mellitus) and I10-I15 (Hypertension). Age-adjusted mortality rates (AAMR) (per 100,000 population) with 95% confidence intervals (CIs) were calculated and trends were analyzed using Joinpoint Regression to determine Annual Percentage Change (APC). Results The analysis of cardiovascular mortality trends due to hypertension and diabetes from 1999 to 2023 shows a steady increase in mortality rates. Hypertension-related CV mortality rose from 42.957 in 1999 to a peak of 172.242 in 2021, with a slight decline to 157.887 in 2023. Diabetes-related CV mortality followed a similar pattern, increasing from 64.165 in 1999 to a peak of 81.947 in 2021, then declining to 68.317 in 2023. Notably, both conditions saw a substantial rise around 2021, likely exacerbated by health disparities and healthcare access issues during the pandemic. Age-group analysis shows differing trends. Among those under 65, hypertension-related mortality increased from 8.6 in 1999 to 42.3 in 2021, while diabetes-related mortality rose from 14.5 to 22.7. In those over 65, both conditions showed a much higher burden, with hypertension-related mortality climbing from 280.3 in 1999 to 1070.7 in 2021, and diabetes-related mortality increasing from 407.2 to 491.6. Both conditions saw a slight decline in mortality after peaking in 2021 for both age groups. In terms of overall impact, hypertension stands out as a larger contributor to CV mortality, particularly in older populations. This highlights hypertension as the more significant killer of the two, despite both conditions showing an increasing burden on public health over the past two decades. Conclusion This study highlights alarming trends in hypertension- and diabetes-related CV mortality in the United States from 1999 to 2023. Despite advances in treatment and management, mortality for both conditions increased significantly, specifically for individuals over age 65 years, with a substantial surge around 2021. However, a slight decline was observed afterwards which is encouraging, it is essential to continue monitoring and implementing targeted public health interventions, improving healthcare access, and enhancing management strategies to further reduce the burden of CV mortality associated with these conditions.