Temporal trends in hypertension related end stage renal disease mortality rates: an analysis of gender, race/ethnicity, and geographic disparities in the United States

Abstract

Background: According to one USA Renal Data System report, 57% of end-stage renal disease (ESRD) cases are attributed to hypertensive and diabetic nephropathy. Yet, trends in hypertension related ESRD mortality rates in adults ≥ 35 years of age have not been studied.

Objectives: The aim of this retrospective study was to analyze the different trends hypertension related ESRD death rates among adults in the United States.

Methods: Death records from the CDC (Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research) database were analyzed from 1999 to 2020 for hypertension related ESRD mortality in adults ≥ 35 years of age. Age-Adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated and stratified by year, sex, race/ethnicity, place of death, and geographic location.

Results: Hypertension-related ESRD caused a total of 721,511 deaths among adults (aged ≥ 35 years) between 1999 and 2020. The overall AAMR for hypertension related ESRD deaths in adults was 9.70 in 1999 and increased all the way up to 43.7 in 2020 (APC: 9.02; 95% CI: 8.19-11.04). Men had consistently higher AAMRs than woman during the analyzed years from 1999 (AAMR men: 10.8 vs women: 9) to 2020 (AAMR men: 52.2 vs women: 37.2). Overall AAMRs were highest in Non-Hispanic (NH) Black or African American patients (45.7), followed by NH American Indian or Alaska Natives (24.7), Hispanic or Latinos (23.4), NH Asian or Pacific Islanders (19.3), and NH White patients (15.4). Region-wise analysis also showed significant variations in AAMRs (overall AAMR: West 21.2; South: 21; Midwest: 18.3; Northeast: 14.2). Metropolitan areas had slightly higher AAMRs (19.1) than nonmetropolitan areas (19). States with AAMRs in 90th percentile: District of Columbia, Oklahoma, Mississippi, Tennessee, Texas, and South Carolina, had roughly double rates compared to states in 10th percentile.

Conclusions: Overall hypertension related ESRD AAMRs among adults were seen to increase in almost all stratified data. The groups associated with the highest death rates were NH Black or African Americans, men, and populations in the West and metropolitan areas of the United States. Strategies and policies targeting these at-risk groups are required to control the rising hypertension related ESRD mortality.

Keywords: end-stage renal disease; hypertension; mortality; renal failure; renovascular hypertension.

Figure 1

Overall and sex-stratified hypertension related ESRD AAMRs per 100,000 in adults in the United States, 1999 to 2020. * Indicates that the annual percentage change (APC) is significantly different from zero at α = 0.05. AAMR, age-adjusted mortality rate.

Figure 2

Hypertension related ESRD AAMRs per 100,000 stratified by race in adults in the United States, 1999 to 2020.* Indicates that the APC is significantly different from zero at α = 0.05. NH, non-Hispanic; other abbreviations as in Figure 1 .

Figure 3

Hypertension related ESRD AAMRs per 100,000 stratified by state in adults in the United States, 1999 to 2020. Age-adjusted mortality rate per 100,000 among states, (9.3 – 44).

Figure 4

Hypertension related ESRD AAMRs per 100,000 stratified by census region in adults in the United States, 1999 to 2020.* Indicates that the APC is significantly different from zero at α = 0.05. Abbreviations as in Figure 1 .

Figure 5

Central illustration.