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. 2025 Sep;57(9):2995-3008.
doi: 10.1007/s11255-025-04493-3. Epub 2025 Apr 4.

Mortality trends of renal diseases due to hypertension in adults: an analysis of gender, race, place of death, and geographical disparities in the United States from 1999 to 2020

Muhammad Shaheer Bin Faheem  1 , Muhammad Bilal Masood  2 , Aleeza Rehman  3 , Shamikha Cheema  4 , Hafiz Muhammad Kamran Ahmad Mughal  5 , Farhan Ahmed  3 , Muhammad Ahmad Abbasi  3 , Syed Ibrahim Ali  6 , Ibrahim Rashid  7
Affiliations

Mortality trends of renal diseases due to hypertension in adults: an analysis of gender, race, place of death, and geographical disparities in the United States from 1999 to 2020

Muhammad Shaheer Bin Faheem et al. Int Urol Nephrol. 2025 Sep.

Abstract

Introduction: Hypertension-related renal diseases remain a significant healthcare concern, particularly in the United States, owing to the higher mortality rate across different demographic groups. This retrospective study aimed to analyze trends in mortality rates of hypertension-related kidney diseases stratified by age, race, gender, urbanization, state, and place of death.

Methods: Database of Center of Disease Control and Prevention (CDC) WONDER was used to extract death certificates among adults in US population from 1999 to 2020 using ICD codes. Gender, race, location of death, urbanization, and geographic location per state were used to determine age-adjusted mortality rates (AAMR) per 1,000,000 at a significant level of p < 0.05. Annual percentage changes (APC) and average annual percentage changes (AAPC) were computed using the Joinpoint Regression Program.

Results: From 1999 to 2020, about 590,139 were reported among adults with a variable trend having a spike of AAMR from 49.5 in 1999 to 140.2 in 2000 followed by another sudden rise in AAMR from 177.5 in 2010 to a peak of 257.4 (APC: 4.85) in 2012. Then there is notable decline to 46.8 (APC: 46.89) in 2015 and afterward, a steady rise to 77.1 (APC: 16.69) observed in 2020. Overall, males (144.9) had higher AAMRs than females (109.2) throughout the study period with females having more deaths. Among races, African Americans (246.2) had highest AAMR among all followed by Hispanics (124.8), American Alaskans (118.6), Whites (111.4), and lastly Asians (102.9). About half deaths were reported in medical facilities (49.44%) with least reported in hospice (3.29%). The highest AAMRs were observed in non-metropolitan regions (142.2) compared to the large metropolitan (114.1) having lowest AAMR with small metropolitan (129.9) in between. The state of Utah (66.5) was observed lowest AAMR in contrast with the state of North Dakota (191.2) having highest AAMR among all states.

Conclusion: Hypertension-related renal diseases were responsible for 590,139 deaths. Males, African American, non-metropolitan areas, and the state of Dakota demonstrated the highest AAMR. Further research is needed to understand the root cause of these disparities.

Keywords: Age-adjusted mortality rates; CDC wonder; Gender and racial disparities; Hypertension; Location of death; Mortality trends; Renal diseases.

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Conflict of interest statement

Declarations. Conflict of interest: On behalf of all authors, the corresponding author states that there is no conflict of interest. Consent to participate: Not applicable. Consent for publication: Not applicable. Declaration of generative AI and AI-assisted technologies in the writing process: During the preparation of this work, the author(s) used Grammarly to improve language clarity, readability, and remove grammatical errors. After using this tool/service, the author(s) reviewed and edited the content as needed and take(s) full responsibility for the content of the publication. Ethics statement: The present study does not involve direct data collection from human subjects or animals. All data used in this study were obtained from previously published and publicly available sources, adhering to the ethical guidelines of the respective studies. No identifiable patient information is presented in this study.

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