AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Hypertensive Heart Disease and Chronic Lower Respiratory Disease Mortality in United States Adults: A Forecasting Analysis Using CDC WONDER (1999-2050)
By Ali Z, Hassan HU, Nayyar AB et al.
Background: Hypertensive heart disease (HHD) and chronic lower respiratory disease (CLRD) co-occur often and contribute to the cardiopulmonary burden on the United States healthcare system. However, their long-term mortality trends, the demographic differences and future mortality patterns to 2050 are understudied. Objective: We examined national mortality trends and demographic differences in HHD and CLRD among adults ≥45 years of age, and estimated potential future burden by 2050. Methods: The CDC WONDER system (1999–2024) was used to analyze death certificates with a principal cause of death of either HHD (ICD-10 code: I11) or CLRD (ICD-10 codes: J40–J47). Age adjusted mortality rates (AAMR) per 100,000 were broken down by sex, race, age, region of census, urbanization. Join point regression was used to calculate annual percent changes (APC) and average annual percent changes (AAPC). Prophet forecasting model is used to project mortality till 2050 through the rolling cross validation. Results: Total deaths caused by HHD and CLRD were 234,486 from 1999 to 2024. Overall AAMR rose from 2.5 to 13.1 (AAPC: +6.38), driven by steady growth from 2.5 in 1999 to 8.1 in 2017 (APC: +5.79), a sharp COVID era surge from 8.1 in 2017 to 12.5 in 2020 (APC: +17.02) followed by slower growth to 13.1 in 2024 (APC: +1.53). Males consistently exceeded females (15.9 vs. 10.7 by 2024; AAPC: +6.34 vs. +6.29). Racially, the largest increase was for Non-Hispanic (NH) White individuals (AAPC: +7.31), while the largest burden was carried by NH Black individuals (AAPC: +3.71). The absolute rates were highest among adults aged 45–64 years (AAPC: +9.58), while adults ≥65 had the steepest increase (AAPC: +6.29). Regionally, the Midwest experienced the greatest increase from 2.1 to 13.3 (AAPC: +7.15), and the South had the highest AAMR in 2024 (16.5). Metropolitan areas recorded a higher average AAMR (5.70 vs. 5.30), yet nonmetropolitan areas experienced a steeper rise (AAPC: +8.24 vs. +7.10). Overall AAMR is expected to reach 34.6 in 2050, with highest estimates among adults aged ≥65 years (75.1), Southern residents (45.3), males (41.8), NH Black individuals (39.6), and nonmetropolitan areas (39.0) versus 35.0 in urban areas. Conclusion: Gender, racial, age and rural-urban differences in mortality rates for HHD and CLRD are growing and projected to almost double by 2050 necessitating urgent and equitable cardiopulmonary intervention.