Trends in mortality with pulmonary hypertension and diabetes mellitus as contributing causes of death among U.S. Adults, 1999-2024

Purpose Pulmonary Hypertension (PH) and Diabetes mellitus (DM) have been extensively studied independently; data on their co-occurrence are limited. This study aims to analyze trends in mortality with PH and DM recorded as contributing causes of death (PH-DM co-mortality) in the U.S from 1999 to 2024. Method The CDC Wonder database was used to examine mortality trends for deaths with PH (I27.0, I27.2, I27.8, I27.9) and DM (E10-E14) recorded as contributing causes of death among adults (≥ 25 years); this age cutoff is consistent with prior CDC WONDER mortality analyses [10]. Data were stratified by year, sex, race, census region, and urbanization. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated, and trends were analyzed using Join point regression to estimate Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs). Results A total of 83,161 deaths had both PH and DM recorded as contributing causes (PH-DM co-mortality), with an increase from 1999 to 2024. The overall AAMRs rose from 0.74 to 1.99 (AAPC: 3.92%; p < 0.001), increasing until 2008 (APC: 5.68%; p < 0.001), continuing more slowly until 2018 (APC: 1.79%; p = 0.050), surging until 2021 (APC: 14.03%; p < 0.001), and then declining until 2024 (APC: -3.46%; p = 0.006). AAMRs were similar in men and women and rose in both (men: 0.72 to 2.06, AAPC: 4.15%; women: 0.72 to 1.97, AAPC: 3.95%; both p < 0.001). Non-Hispanic (NH) Blacks had the highest AAMRs (1.33 to 3.31; AAPC: 4.17%), followed by NH Whites (0.67 to 1.93; AAPC: 4.25%), Hispanics (0.37 to 1.64; AAPC: 3.94%) and NH Asian or Pacific Islander (0.51 to 1.08; AAPC: 4.08%); all AAPCs were significant (p < 0.001). AAMRS also increased across regions-Northeast (0.57 to 1.38; AAPC: 3.08%), Midwest (0.94 to 2.12; AAPC: 3.25%), South (0.64 to 1.96; AAPC: 4.37%), and West (0.8 to 2.47; AAPC: 4.59%) (all p < 0.001). The rural AAMRs exceeded urban AAMRs from 1999 (0.83 vs. 0.70) to 2020 (2.42 vs. 1.88), with increases in both regions (rural: AAPC: 4.94%; urban: AAPC: 4.64%; both p < 0.001). Conclusion PH-DM co-mortality increased significantly from 1999 to 2024, despite a decline after 2021. The burden was greatest among NH Blacks and rural residents, highlighting the need for equity-focused intervention. Supplementary information The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02093-1.