Variability of hypertension-related mortality in the United States, 1968-1986

There has been recent interest in trying to understand the way demographic changes and population structure affect disease rates in the Unites States. We analysed mortality data for 1968 to 1986 to examine how ageing and a changing population structure have affected hypertension mortality rates in the United States. Multiple-cause-of-death data were used with census projections to estimate age-adjusted, reported-prevalence-at-death rates for hypertension. For the period 1970 to 1986, we found considerable geographic diversity, including an eightfold difference in the range of hypertension mortality by state (from 11.4 in Hawaii to 82.3 in the District of Columbia). Substantial differences appeared in age-adjusted rates by race; an average twofold excess among blacks was observed throughout the period. The largest race difference in 1986 was observed in Florida, where the reported-prevalence-at-death rate was 3.2 times greater among blacks (112.2 per 100,000) than among whites (34.7 per 100,000). When we allow for discontinuities in coding between ICD-8 and ICD-9, the states will appear to be relatively stable with regard to both age-adjusted rate and relative rank. Age-adjusted, reported-prevalence-at-death rates for blacks also show geographic variability and suggest that factors other than genetics play an important role in the contribution of hypertension to mortality in the United States.