Hypertension and sleep apnea as contributor to mortality trends in the United States: CDC WONDER data analysis

Sleep apnea (OSA) is a highly prevalent, yet significantly underdiagnosed, condition in the United States. The consequences of unmanaged OSA are substantial, with well-documented associations with cardiovascular disease.

This study examines trends in sleep apnea- and hypertension-associated mortality between 1999 and 2020, focusing on demographics and regional differences.

This observational, retrospective, population-based study examines trends and disparities among individuals aged >25 years in the United States from 1999 to 2020, using the CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database. Age-adjusted mortality rates (AAMRs) per 100,000 population were extracted, and mortality trends by demographics and region were analyzed using Join-point Regression Software to evaluate the annual percent change (APC) and corresponding 95 % confidence intervals (CIs). Analyses were adjusted for gender, race/ethnicity, urbanization, and census region.

From 1999 to 2020, 71,495 sleep apnea- and hypertension-related deaths were recorded. During the year 1999, the age-adjusted mortality rate (AAMR) was reported as 0.17 per 100,000, which increased substantially to 4.14 per 100,000 by 2020. AAMR showed a rising trend in both males (2.13) and females (0.96). Among females, from 1999 to 2006, the APC was 22.99, followed by a significant decrease to 7.55 from 2006 to 2020. In the male population, the APC was 15.28 from 1999 to 2009. After a decline in mortality from 2009 to 2018, a steep upward trend was observed with an APC of 22.52 from 2018 to 2020. AAMR showed a consistent upward trend in both African American and White populations. However, significant differences in AAMR were present between the two races, with rates consistently higher among African Americans from 1999 to 2020. From 2018 to 2020, Black individuals experienced a particularly sharp rise in mortality (APC = 26.81), surpassing the increase observed in White individuals (APC = 18.83). AAMR showed a steep rise in all census regions except the Midwest during 2018-2020. The APC in the Northeast was 29.25, in the South region 19.73, and in the West region 19.43. The Midwest had the lowest APC among all regions (9.29). We observed a significant disparity between urban or large metro areas and nonurban, rural, or smaller metro/rural areas during the years 2018-2020. Large central metro and large fringe metro regions had APCs of 7.58 and 8.30, respectively. In contrast, medium metro areas had an APC of 23.27, small metro 10.65, nonmetro 23.01, and noncore metro 25.42.

Disparities in mortality trends were observed across race, gender, urbanization, and census regions, with recent years showing a marked rise among African Americans, males, nonurban and rural populations, and in all census regions except the Midwest.