Temporal trends and projections in Hypertension with Substance Use-related mortality, 1999-2035: Insights from the...

To examine national trends and forecast future mortality involving hypertension and substance use among United States (US) adults from 1999 to 2035. Hypertension contributes substantially to mortality in the US, particularly among populations with substance use. The interplay between hypertension and substance use varies by gender, race, age, and geography. Hypertension contributes substantially to mortality across the US, particularly among populations with substance use. The interplay between hypertension and SU varies by gender, race, age, and geography.

Using the CDC WONDER Multiple Cause-of-Death database, we conducted a retrospective analysis of hypertension with substance use mortality from 1999-2024 among adults aged ≥ 25 years. Age-Adjusted Mortality Rates (AAMRs) were calculated, and Joinpoint regression estimated annual and average annual percentage changes (APC, AAPC) with 95% confidence intervals. Auto-ARIMA and Prophet time-series models in R (v4.5.0) projected AAMRs through 2035, evaluated by root mean squared error (RMSE).

From 1999 to 2024, a total of 405,692 deaths involving hypertension and substance use occurred in the US. AAMR increased from 1.32 to 13.9 (AAPC 9.38; p < 0.001). Men had higher AAMRs than women (10.38 vs 3.06). NH American Indian/Alaska Native adults had the highest mean AAMR (17.89), followed by NH Black (11.59), White (6.37), and Hispanic (4.94) adults. Middle-aged adults (45-64) had the greatest burden (10.95). AAMRs ranged from 2.91 in Alabama to 15.03 in the District of Columbia, highest in the West (8.05) and South (6.76). Urban areas slightly exceeded rural (5.31 vs 5.10). Alcohol accounted for 49.3% of deaths, followed by intentional overdose (16.4%) and cocaine (12.7%). Projections to 2035 indicate continued rises, particularly among men, NH American Indian/Alaska Native individuals, middle-aged adults, and in the West and South.

Hypertension with substance use-related mortality has risen sharply, with persistent demographic and regional disparities warranting targeted prevention strategies.