Hypertensive disorders of pregnancy (HDP) mortality in the United States: a CDC WONDER population analysis, 1999-2023

Hypertensive disorders of pregnancy (HDP) are a leading cause of maternal morbidity and mortality in the United States (US), yet national trends across demographic groups are not well characterized.

This population-based retrospective study analyzed HDP-related maternal mortality from 1999 to 2023 using the Centers for Disease Control and Prevention, Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). Age-adjusted mortality rates (AAMRs) were calculated using the 2000 US standard population, and trends were evaluated using Joinpoint regression to calculate Annual Percent Change (APC) and Average Annual Percent Change (AAPC) for different demographic groups.

From 1999 to 2023, 1,851 HDP-related deaths occurred. While the AAMR remained stable at 0.10 deaths per 100,000 people, Joinpoint analysis identified a significant upward trend (AAPC 0.89*). AAMR for Non-Hispanic (NH) Black females was 4-5 times higher than the rate for NH White females and increased throughout the study period. Meanwhile, AAMR for NH White women showed no statistically significant overall trend. Age-stratified analysis demonstrated declining mortality among women aged 25-34 (AAPC -1.24*) and a non-significant upward trend in mortality among women aged 35-44 (AAPC 0.24), with rates between the two groups converging from approximately 2018 onwards. Geographic analysis indicated the highest HDP-related mortality burden in the South census region and no significant changes in urban populations.

These findings emphasize persistent disparities and the need for equitable access to obstetric and cardiovascular care, as well as improved peri-and postpartum monitoring to reduce preventable maternal deaths. However, these findings should be interpreted in the context of limitations inherent to the use of a single database (CDC WONDER), which may be affected by incomplete reporting in death certificate data.