Abstract Body (Do not enter title and authors here): Introduction:
Pulmonary hypertension (PH), a progressive and life-threatening disorder, is often associated with chronic obstructive pulmonary disease (COPD). This combination worsens prognosis, increases healthcare burden through hospitalizations, and raises mortality risk. Despite its impact, PH-related mortality trends in COPD patients have not been assessed in the U.S. over two decades.
Aim:
To investigate trends and demographic patterns of COPD-associated PH deaths among U.S. adults ≥ 25 years from 1999–2023.
Methods:
CDC WONDER multiple-cause-of-death data (1999–2023) for decedents ≥ 25 years listing PH (ICD-10: I27) and COPD (J40–J44) were used. Crude and age-adjusted mortality rates (AAMR) per 100,000 were computed using the 2000 U.S. standard population. Joinpoint Regression v5.2.0 calculated annual percent changes (APC) with 95% confidence intervals (CIs; p ≤ 0.05), stratified by year, sex, race/ethnicity, region, urbanization, and age.
Results:
Between 1999 and 2023, 162,517 COPD-associated PH deaths occurred. Overall, AAMR declined from 2.7 in 1999 to 2.2 in 2001 (APC: –12.41; 95% CI: –21.91 to –1.76), surged to 3.0 by 2004 (APC: 12.15), plateaued until 2015 (APC: 0.04), then rose to 3.5 in 2023 (APC: 2.44; 95% CI: 1.49 to 3.40). Among women, AAMRs declined initially (1999–2001; APC: –12.78), rebounded to 3.0 by 2004 (APC: 16.43), climbed modestly to 2015 (APC: 0.50), and increased further from 2015 to 2023 (APC: 2.97). In contrast, men had a continuous upward trend over the entire period (APC: 0.39). Non-Hispanic Whites had the highest AAMR (3.22), followed by Non-Hispanic Blacks (3.05), Non-Hispanic American Indians (2.50), Hispanics (1.08), and Non-Hispanic Asians (0.91). Regionally, the Midwest recorded the highest AAMR (3.5); rural areas exceeded urban areas (3.4 vs 2.8). At the state level, Colorado had the highest AAMR (6.7), while Louisiana had the lowest (1.4). Age-stratified analysis showed that individuals ≥ 85 years experienced the highest rates over time (AAPC: 3.64; 95% CI: 0.60–6.55).
Conclusion:
COPD-associated PH mortality initially declined and then rose, particularly among women, American Indians, Hispanics, Southern and rural residents, and adults aged 55–64 and ≥ 75. These findings highlight the urgent need to address underlying demographic and geographic disparities.