Abstract Body: Background:
Obstructive sleep apnea (OSA) and hypertension (HTN) are comorbid conditions with rising mortality rates in the United States. Approximately 50% of hypertensive patients have OSA, contributing to cardiovascular complications.
Methods:
Mortality data (1999–2023) were extracted from the CDC WONDER database, using ICD-10 codes for OSA (G47.3) and HTN (I10–I15). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, race, age, geography, and urbanization. Temporal trends were analyzed using Joinpoint regression. Future mortality rates were forecasted using an optimal Autoregressive Integrated Moving Average (ARIMA) model.
Results:
From 1999–2023, OSA and HTN related mortality was 107,514 deaths in the U.S, with AAMR rising from 0.4 to 12.4 per 100,000. The AAPC was 12.8% (p<0.001). Forecasted trends suggest an APC of 2.56% from 2024 through 2035, with AAMR projected to increase from 12.4 in 2023 to 15.7 by 2035. AAMRs rose across all age groups, with steep increase observed in adults aged ≥75 (AAPC: 15.3%; p<0.001), compared to 10.9% in those aged 55–74 (p<0.001). By sex, male AAMR increased from 6.4 to 18.4 (AAPC: 13.2%; p<0.001), while female AAMR rose from 2.8 to 8.3 (AAPC: 13.1%; p<0.001). Among ethnic groups, Caucasians experienced a rise from 4.3 to 13.4 (AAPC: 13.8%; p<0.001). African-Americans had the highest absolute rates, rising from 5.6 to 13.1 (AAPC: 9.2%; p<0.001). American Indians and Hispanics also showed marked increases, with Hispanic AAMR rising from 5.0 to 6.3. Asian populations had the lowest absolute rates (1.3 to 2.9). Geographically, the South experienced the highest burden with an AAPC of 12.9% (p<0.001), followed by the Midwest (AAPC: 15.0%), West (13.8%), and Northeast (13.3%). The Midwest had the highest AAMR (5.3), while the Northeast had the lowest (2.8). Statewise, West Virginia, Mississippi, Kentucky, Alabama, and Oklahoma had the highest AAMRs, while California, New York, Connecticut, and Minnesota had the lowest. Urban-rural analysis revealed higher AAMRs in rural areas (4.9) compared to urban (4.2). Both showed upward trends AAPC: 15.5% in rural vs. 13.8% in urban areas (p<0.001).
Conclusion:
OSA and HTN mortality increased disproportionately among older adults, males, and rural populations. The Midwest and South had the highest burden. Forecasted rising trends underscore the need for targeted interventions addressing disparities in healthcare access and comorbidities.