Abstract Body: Introduction:
Cardiovascular disease is a leading cause of death in older adults who have both renal failure and hypertensive disease. However, national trends describing mortality in this high-risk population remain unclear.
Hypothesis:
We hypothesized that cardiovascular mortality in older adults with renal failure and hypertensive disease experienced significant changes from 1999 to 2020, with variations by sex, race, region, and urbanization status.
Methods:
We used public-use mortality data from the Centers for Disease Control and Prevention for decedents ≥65 years with renal failure and hypertensive disease listed as contributing conditions and cardiovascular disease as the underlying cause of death. Annual percentage changes (APCs) in age-adjusted mortality rates were estimated using joinpoint regression. Statistical significance was set at P<0.05.
Results:
From 1999 to 2012, the overall mortality rate rose modestly (APC ~+2.1; P=0.12), followed by a sharp decline from 2012 to 2015 (APC ~−47; P<0.01). A subsequent increase from 2015 to 2020 (APC ~+13; P=0.09) was not statistically significant. Analyses by sex showed similar patterns, with males and females exhibiting substantial downturns between 2012 and 2015. Race and ethnicity subgroups likewise demonstrated steep drops (APC ~−43% to −53%) during 2012–2015, followed by partial rebounds. Regionally, the West had a small but significant rise from 1999 to 2012 (APC ~+3.6; P=0.01) before a pronounced decline (APC ~−48; P=0.001). Both metropolitan and non-metropolitan areas reflected the overall trend, with mild increases until 2012, then marked reductions, and modest upticks thereafter.
Conclusions:
In older adults with renal failure and hypertensive disease, cardiovascular mortality underwent a modest increase through 2012, a dramatic dip from 2012 to 2015, and a partial rebound afterward. These patterns underscore the importance of ongoing surveillance and targeted prevention strategies to reduce the cardiovascular burden in this susceptible population.