Temporal trends and demographic patterns in hypertension-related mortality with intracerebral hemorrhage in the United States: 1999–2020

Abstract

Introduction: Hypertension contributes to cardiovascular mortality, yet its role as an underlying cause with intracerebral hemorrhage (ICH) as a contributing cause is underexplored. Understanding demographic and geographic patterns can guide prevention.
Aim: To analyze mortality trends and demographic disparities in deaths with hypertension as the underlying cause and ICH as a contributing cause, using the CDC Multiple Cause of Death (MCD) database from 1999–2020.
Methods: Retrospective observational analysis of the CDC MCD database for adults aged ≥25 years in the United States from 1999–2020. Deaths were included if hypertension (I10–I15) was the underlying cause and intracerebral hemorrhage (ICH I61) a contributing cause. Data were stratified by gender, race, geographic region, and place of death. Crude and age-adjusted mortality rates per 1,000,000 and annual percentage change (APC) were calculated. Temporal trends were assessed using Joinpoint software.
Results: Among 14,613 deaths (crude rate 3.3 per million), most decedents were male (56.5%) and White (62.8%); Black/African American individuals accounted for 31.2%, Asian/Pacific Islander 5.3%, and American Indian/Alaska Native 0.7%. Most deaths occurred in metropolitan areas (89.4%) and in medical facilities (61.0%), while 25.2% occurred at home. Age-adjusted rates were stable from 1999–2007, declined 2007–2013, then rose 2013–2020. Females showed larger early declines followed by a modest rise, whereas males experienced a later sharper increase. Black/African American decedents had early declines with a subsequent plateau, while White decedents showed smaller early change, followed by decline and later increase.
Conclusion: Deaths with hypertension as the underlying cause and ICH as a contributing cause were concentrated among males, White and Black populations, and metropolitan residents, with most deaths in medical facilities. Notably, after a period of decline, mortality rates increased again after 2013, particularly among males and White individuals, underscoring the urgency of renewed prevention efforts.