Introduction: Anemia and hypertensive diseases are common and clinically significant conditions among older adults, each independently associated with increased morbidity and mortality. When concomitant, anemia may increase mortality risk in hypertensive diseases and contribute to poor health outcomes, particularly in the elderly. Despite their clinical relevance, national anemia and hypertensive disease-related mortality trends and disparities have not been strongly elucidated. This study aims to analyze temporal mortality trends and demographic disparities in adults aged ≥65 years with anemia and hypertensive diseases in the United States from 1999 to 2023.

Methods: Data from death certificates among adults aged ≥ 65 years from the CDC WONDER database from 1999 to 2023 were analyzed using ICD-10 codes corresponding to anemia (D55-D59, D60-D64) and hypertensive diseases (I10-I15), both as contributing causes of death. Results were stratified by place of death, year, sex, race, census region, and state. Age-adjusted mortality rates (AAMR) were quantified per 100,000 people with 95% confidence intervals (95%CI). Average annual percentage change (AAPC) was calculated using Joinpoint regression software. Statistical significance was set at p-value < 0.05.

Results: Between 1999 and 2023, 305,244 anemia and hypertensive disease-related fatalities occurred in adults aged ≥65 years in the United States. Most of the deaths occurred in nursing home/long-term care facilities (36.19%), and the least amount of deaths occurred in hospices (4.09%). Overall AAMR increased from 11.0 in 1999 to 37.1 in 2023 (AAPC: 4.6; 95%CI: 3.8 to 5.4). Men had a slightly higher average AAMR (27.6) compared to women (27.1), as well as a greater rate of increase (AAPC men: 5.2; 95%CI: 4.4 to 6.0; AAPC women: 4.5; 95%CI: 3.8 to 5.3). Racially, non-Hispanic (NH) Black/African Americans had the highest average AAMR (50.9), followed by Hispanic/Latino (26.8), NH Asian/Pacific Islanders (25.7), and NH White (25.2). NH Whites had the greatest rate of increase in AAMRs (AAPC: 5.0; 95%CI: 4.3 to 5.8) while NH Black/African Americans had the lowest rate of increase (AAPC: 2.7; 95%CI: 1.9 to 3.4). Among the census regions, the South had the highest average AAMR (29.6), followed by the Midwest (23.8), the West (25.9), and the Northeast (24.0). AAMRs increased at the highest rate in the South (AAPC: 5.1; 95%CI: 4.4 to 6.1) while the Midwest had the lowest rate of increase (AAPC: 3.8; 95%CI: 2.9 to 5.1). Throughout the study duration, California had the greatest number of deaths statewide at 38,873 (12.74%). From 1999 to 2020, states in the top 90th percentile of AAMRs included Maryland, Ohio, Rhode Island, Texas, and West Virginia, while states in the bottom 10th percentile were Arizona, Idaho, Massachusetts, Nevada, and Utah. From 2021 to 2023, states in the top 90th percentile of AAMRs included Maryland, Minnesota, Nebraska, Oklahoma, and South Carolina, while states in the bottom 10th percentile were Connecticut, Illinois, Massachusetts, New Mexico, and Utah.

Conclusion: From 1999 to 2023, national anemia and hypertensive disease-related mortality rates in adults aged ≥65 years with anemia and hypertensive disease showed a marked and sustained rise, with pronounced disparities across place of death, sex, race, census region, and state. These findings highlight the growing public health burden of comorbid anemia and hypertensive diseases in an aging population in the United States and the need for equitably targeted prevention and intervention strategies to address these disparities in at-risk communities.

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2025
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