Hypertension and renal cancer-related mortality patterns in the United States from 1999 to 2020.

Abstract

e16517 Background: According to the American Cancer Society, approximately 14,000 individuals died from kidney cancer in 2024. Hypertension (HTN) is a well-established risk factor for renal cancer (RC), as it promotes endothelial dysfunction and kidney damage. A meta-analysis of 18 prospective studies and 14 case-control studies demonstrated that for every 10 mmHg increase in systolic blood pressure, the risk of renal cell carcinoma increased by 5%, while a 10 mmHg increase in diastolic blood pressure was associated with a 7% higher risk. Conversely, RC can directly impact the kidney parenchyma, resulting in abnormal renin secretion and subsequent activation of the renin-angiotensin-aldosterone system (RAAS), which elevates blood pressure through vasoconstriction and sodium retention. Additional mechanisms, such as excessive erythropoietin production, renal artery stenosis induced by the tumor, and the side effects of targeted therapies, can further exacerbate HTN in RC patients. We identified demographic and regional mortality trends due to HTN and RC in the US from 1999 to 2020. Methods: We obtained death certificate data from the Centers for Disease Control and Prevention's WONDER (Wide-Ranging Online Data for Epidemiologic Research) database to evaluate the crude death rates (CMRs) and age-adjusted mortality rates (AAMRs) per 1000,000 population. The trends in AAMR were examined through the annual percent change (APC). The statistical analysis was conducted using Joinpoint regression. Results: A total of 34,425 deaths occurred in patients suffering from both RC and HTN in the US from 1999 to 2020 (AAMR = 13.3). The mortality trend nearly doubled between 1999 to 2002 (APC = 19.67), followed by a relatively steady AAMR from 2002 to 2018, with an abrupt rise again during 2018 to 2020 (APC = 10.63). Males had more than twice the overall AAMR (19.1) as compared to females (9.0). The highest mortality rate, however, was seen in NonHispanic (NH) Blacks (18.4), with NH Whites having the lowest mortality rate (12.9). The highest CMR was shown by individuals aged >85 years (69.6). Overall, nonmetropolitan areas had a higher AAMR (15.8) than metropolitan areas (12.8). States in the upper spectrum include Oklahoma and Mississippi, which have more than 4 times the AAMR compared to the states in the lower spectrum, which are Utah and Nevada. The highest AAMRs were observed in the Midwest (14.3), followed by the South (13.9), the West (13.6) and the Northeast (10.8). The highest number of deaths occurred in the decedent’s home (40.1%), followed by medical facilities (28.3%). Conclusions: Mortality from RC and HTN has increased in the United States from 1999 to 2020. High-risk subgroups include males, NH Blacks, individuals living in non-metropolitan and Midwestern areas. Examining the determinants of these variations offers critical opportunities to mitigate mortality within these subgroups.