Insights from a 21-year analysis of mortality due to hypertension and esophageal cancer in the United States.

Abstract

e16131 Background: Hypertension (HTN) is one of the most common non-communicable diseases globally, affecting nearly half of all adults in the United States (US). It is considered to be an independent risk factor for rising cancer incidence and mortality. In 2024, an estimated 22,370 new cases of esophageal cancer (EC) were diagnosed in the US. Research has identified gastroesophageal reflux disease (GERD) as a significant risk factor for esophageal adenocarcinoma, and it is known that GERD is more prevalent among individuals with HTN. This suggests a potential link between HTN and EC, although this association has not been extensively explored in the literature. A nationwide study in Korea found that both HTN and pre-HTN were associated with an increased risk of developing EC. Moreover, a meta-analysis of four prospective studies revealed a significant positive relationship between HTN and the incidence of EC.In this study, we aim to explore mortality trends related to HTN and EC in the United States, categorized by demographics and geographical variables, from 1999 to 2020. Methods: Using data derived from the CDC WONDER database, we evaluated the crude death rates (CDRs) and age-adjusted mortality rates (AAMRs) per 1000,000 population. The trends in AAMR were examined through the annual percent change (APC) and the average annual percent change (AAPC), with statistical analysis conducted using Joinpoint regression. Results: A rising trend of mortality due to HTN and EC was observed among adults in the US (AAPC = 4.56), with a total of 19,704 deaths. There was a sharp incline in mortality from 1999 to 2001, followed by a period of moderate rise till 2007. AAMRs remained stable from 2007 to 2016, however, a moderate increase was observed again from 2016 onwards till 2020. Males (14,977) had thrice the number of deaths compared to females (4727). The AAMR was also higher in males (0.71 versus 0.15). Among all the age groups, the highest mortality was exhibited by 85+ year-olds (2.70) and 75-84 year-olds (2.04). Racial stratification demonstrated that non-Hispanic (NH) Whites (0.42) and NH Asian or Pacific Islanders (0.17) had the highest and the lowest AAMR, respectively. AAMRs were higher in rural areas than urban areas (0.46 versus 0.39). All census regions had almost similar AAMRs. The highest number of deaths were reported in the decedent’s home (8010). The states with the highest AAMR were Oklahoma and Nebraska, while the states with the lowest AAMR were Utah and Arizona. Conclusions: An increasing trend of mortality due to HTN and EC was observed in the US from 1999 to 2020. High-risk subgroups included males, NH Whites, and residents of rural areas. These findings can inform future public health policy and encourage further research into the relationship between these two diseases, as well as the risk factors affecting these specific subgroups.