Abstract
Pulmonary Hypertension And End Stage Kidney Disease A 20-year U.s Cardiovascular Mortality Analysis Using CDC WONDER
Journal of cardiac failure, Vol.32(1), p.237
01/2026
DOI: 10.1016/j.cardfail.2025.11.161
Abstract
Background
Pulmonary hypertension (PH) and end-stage kidney disease (ESKD) contribute significantly to cardiovascular mortality, yet their relative impact on cardiovascular outcomes remains understudied. PH leads to right heart failure while ESKD accelerates atherosclerosis and hypertension. This study examines the influence of PH and ESKD on mortality trends in the U.S.
Methods
We used CDC mortality data (1999-2020) to assess trends across census regions, races, gender and urbanization levels. Age-adjusted mortality rates (AAMR) per 100,000 people were calculated. Confidence intervals and standard errors were included to assess variability.
Results
Gender: PH-related mortality rose across all demographics. Female AAMR increased from 2.50 (1999) to 8.26 (2020), with the sharpest rise from 2019-2020 (7.64 to 8.26). Male AAMR increased from 2.05 to 7.42, widening the gender gap from 0.45 to 0.84. ESKD-related mortality fluctuated; female rates started at 7.16, stabilizing at 6.64 (2010), while male rates peaked at 11.50 (2010), widening the gender gap from 3.10 to 4.86. Geography: PH-related mortality increased in all regions, highest in the Midwest (2.45 to 8.62), followed by the South (2.13 to 7.04). ESKD-related mortality remained highest in the South (peaking at 9.93 in 1999), while the Midwest showed a steady rise (5.92 to 7.09). Race: PH-related mortality rose across all racial groups, highest in Black individuals (3.96 to 10.62), followed by White (2.14 to 7.80) and Hispanic (1.41 to 5.31). ESKD-related mortality declined in Black individuals (27.22 to 21.65) but remained highest. White mortality increased (6.26 to 7.09), while other groups saw declines. Urbanization: PH-related mortality surged across all urbanization levels, peaking in micropolitan/rural areas (9.24 in 2020). ESKD-related mortality was highest in large central metros (10.81 to 11.13).
Conclusion
PH-related mortality increased steadily, disproportionately affecting rural areas, Black individuals, and the Midwest. In contrast, ESKD-related mortality fluctuated but remained highest in Black individuals and the South. The widening urban-rural and racial gaps emphasize the need for targeted interventions, improved healthcare access, and early screening.
Details
- Title: Subtitle
- Pulmonary Hypertension And End Stage Kidney Disease A 20-year U.s Cardiovascular Mortality Analysis Using CDC WONDER
- Creators
- Ishtiaq Ahmad - Geisinger Wyoming Valley Medical CenterMian Zahid Jan Kakakhel - Khyber Medical CollegeSeema Gul - Khyber Medical CollegeZaraq Khan - Vincennes UniversitySaniya Ishtiaq - Rawalpindi Medical UniversityHasan Ilyas - Delray Medical CenterLaiba Yumn - Nishtar Medical College and HospitalVyom Patel - Vincennes UniversityAbdullah Afridi - Khyber Medical CollegeZaryab Bacha - Khyber Medical UniversityMuhammad Usman Haider - Geisinger Wyoming Valley Medical Center
- Resource Type
- Abstract
- Publication Details
- Journal of cardiac failure, Vol.32(1), p.237
- DOI
- 10.1016/j.cardfail.2025.11.161
- ISSN
- 1071-9164
- Publisher
- Elsevier
- Language
- English
- Date published
- 01/2026
- Academic Unit
- Internal Medicine
- Record Identifier
- 9985129576702771
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