Increasing mortality burden in patients with hypertension and colorectal cancer in the United States from 1999 to 2020.

Abstract

e15646 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States (US) in 2024. With a multifactorial etiology, the global variation in CRC incidence suggests that modifiable dietary and lifestyle factors play a significant role in its development. Although evidence linking hypertension (HTN) to CRC has been weak in the past, emerging literature increasingly supports the association. A recent meta-analysis of 25 observational studies involving 1.95 million participants found that individuals with HTN have a 15% higher risk of CRC compared to those with normal blood pressure (BP). Similarly, the Atherosclerosis Risk in Communities cohort study identified a 1.35-fold increased risk of CRC among individuals with HTN. Furthermore, the European Prospective Investigation into Cancer and Nutrition study demonstrated that for every 10 mmHg increase in diastolic BP, the risk of CRC rises by 1–7%, after adjusting for confounding factors. These findings highlight the growing body of evidence linking HTN to an elevated risk of CRC. Our study aims to investigate mortality trends attributable to HTN and CRC in the US stratified by year, sex, race, and region from 1999 to 2020. Methods: Using data obtained from the CDC WONDER database, we assessed the crude death rates (CDRs) and age-adjusted mortality rates (AAMRs) per 100,000 individuals. Changes in AAMR were analyzed through the annual percent change (APC) and the average APC (AAPC), employing Joinpoint regression for statistical analysis. Results: A total of 117,626 deaths occurred due to HTN and CRC in the US from 1999-2020, demonstrating a significantly increasing overall trend (AAPC = 2.32). 85+ year-olds had the highest CDRs (35.01). Males (2.87) had higher AAMR than females (2.14). Non-Hispanic (NH) Blacks had the highest AAMR (4.26), while NH Asian or Pacific Islanders had the lowest (1.77). No significant variations were observed in the AAMRs across regions (West: 2.33, Northeast: 2.33, South: 2.47, Midwest: 2.65). The states with the highest AAMR were Mississippi (4.72) and Nebraska (4,14), while the states with the lowest AAMR were Utah (0.85) and Nevada (1.28). Rural areas (2.97) had a higher AAMR than urban areas (2.34). The highest number of deaths were reported in the decedent’s home (41,969), followed by nursing home/long-term care (30,049). Conclusions: An overall increasing trend in mortality was observed among adults in the US from 1999 to 2020. However, disparities were observed within specific subpopulations, including males, NH Blacks, residents of the Midwestern region, and those in rural areas. Future research should further explore the association between HTN and CRC in large trials, with a focus on the risk factors contributing to these disparities in vulnerable groups.