Diabetes mellitus (DM) increases the risk of Hypertension (HTN) through mechanisms such as vascular dysfunction, increased arterial stiffness, and diabetic kidney disease. Both DM and HTN often occur together due to shared risk factors and are common in the United States. We analyzed trends in DM and HTN-related mortality in the U.S. from 1999 to 2023, focusing on sex, racial, and regional differences, as well as specific age groups.

The CDC WONDER database was used to extract mortality data among adults (≥ 65 years old) in the US with concomitant DM and HTN from 1999 to 2023, expressed per 100,000 persons. Age-Adjusted Mortality Rates (AAMRs) were stratified by year, gender, race, age groups, and geographic distribution. The change in AAMRs was calculated as Annual Percentage Change (APC) with 95% Confidence Intervals (CIs).

A total of 2132,393 deaths related to the co-morbidity of DM and HTN were recorded between 1999 and 2023. The AAMRs increased from 59.89 to 264.18 deaths per 100,000 population during this period, representing a 4.4-fold increase relative to the 1999 rate. A peak in mortality occurred during 2018-2021, with the AAMR reaching 302.62 in 2021 and an APC of 15.33 (95 % CI: 9.13 to 21.87; p = 0.00007). Men consistently had higher AAMRs than women (325.39 vs. 216.94 in 2023). Among racial and ethnic groups, NH Black or African American individuals had the highest average AAMR, followed by NH American Indian or Alaska Native, Hispanic or Latino, NH Asian or Pacific Islander, and NH White populations. Mortality rates increased with age, with those aged 85+ showing the highest averages, followed by the 75–84 and 65–74 age groups. From 1999 to 2023, the South had the highest average AAMR, followed by the West, Midwest, and Northeast. Rural areas exhibited significantly higher average AAMR (198.27 vs. 178.7) than urban areas from 1999 to 2020. The location of death varied: 37.56 % occurred in medical facilities, 30.45 % at the decedent’s home, 3.41 % in hospices, 24.62 % in nursing homes, and 3.96 % in other or unknown places. The highest AAMRs were observed in Mississippi (324.78), the District of Columbia (323.76), and Oklahoma (302.29), while the lowest were in Massachusetts (98.54), Connecticut (112.04), and Utah (113.23).

DM and HTN-related mortality have risen significantly over time in the United States, with a peak between 2018 and 2021. Our study shows a 4.4-fold increase in DM and HTN-related deaths in the U.S. from 1999 to 2023. The highest rates were observed in men aged 85+ from rural areas of the NH Black community in the Southern region. This underscores the need for enhanced public health surveillance, better healthcare, and targeted interventions for these groups to reduce disparities.