Temporal trends and demographic patterns in hypertension-related mortality with intracerebral hemorrhage in the United States

Introduction
Hypertension is a leading contributor to cardiovascular mortality; however, its role as an underlying cause of death when intracerebral hemorrhage (ICH) is a contributing factor remains insufficiently characterized. Identifying demographic and geographic patterns may support more targeted prevention strategies.
Methods
We performed a retrospective observational study using the CDC Multiple Cause of Death database from 1999 to 2020. Adults aged ≥25 years were included if hypertension (ICD-10 codes I10–I15) was listed as the underlying cause of death and ICH (I61) as a contributing cause. Mortality data were stratified by sex, race, geographic region, and place of death. Crude and age-adjusted mortality rates per 1,000,000 population were calculated. Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC).
Results
A total of 14,613 deaths met inclusion criteria, corresponding to a crude mortality rate of 3.3 per million. Most decedents were male (56.5%) and White (62.8%), followed by Black/African American (31.2%), Asian/Pacific Islander (5.3%), and American Indian/Alaska Native individuals (0.7%). The majority of deaths occurred in metropolitan areas (89.4%) and medical facilities (61.0%), while 25.2% occurred at home. Age-adjusted mortality rates remained stable from 1999 to 2007, declined between 2007 and 2013, and subsequently increased from 2013 to 2020. Females experienced more pronounced early declines followed by a modest increase, whereas males demonstrated a delayed but sharper rise. Black/African American individuals showed early declines followed by a plateau, while White individuals exhibited smaller initial changes, followed by decline and subsequent increase.
Conclusions
Mortality involving hypertension as the underlying cause and ICH as a contributing factor disproportionately affects males and White and Black populations, with most deaths occurring in metropolitan and clinical settings. The reversal of declining trends after 2013, particularly among males and White individuals, highlights the need for renewed public health focus on hypertension control and stroke prevention.