A 25-Year Analysis of Liver Disease–Hypertension Comorbid Mortality Trends in the United States, 1999–2023

Background Death certificates frequently list both liver disease and hypertension codes, yet trends in this co-occurrence have been underexplored. This study analyzed 25 years of U.S. data to identify patterns in deaths that list both conditions. Methods We conducted a descriptive analysis of mortality data from CDC WONDER for 1999–2023, focusing on adults aged ≥ 25 years. Deaths that listed both liver diseases (K70–K76) and hypertensive diseases (I10–I15) were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were standardized to the 2000 U.S. population. Temporal trends were assessed with Joinpoint regression, which estimated annual percent changes (APCs) with 95% confidence intervals. Analyses were stratified by age, sex, race/ethnicity, region, state, and urbanization level. Results Between 1999 and 2023, deaths with both conditions listed increased from 2,307 to 18,769, totaling 208,666 deaths. The national AAMR rose from 1.30 per 100,000 in 1999 to 6.75 in 2023, with an average annual percent change (AAPC) of + 6.71% (95% CI: 5.64–7.80). Joinpoint regression identified four phases: rapid early growth (1999–2001, APC 19.50%), steady increase (2001–2018, APC 4.27%), sharp acceleration (2018–2021, APC 17.64%), and stabilization (2021–2023, APC 0.28%). In 2023, males had higher rates than females (9.02 vs. 4.71 per 100,000). Non-Hispanic (NH) American Indian or Alaska Native populations had the highest rates (12.74 per 100,000), followed by Hispanic (8.15), NH White (6.95), and NH Black (6.84), while NH Asian or Pacific Islander individuals had the lowest (3.05). Geographic variation was substantial, with rates ranging from 2.87 (Connecticut) to 21.54 (Oklahoma) per 100,000. Conclusion Deaths that list both liver disease and hypertension codes increased substantially over 25 years (AAPC + 6.71%), with notable acceleration during 2018–2021. These documentation patterns warrant continued surveillance to understand evolving mortality trends.