Abstract / Summary
Pulmonary vascular disease (PVD) (pulmonary hypertension [PH] and pulmonary heart disease [PHD]) has pathophysiological similarities with renal failure, which are important to cardiovascular death. There are no comprehensive national mortality trends at this intersection. This study looks at the trends in deaths involving renal failure and pulmonary vascular disease from 26 years across sex, race, ethnicity, region and urbanization. Data from CDC WONDER (Multiple Cause of Death) were analyzed for a primary cohort (1999–2020, n = 27,672) and a recent-period (sensitivity) analysis (2018–2024, n = 14,336), not an independent cohort, as this period overlaps with 1999–2020. The underlying condition was renal failure (N17–N19) as the underlying cause of death, and pulmonary vascular disease codes (I26–I28) were recorded as multiple-cause-of-death (contributing) mentions on the same certificate. The Annual Percent Change (APC) and 95% confidence intervals (CIs) were calculated using JoinPoint regression program. From 1999 to 2020, mortality increased significantly in females (APC + 2.14%) and males (+ 1.54%). The rise was largest for the Hispanic (+ 2.94%) and the highest number of deaths occurred in the South ( n = 10,361). In the 2018–2024 recent-period analysis, accelerated trends appeared: females (APC + 5.14%), males (+ 4.15%), and the Midwest (+ 6.10%). Most deaths were due to secondary pulmonary hypertension (75.2%). The number of deaths due to renal failure and pulmonary vascular disease are increasing, particularly between 2018 and 2024. When data are aggregated, there are increasing racial/ethnic and rural disparities. Results support targeted screening and a multi-disciplinary approach to cardio-renal-pulmonary axis and equity focused public health interventions. These explanations are hypothesis-generating and require further studies with individual-level clinical and socioeconomic data.