(202) Describing trends in hypertension-diabetes comorbidity in United States adults from 2008 to 2022 using Real World Data

Publication Number: 863

Background: The coexistence of diabetes mellitus (DM) and hypertension (HT) confers a significant risk of cardiovascular disease, end-stage kidney disease, and death, and older adults from minority racial/ethnic groups are disproportionately affected. Limited data exist, however, of the impact of racial/ethnic disparities on the prevalence of DM and HT comorbidities in young adults.

Objectives: To estimate trends in prevalence of comorbid DM and HT from 2008-2022 among adults under the age of 65 overall and by age, sex, and race/ethnicity, using real world data.

Methods: A retrospective cohort study was conducted using administrative claims data of research-eligible members aged 18-64 years diagnosed with DM and HT from 01/01/2008 to 12/31/2022. Annual prevalence of comorbid DM and HT diagnoses was estimated overall and by subgroups based on age group (18-35, 36-45,46-55, 56-64 years), sex, race (White, Black, Asian/Pacific Islander, Native American, and multiracial) and ethnicity (Hispanic and Non-Hispanic).

Results: During the study period, the mean annual enrollment for the research-eligible population aged 18 to 64 years from 2008-2022 was 4,065,658 individuals. The overall prevalence of coexisting DM and HT among adults 18-64 years of age enrolled in Aetna health insurance plans increased by 39% from 52.7 per 1,000 persons in 2008 to 73.3 per 1,000 persons in 2022. The older age group, 55–64 years, experienced a 38% increase in the burden of DM and HT from 44.2 per 1,000 persons in 2008 to 61.2 per 1,000 persons in 2022. No gender differences were observed in the prevalence of coexisting HT and DM over the past 14 years, although males had consistently higher rates as compared to females. Non-Hispanic Black adults experienced a marked increase in the prevalence of coexisting DM and HT from 207.2 per 1,000 persons in 2008 to 253.2 per 1,000 persons in 2022. Similar trends were observed in Hispanic multiracial adults (11.9 per 1,000 persons in 2008 to 18.5 per 1,000 persons in 2022) while the non-Hispanic White and the Asian adults had a decline in these comorbidities over the same period of time.

Conclusions: Black and Hispanic adults less than 65 years of age in a commercial health plan had notable increases in the burden of coexistent DM and HT from 2008 to 2022. Public health policy is needed to support DM and HT screening and management in these young vulnerable groups so that appropriate measures are implemented to prevent premature morbidity and mortality in these population.