TOPLINE:

Age-adjusted rates of cardiovascular disease (CVD) mortality tripled from 3.4 to 10.34 per 100,000 people between 1999 and 2023 among US adults with obesity, with higher rates observed in men, older adults, non-Hispanic Black adults, and in the South.

METHODOLOGY:

• Obesity is a well‑established risk factor for CVD, yet patterns of CVD mortality among adults with obesity across demographic, racial or ethnic, and geographic subgroups have not been comprehensively characterized.
• This study analyzed 363,203 CV deaths among US adults aged ≥ 25 years, in which obesity was an underlying factor from 1999 to 2023.
• Researchers calculated age-adjusted mortality rates per 100,000 population and identified temporal trends stratified by sex, age, race or ethnicity, and geographic region.

TAKEAWAY:

• From 1999-2023, the CVD age-adjusted mortality rate among adults with obesity tripled from 3.4 to 10.34 per 100,000 people. Within that span, three phases were identified: The rate rose steadily from 1999-2018 (3.4 to 7.95 per 100,000); surged sharply from 2018-2021 (a period that included the COVID pandemic) to a peak of 11.4 per 100,000 people in 2021; and by 2023 declined to 10.34 per 100,000, which was still higher than pre-pandemic levels.
• Men vs women consistently had a higher age-adjusted mortality rate (12.69 vs 8.06 per 100,000 people in 2023). Across age groups, adults aged 75-84 years experienced the steepest increase in mortality rates (from 5.95 to 21.1 per 100,000) during the study period.
• Non-Hispanic Black adults had the highest age-adjusted mortality rate per 100,000 (18.3), followed by non-Hispanic White (10.38), Hispanic (6.28), and non-Hispanic other (3.99). Regionally, the South shifted from having the lowest age-adjusted mortality rate per 100,000 (3.06) in 1999 to the highest (11.5) in 2023.
• The leading causes of CVD death shifted toward atherosclerotic CVD and hypertensive heart disease; by 2023, atherosclerotic conditions collectively accounted for more than half of the top 10 causes of CVD mortality.

IN PRACTICE:

“These findings establish obesity as a critical driver of CVD mortality and health inequities in the US, demanding sustained, equitable, and comprehensive public health strategies and healthcare policies to effectively prevent and treat obesity while managing associated CVD risk,” the authors wrote.

SOURCE:

The study, led by Xiaoqin Zhou and Weiqiang Ruan, Sichuan University, Chengdu, China, was published online in Obesity.

LIMITATIONS:

The database used in this study relied on death certificates that may have been subject to misclassification due to the potential underreporting of obesity as a contributing factor. The extent of underreporting may vary by region, race/ethnicity, or geography; consequently, the observed tripling of age-adjusted mortality rates may reflect not only genuine increases in obesity-related CVD mortality but also improved recognition and documentation of obesity as a contributing cause. The lack of data on BMI prevented analysis of the severity or duration of obesity.

DISCLOSURES:

The authors reported receiving no funding for this study and declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.